Archive for April 2, 2020

Letter – COVID-19 can present with a rash and be mistaken for Dengue.

Journal of the American Academy of Dermatology  March 22, 2020 

Joob B1, Wiwanitkit V2.

Author information

1 Sanitation1 Medical Academic Center, Bangkok Thailand. Electronic address:

2 Honorary professor, dr DY Patil University, Pune, India; visiting professor, Hainan Medical University, Haikou, China.

Carta al Editor: Nos gustaría compartir nuestra experiencia de Tailandia, el 2do país en el que se produjo la infección COVID-19 desde principios de enero de 2020 [2].

Al 5/marzo/20, hay 48 casos acumulados de COVID-19 en Tailandia. Entre estos 48 casos, hubo un caso interesante que se presentó con un rash cutáneo con petequias.

Debido a que el dengue es muy común en nuestra región y la erupción petequial es un hallazgo clínico común en el dengue y el paciente tenía un recuento bajo de plaquetas, el 1er médico a cargo hizo diagnóstico clínico de dengue.

No hubo fotografía y la biopsia no es una práctica de rutina según la guía de práctica clínica del dengue en nuestro región tropical. De modo que el caso fue inicialmente diagnosticado erróneamente como dengue, lo que resultó en un diagnóstico tardío [3].

En este caso, el paciente posteriormente presentó problemas respiratorios y fue remitido a otro centro médico donde descartaron otras infecciones virales comunes que pueden causar fiebre, rash cutáneo y trastornos  respiratorios. Investigaciones posteriores y la rt-PCR concluyeron que se trataba de infección por COVID-19.

Existe la posibilidad de que un paciente con COVID-19 presente inicialmente un rash cutáneo que puede diagnosticarse erróneamente como otra enfermedad común. Además, algunos de estos pacientes se presentan inicialmente afebriles [4].

Creemos que el médico debe tener presente la posibilidad de que el paciente solo tenga una erupción cutánea y pensar en COVID-19 para prevenir la transmisión.




April 2, 2020 at 8:52 pm

REVIEW Practical recommendations for critical care and anesthesiology teams caring for COVID-19.

Canadian Journal of Anaesthesia. February 12, 2929

Wax RS1,2,3, Christian MD4.

Author information

1 Department of Critical Care Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada. .

2 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .

3 Department of Critical Care Medicine, Lakeridge Health, 1 Hospital Court, Oshawa, ON, L1G 2B9, Canada. .

4 London’s Air Ambulance, Royal London Hospital, Barts Health NHS Trust, London, England, UK.


A global health emergency has been declared by the World Health Organization as the 2019-nCoV outbreak spreads across the world, with confirmed patients in Canada.

Patients infected with 2019-nCoV are at risk for developing respiratory failure and requiring admission to critical care units.

While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to healthcare workers providing care.

Although the exact mechanisms of transmission are currently unclear, human-to-human transmission can occur, and the risk of airborne spread during aerosol-generating medical procedures remains a concern in specific circumstances.

This paper summarizes important considerations regarding patient screening, environmental controls, personal protective equipment, resuscitation measures (including intubation), and critical care unit operations planning as we prepare for the possibility of new imported cases or local outbreaks of 2019-nCoV.

Although understanding of the 2019-nCoV virus is evolving, lessons learned from prior infectious disease challenges such as Severe Acute Respiratory Syndrome will hopefully improve our state of readiness regardless of the number of cases we eventually manage in Canada.



April 2, 2020 at 8:02 pm

The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak.

Journal of Autoimmunuty February 2020 

Rothan HA1, Byrareddy SN2.


Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.



April 2, 2020 at 7:59 pm

Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome.

Arthritis Rheumatol. september 2014 V.66 N.9 P.2613-20.   

Fardet L1, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, Coppo P, Hejblum G.



Because it has no unique clinical, biologic, or histologic features, reactive hemophagocytic syndrome may be difficult to distinguish from other diseases such as severe sepsis or hematologic malignancies. This study was undertaken to develop and validate a diagnostic score for reactive hemophagocytic syndrome.


A multicenter retrospective cohort of 312 patients who were judged by experts to have reactive hemophagocytic syndrome (n = 162), were judged by experts to not have reactive hemophagocytic syndrome (n = 104), or in whom the diagnosis of reactive hemophagocytic syndrome was undetermined (n = 46) was used to construct and validate the reactive hemophagocytic syndrome diagnostic score, called the HScore. Ten explanatory variables were evaluated for their association with the diagnosis of hemophagocytic syndrome, and logistic regression was used to calculate the weight of each criterion included in the score. Performance of the score was assessed using developmental and validation data sets.


Nine variables (3 clinical [i.e., known underlying immunosuppression, high temperature, organomegaly], 5 biologic [i.e., triglyceride, ferritin, serum glutamic oxaloacetic transaminase, and fibrinogen levels, cytopenia], and 1 cytologic [i.e., hemophagocytosis features on bone marrow aspirate]) were retained in the HScore. The possible number of points assigned to each variable ranged from 0-18 for known underlying immunosuppression to 0-64 for triglyceride level. The median HScore was 230 (interquartile range [IQR] 203-257) for patients with a positive diagnosis of reactive hemophagocytic syndrome and 125 (IQR 91-150) for patients with a negative diagnosis. The probability of having hemophagocytic syndrome ranged from <1% with an HScore of ≤90 to >99% with an HScore of ≥250.


The HScore can be used to estimate an individual’s risk of having reactive hemophagocytic syndrome. This scoring system is freely available online (



April 2, 2020 at 7:57 pm

Letter COVID-19 – consider cytokine storm syndromes and immunosuppression.

Lancet. March 16, 2020 V.395 N.10229 P.1033-1034.


April 2, 2020 at 7:54 pm

The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status.

Mil Med Res. March 13, 2020 V.7 N.1 P.11.

Guo YR1, Cao QD2, Hong ZS3, Tan YY1, Chen SD1, Jin HJ1, Tan KS4, Wang DY5, Yan Y6,7.

An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4%) had been reported by WHO. Meanwhile, several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human-to-human transmission, along with many exported cases across the globe. The clinical symptoms of COVID-19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.


April 2, 2020 at 4:40 pm

Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China.

Emerg Infect Dis. March 31, 2020 V.26 N.7 

Li C, Ji F, Wang L, Wang L, Hao J, Dai M, Liu Y, Pan X, Fu J, Li L, Yang G, Yang J, Yan X, Gu B.


We report epidemiologic, laboratory, and clinical findings for 7 patients with 2019 novel coronavirus disease in a 2-family cluster. Our study confirms asymptomatic and human-to-human transmission through close contacts in familial and hospital settings. These findings might also serve as a practical reference for clinical diagnosis and medical treatment.


April 2, 2020 at 4:38 pm

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