Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms

Gut

Jin, X.; Lian, J. S.; Hu, J. H.; Gao, J.; Zheng, L.; Zhang, Y. M.; Hao, S. R.; Jia, H. Y.; Cai, H.; Zhang, X. L.; Yu, G. D.; Xu, K. J.; Wang, X. Y.; Gu, J. Q.; Zhang, S. Y.; Ye, C. Y.; Jin, C. L.; Lu, Y. F.; Yu, X.; Yu, X. P.; Huang, J. R.; Xu, K. L.; Ni, Q.; Yu, C. B.; Zhu, B.; Li, Y. T.; Liu, J.; Zhao, H.; Zhang, X.; Yu, L.; Guo, Y. Z.; Su, J. W.; Tao, J. J.; Lang, G. J.; Wu, X. X.; Wu, W. R.; Qv, T. T.; Xiang, D. R.; Yi, P.; Shi, D.; Chen, Y.; Ren, Y.; Qiu, Y. Q.; Li, L. J.; Sheng, J.; Yang, Y.

Abstract

OBJECTIVE: The SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics.

DESIGN: COVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province. RESULTS: Among enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5 degrees C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m(6)A methylation and changed binding capacity with ACE2.

CONCLUSION: We report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.

Keywords

Clinical aspects, diagnosis, treatment

COVID-19, guests and crews of cruise: observation on Thai citizens

International maritime health
Volume 71, 2020, Issue 1, p 9

Yasri, S.; Wiwanitkit, V.

Introduction

COVID-19 is a new emerging infection starting from China [1]. This new disease was imported to many countries such as Thailand [2]. After the firs importation to Thailand as the first country, there are already more than 20 countries with imported disease. At first, the importation of disease is mainly by air travel. However, the new consideration is raised when there is an emerging problem of disease outbreak at international tourist cruise. The outbreak on Diamond Princess, which was detected in Japan, became an interesting situation.

Keywords

COVID-19, guest, crew, cruise

Coronavirus Disease 2019 as a challenge for maritime medicine

International maritime health

Vol 71, No 1 (2020)

Sikorska, K.

Introduction

On 11 March 2020 World Health Organization (WHO) ”made the assessment that Coronavirus Disease 2019 (COVID-19) can be characterised as a pandemic”. Six weeks earlier, on 30 January 2020, the outbreak caused by a novel coronavirus was declared a Public Health Emergency of International Concern.

Keywords

Epidemiology

Coronavirus (Covid-19) outbreak on the cruise ship Diamond Princess

International maritime health
Volume 71, Issue 1

Dahl, E.

Introduction

The whole world has recently been following the media frenzy covering the quarantine of Diamond Princess, the first cruise ship that had an outbreak of coronavirus illness (Covid-19) on board. It developed soon after the occurrence of China’s Covid-19 outbreak, which — according to the World Health Organization (WHO) — “poses a very grave threat for the rest of the world” and should be viewed as “Public Enemy Number 1” [1]. Lasting more than 14 days, the ship quarantine is unprecedented for the cruise industry, and some maritime health issues of concern may be worth addressing already shortly after the interned passengers and crew had finally disembarked the vessel.

Keywords

coronavirus, COVID-19, outbreak, passengers, crew, cruise ship medicine

Multi-omics Evaluation of Gastrointestinal and Other Clinical Characteristics of SARS-CoV-2 and COVID-19

Gastroenterology

Du, Mulong; Cai, Guoshuai; Chen, Feng; Christiani, David C.; Zhang, Zhengdong; Wang, Meilin.

Introduction

Since December 2019, coronavirus disease 2019 (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has produced a worldwide panic. Except for a principal human to human transmission method by droplet and contact, there is still limited knowledge about possible alternate transmission methods to guide clinical care. Recent clinical studies have observed digestive symptoms in COVID-19 patients, possibly because of the enrichment and infection of SARS-CoV-2 in the gastrointestinal tract, mediated by virus receptor of angiotensin converting enzyme II (ACE2), which suggests the potential for a fecaloral route of SARS-CoV-2 transmission 3, 4. However, there is still a large gap in the biological knowledge of COVID-19. In this study, via a bulk-to-cell strategy focusing on ACE2, we performed an integrated omics analysis at the genome, transcriptome and proteome levels in bulk tissues and single cells across species to decipher the potential routes for SARS-CoV-2 infection in depth.

Keywords

COVID-19, SARS-CoV-2, Treatment

Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis

European Journal of Neurology

Guan, Wei-Jie; Liang, Wen-Hua; Zhao, Yi; Liang, Heng-Rui; Chen, Zi-Sheng; Li, Yi-Min; Liu, Xiao-Qing; Chen, Ru-Chong; Tang, Chun-Li; Wang, Tao; Ou, Chun-Quan; Li, Li; Chen, Ping-Yan; Sang, Ling; Wang, Wei; Li, Jian-Fu; Li, Cai-Chen; Ou, Li-Min; Cheng, Bo; Xiong, Shan; Ni, Zheng-Yi; Xiang, Jie; Hu, Yu; Liu, Lei; Shan, Hong; Lei, Chun-Liang; Peng, Yi-Xiang; Wei, Li; Liu, Yong; Hu, Ya-Hua; Peng, Peng; Wang, Jian-Ming; Liu, Ji-Yang; Chen, Zhong; Li, Gang; Zheng, Zhi-Jian; Qiu, Shao-Qin; Luo, Jie; Ye, Chang-Jiang; Zhu, Shao-Yong; Cheng, Lin-Ling; Ye, Feng; Li, Shi-Yue; Zheng, Jin-Ping; Zhang, Nuo-Fu; Zhong, Nan-Shan; He, Jian-Xing.

Abstract

BACKGROUND: The coronavirus disease 2019 (Covid-19) outbreak is evolving rapidly worldwide. OBJECTIVE: To evaluate the risk of serious adverse outcomes in patients with coronavirus disease 2019 (Covid-19) by stratifying the comorbidity status. METHODS: We analysed the data from 1590 laboratory-confirmed hospitalised patients 575 hospitals in 31 province/autonomous regions/provincial municipalities across mainland China between December 11(th), 2019 and January 31(st), 2020. We analyse the composite endpoints, which consisted of admission to intensive care unit, or invasive ventilation, or death. The risk of reaching to the composite endpoints was compared according to the presence and number of comorbidities. RESULTS: The mean age was 48.9 years. 686 patients (42.7%) were females. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD [hazards ratio (HR) 2.681, 95% confidence interval (95%CI) 1.424-5.048], diabetes (HR 1.59, 95%CI 1.03-2.45), hypertension (HR 1.58, 95%CI 1.07-2.32) and malignancy (HR 3.50, 95%CI 1.60-7.64) were risk factors of reaching to the composite endpoints. The HR was 1.79 (95%CI 1.16-2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61-4.17) among patients with two or more comorbidities. CONCLUSION: Among laboratory-confirmed cases of Covid-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.

Keywords

Clinical aspects, diagnosis, treatment

Role of changes in SARS-CoV-2 spike protein in the interaction with the human ACE2 receptor: An in silico analysis

EXCLI journal
Volume 19, March 2020, pp 410-417

Ortega, J. T.; Serrano, M. L.; Pujol, F. H.; Rangel, H. R.

Abstract

Many human viral diseases are a consequence of a zoonotic event. Some of the diseases caused by these zoonotic events have affected millions of people around the world, some of which have resulted in high rates of morbidity/mortality in humans. Changes in the viral proteins that function as ligands of the host receptor may promote the spillover between species. The most recent of these zoonotic events that have caused an ongoing epidemic of high magnitude is the Covid-19 epidemics caused by SARS-CoV-2. The aim of this study was to determine the mutation(s) in the sequence of the spike protein of the SARS-CoV-2 that might be favoring human to human transmission. An in silico approach was performed, and changes were detected in the S1 subunit of the receptor-binding domain of spike. The observed changes have significant effect on SARS-CoV-2 spike/ACE2 interaction and produce a reduction in the binding energy, compared to the one of the Bat-CoV to this receptor. The data presented in this study suggest a higher affinity of the SARS-Cov-2 spike protein to the human ACE2 receptor, compared to the one of Bat-CoV spike and ACE2. This could be the cause of the rapid viral spread of SARS-CoV-2 in humans.

.

Keywords

Comparative study, RCT; Clinical aspects, diagnosis, treatment

Unrevealing sequence and structural features of novel coronavirus using in silico approaches: The main protease as molecular target

EXCLI journal
Volume 19, March 2020, pp 400-409

Ortega, J. T.; Serrano, M. L.; Pujol, F. H.; Rangel, H. R.

Abstract

Direct-acting antivirals are effective tools to control viral infections. SARS-CoV-2 is a coronavirus associated with the epidemiological outbreak in late 2019. Previous reports showed that HIV-1 protease inhibitors could block SARS-CoV main protease. Based on that and using an in silico approach, we evaluated SARS-CoV-2 main protease as a target for HIV-1 protease inhibitors to reveal the structural features related to their antiviral effect. Our results showed that several HIV inhibitors such as lopinavir, ritonavir, and saquinavir produce strong interaction with the active site of SARS-CoV-2 main protease. Furthermore, broad library protease inhibitors obtained from PubChem and ZINC (www.zinc.docking.org) were evaluated. Our analysis revealed 20 compounds that could be clustered into three groups based on their chemical features. Then, these structures could serve as leading compounds to develop a series of derivatives optimizing their activity against SARS-CoV-2 and other coronaviruses. Altogether, the results presented in this work contribute to gain a deep understanding of the molecular pharmacology of SARS-CoV-2 treatment and validate the use of protease inhibitors against SARS-CoV-2.

Keywords

Clinical aspects, diagnosis, treatment

Clinical and CT features of early-stage patients with COVID-19: a retrospective analysis of imported cases in Shanghai, China

The European respiratory journal

Yang, Shuyi; Shi, Yuxin; Lu, Hongzhou; Xu, Jianqing; Li, Feng; Qian, Zhiping; Hua, Xinyan; Ding, Xueting; Song, Fengxiang; Shen, Jie; Lu, Yang; Shan, Fei; Zhang, Zhiyong.

To the Editor,

Since December 2019, some patients with novel corona virus infectious disease (COVID-19) emerged in Wuhan, Hubei, China. The pathogen analysis discovered a new type of coronavirus from infected airway epithelial cells and named as sever acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). At the time of Chinese people were heading home for celebrating the Spring Festival, many latent cases left Wuhan, which led to the emergence of imported COVID-19 cases across the mainland of China and some other countries. Shanghai is one of the major cities with imported cases.

Keywords

COVID-19, SARS-CoV-2, Treatment

National Institute for the Infectious Diseases "L. Spallanzani", IRCCS. Recommendations for COVID-19 clinical management

Infectious Disease Reports
Volume 12, March 2020, Issue 1, 8543

Nicastri, E.; Petrosillo, N.; Bartoli, T. A.; Lepore, L.; Mondi, A.; Palmieri, F.; D'Offizi, G.; Marchioni, L.; Murachelli, S.; Ippolito, G.; Antinori, A.

Abstract

On January 9 2020, the World Health Organization (WHO) declared the identification, by Chinese Health authorities, of a novel coronavirus, further classified as SARS-CoV-2 responsible of a disease (COVID-19) ranging from asymptomatic cases to severe respiratory involvement. On March 9 2020, WHO declared COVID-19 a global pandemic. Italy is the second most affected country by COVID-19 infection after China. The "L. Spallanzani" National Institute for the Infectious Diseases, IRCCS, Rome, Italy, has been the first Italian hospital to admit and manage patients affected by COVID-19. Hereby, we show our recommendations for the management of COVID-19 patients, based on very limited clinical evidences; they should be considered as expert opinions, which may be modified according to newly produced literature data.

Keywords

COVID-19, SARS-CoV-2, Treatment

Can chlorine dioxide prevent the spreading of coronavirus or other viral infections? Medical hypotheses

Physiology international
Pages 1-11

Kaly-Kullai, K.; Wittmann, M.; Noszticzius, Z.; Rosivall, L.

Introduction

Viruses have caused many epidemics throughout human history. The novel coronavirus is just the latest example. A new viral outbreak can be unpredictable, and development of specific defense tools and countermeasures against the new virus remains time-consuming even in today's era of modern medical science and technology. In the lack of effective and specific medication or vaccination, it would be desirable to have a nonspecific protocol or substance to render the virus inactive, a substance/protocol, which could be applied whenever a new viral outbreak occurs. This is especially important in cases when the emerging new virus is as infectious as SARS-CoV-2

Keywords

COVID-19, SARS-CoV-2, Medication