phenylephrine-hydrochloride and Pneumonia--Viral

Adenovirus infection is common in childhood and is generally associated with self-limited disease. Cidofovir, a viral DNA polymerase inhibitor, is used to treat adenovirus infection in select populations but is not often recommended for immunocompetent patients because of limited antiviral activity and nephrotoxicity. Here, we report a case of fulminant adenovirus infection associated with lymphopenia and multiple organ failure requiring extracorporeal membrane oxygenation support in a previously healthy child. After 1 week of supportive therapy, the patient had persistent organ failure and continued to have adenoviremia of >560 000 copies per mL. Weekly doses of cidofovir with concurrent probenecid for renal protection was initiated. Adenovirus blood load declined after the first cidofovir dose, becoming undetectable after 3 doses. The patient was successfully decannulated from extracorporeal membrane oxygenation, extubated, and eventually discharged at his functional baseline without need for ongoing respiratory support. Lymphopenia improved after viremia resolved, and a subsequent immunologic workup revealed no evidence of primary immunodeficiency. The viral isolate was genotyped as adenovirus type 7. This case reveals the successful use of cidofovir for management of severe adenovirus infection in a previously healthy child. To date, there are no universally accepted recommendations for the use of cidofovir in this population. Further study is warranted to determine the potential role of cidofovir in treating severe adenovirus infections in immunocompetent children.

Topics: Adenoviridae; Adenoviridae Infections; Antiviral Agents; Child, Preschool; Cidofovir; Combined Modality Therapy; Consciousness Disorders; Extracorporeal Membrane Oxygenation; Humans; Immunocompetence; Male; Multiple Organ Failure; Nose; Patient Acuity; Pneumonia, Viral; Polymerase Chain Reaction; Radiography, Thoracic; Respiratory Distress Syndrome; Shock

COVID-19 infection poses a serious risk to patients and - due to its contagious nature - to those healthcare workers (HCWs) treating them. If the mouth and nose of patients with infection are irrigated with antimicrobial solutions, this may help the patients by killing any coronavirus present at those sites. It may also reduce the risk of the active infection being passed to HCWs through droplet transmission or direct contact. However, the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose.. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to both the patients and the HCWs caring for them.. Information Specialists from Cochrane ENT and Cochrane Oral Health searched the Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embase and additional sources for published and unpublished trials. The date of the search was 1 June 2020.  SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies: randomised controlled trials (RCTs); quasi-RCTs; non-randomised controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before-and-after studies. We set no minimum duration for the studies.   We sought studies comparing antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered with any frequency or dosage to suspected/confirmed COVID-19 patients.. We used standard Cochrane methodological procedures. Our primary outcomes were: 1) RECOVERY* (www.recoverytrial.net) outcomes in patients (mortality; hospitalisation status; use of ventilation; use of renal dialysis or haemofiltration); 2) incidence of symptomatic or test-positive COVID-19 infection in HCWs; 3) significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 4) change in COVID-19 viral load in patients; 5) COVID-19 viral content of aerosol (when present); 6) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 7) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome.. We found no completed studies to include in this review. We identified 16 ongoing studies (including 14 RCTs), which aim to enrol nearly 1250 participants. The interventions included in these trials are ArtemiC (artemisinin, curcumin, frankincense and vitamin C), Citrox (a bioflavonoid), cetylpyridinium chloride, chlorhexidine, chlorine dioxide, essential oils, hydrogen peroxide, hypertonic saline, Kerecis spray (omega 3 viruxide - containing neem oil and St John's wort), neem extract, nitric oxide releasing solution, povidone iodine and saline with baby shampoo.  AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by a number of RCTs and other studies. We are concerned that few of the ongoing studies specifically state that they will evaluate adverse events such as changes in the sense of smell or to the oral and nasal microbiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrated when studies are available for inclusion in this review, it may not be large. In these circumstances in particular it may be a challenge to weigh up the benefits against the harms if the latter are of uncertain frequency and severity.

Topics: Anti-Infective Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Health Personnel; Humans; Infectious Disease Transmission, Patient-to-Professional; Mouth; Mouthwashes; Nasal Sprays; Nose; Occupational Diseases; Pandemics; Pneumonia, Viral; SARS-CoV-2; Therapeutic Irrigation

COVID-19 infection poses a serious risk to patients and - due to its contagious nature - to those healthcare workers (HCWs) treating them. The risks of transmission of infection are greater when a patient is undergoing an aerosol-generating procedure (AGP). Not all those with COVID-19 infection are symptomatic, or suspected of harbouring the infection. If a patient who is not known to have or suspected of having COVID-19 infection is to undergo an AGP, it would nonetheless be sensible to minimise the risk to those HCWs treating them. If the mouth and nose of an individual undergoing an AGP are irrigated with antimicrobial solutions, this may be a simple and safe method of reducing the risk of any covert infection being passed to HCWs through droplet transmission or direct contact. Alternatively, the use of antimicrobial solutions by the HCW may decrease the chance of them acquiring COVID-19 infection. However, the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose.. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to HCWs and/or patients when undertaking AGPs on patients without suspected or confirmed COVID-19 infection.. Information Specialists from Cochrane ENT and Cochrane Oral Health searched the Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embase and additional sources for published and unpublished trials. The date of the search was 1 June 2020.  SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies: randomised controlled trials (RCTs); quasi-RCTs; non-randomised controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before-and-after studies. We set no minimum duration for the studies.   We sought studies comparing any antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered to the patient or HCW before and/or after an AGP.. We used standard Cochrane methodological procedures. Our primary outcomes were: 1) incidence of symptomatic or test-positive COVID-19 infection in HCWs or patients; 2) significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 3) COVID-19 viral content of aerosol (when present); 4) change in COVID-19 viral load at site(s) of irrigation; 5) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 6) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome.. We found no completed studies to include in this review.   AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review, nor any ongoing studies. The absence of completed studies is not surprising given the relatively recent emergence of COVID-19 infection. However, we are disappointed that this important clinical question is not being addressed by ongoing studies.

Topics: Administration, Intranasal; Air Microbiology; Anti-Infective Agents; Asymptomatic Infections; Betacoronavirus; Coronavirus Infections; COVID-19; Health Personnel; Humans; Infectious Disease Transmission, Patient-to-Professional; Mouth; Mouthwashes; Nasal Sprays; Nose; Occupational Diseases; Pandemics; Pneumonia, Viral; SARS-CoV-2

COVID-19 infection poses a serious risk to patients and - due to its contagious nature - to those healthcare workers (HCWs) treating them. If the mouth and nose of HCWs are irrigated with antimicrobial solutions, this may help reduce the risk of active infection being passed from infected patients to HCWs through droplet transmission or direct contact. However, the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves, or alterations in the natural microbial flora of the mouth or nose. Understanding these possible side effects is particularly important when the HCWs are otherwise fit and well.. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays used by healthcare workers (HCWs) to protect themselves when treating patients with suspected or confirmed COVID-19 infection.. Information Specialists from Cochrane ENT and Cochrane Oral Health searched the Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embase and additional sources for published and unpublished trials. The date of the search was 1 June 2020.  SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed randomised controlled trials (RCTs). We therefore planned to include the following types of studies: RCTs; quasi-RCTs; non-randomised controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before-and-after studies. We set no minimum duration for the studies.   We sought studies comparing any antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered to HCWs, with or without the same intervention being given to the patients with COVID-19.. We used standard Cochrane methodological procedures. Our primary outcomes were: 1) incidence of symptomatic or test-positive COVID-19 infection in HCWs; 2) significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 3) viral content of aerosol, when present (if intervention administered to patients); 4) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 5) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome.. We found no completed studies to include in this review. We identified three ongoing studies (including two RCTs), which aim to enrol nearly 700 participants. The interventions included in these trials are povidone iodine, nitric oxide and GLS-1200 oral spray (the constituent of this spray is unclear and may not be antimicrobial in nature).   AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by two RCTs and a non-randomised study. We are concerned that only one of the ongoing studies specifically states that it will evaluate adverse events and it is not clear if this will include changes in the sense of smell or to the oral and nasal microbiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrated when studies are available for inclusion in this review, it may not be large. In these circumstances in particular, where those receiving the intervention are otherwise fit and well, it may be a challenge to weigh up the benefits against the harms if the latter are of uncertain frequency and severity.

Topics: Anti-Infective Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Health Personnel; Humans; Infectious Disease Transmission, Patient-to-Professional; Mouth; Mouthwashes; Nasal Sprays; Nose; Occupational Diseases; Pandemics; Pneumonia, Viral; SARS-CoV-2; Therapeutic Irrigation

Among the illnesses that may develop from COVID-19, the disease caused by the novel coronavirus (SARS-CoV-2), is pneumonia, a severe acute respiratory infectious disease. SARS-CoV-2 continues to spread worldwide and has caused hundreds of thousands of deaths thus far and has disrupted the world economy.. This review summarized the reported distributions of SARS-CoV-2 in 13 biological samples of the human body, including nose, feces, sperm, tears, breast milk, cerebrospinal fluid, urine, organs, sputum, cell lines, bronchial brush, blood, throat, and bronchoalveolar lavage fluid. Moreover, this review briefly describes the detection of SARS-CoV-2 in human body samples of five other coronaviruses.. This review offers several recommendations for controlling the spread of SARS-CoV-2 control, specifically, sample collection from suspected cases from foreign countries and risk assessment of imported special goods (biological materials).

Topics: Betacoronavirus; Breast; Coronavirus Infections; COVID-19; Early Diagnosis; Feces; Female; Humans; Male; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2; Spermatozoa; Sputum; Tears

To determine whether a combination modified-live bovine respiratory syncytial virus (BRSV) vaccine can stimulate protective immunity in young BRSV-seropositive calves following intranasal (IN) administration.. Controlled challenge study.. 66 Holstein bull calves, 3 to 8 days old.. In experiment 1, BRSV-seropositive and -seronegative calves were vaccinated IN with a commercially available combination modified-live virus vaccine formulated for SC administration; calves underwent BRSV challenge 4.5 months later. In experiment 2, BRSV-seronegative calves were vaccinated IN or SC (to examine the effect of route of administration) with the same combination vaccine that instead had a 1/100 dose of BRSV (to examine the effect of dose); calves underwent BRSV challenge 21 days later.. In experiment 1, BRSV challenge resulted in severe respiratory tract disease with low arterial partial pressures of oxygen and lung lesions in most calves from all groups. Maximum change in rectal temperature was significantly greater in seropositive IN vaccinated calves, compared with seronegative IN vaccinated and seropositive control calves. Number of days of BRSV shedding was significantly lower in seronegative IN vaccinated calves than in seropositive IN vaccinated and seropositive control calves. In experiment 2, maximum change in rectal temperature was significantly greater in seronegative control calves, compared with seronegative IN and SC vaccinated calves. Shedding of BRSV was significantly reduced in seronegative IN and SC vaccinated calves, compared with control calves; also, lung lesions were reduced in seronegative IN and SC vaccinated calves.. Maternal antibodies may inhibit priming of protective responses by IN delivered BRSV vaccines.

Topics: Administration, Intranasal; Animals; Antibodies, Viral; Cattle; Cattle Diseases; Lung; Male; Nose; Pneumonia, Viral; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Bovine; Viral Vaccines; Virus Shedding

Topics: Adult; Aged; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Humans; Male; Middle Aged; Nose; Pharynx; Pneumonia, Viral; SARS-CoV-2; Viral Load

Topics: Adolescent; Adult; Aged; Betacoronavirus; Bronchoalveolar Lavage Fluid; Bronchoscopy; Child; Child, Preschool; China; Coronavirus Infections; COVID-19; Feces; Female; Gene Dosage; Genes, Viral; Humans; Male; Middle Aged; Nose; Open Reading Frames; Pandemics; Pharynx; Pneumonia, Viral; Real-Time Polymerase Chain Reaction; RNA, Viral; SARS-CoV-2; Sputum; Viral Load; Young Adult

Topics: Betacoronavirus; Coronavirus Infections; COVID-19; Eye; Humans; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2; Virus Internalization

Human cases of H7N9 influenza A virus infection have been increasing since 2013. The first choice of treatment for influenza is neuraminidase (NA) inhibitors (NAIs), but there is a concern that NAI-resistant viruses are selected in the presence of NAIs. In our previous study, an H7N9 virus carrying AA substitution of threonine (T) for isoleucine (I) at residue 222 in NA (NA222T, N2 numbering) and an H7N9 virus carrying AA substitution of lysine (K) for arginine (R) at residue 292 in NA (NA292K, N2 numbering) were found in different macaques that had been infected with A/Anhui/1/2013 (H7N9) and treated with NAIs. In the present study, the variant with NA292K showed not only resistance to NAIs but also lower replication activity in MDCK cells than did the virus with wild-type NA, whereas the variant with NA222T, which was less resistant to NAIs, showed replication activity similar to that of the wild-type virus. Next, we examined the pathogenicity of these H7N9 NAI-resistant viruses in macaques. The variants caused clinical signs similar to those caused by the wild-type virus with similar replication potency. However, the virus with NA292K was replaced within 7 days by that with NA292R (same as the wild-type) in nasal samples from macaques infected with the virus with NA292K, i.e. the so-called revertant (wild-type virus) became dominant in the population in the absence of an NAI. These results suggest that the clinical signs observed in macaques infected with the NA292K virus are caused by the NA292K virus and the NA292R virus and that the virus with NA292K may not replicate continuously in the upper respiratory tract of patients without treatment as effectively as the wild-type virus.

Topics: Amino Acid Substitution; Animals; Antiviral Agents; Drug Resistance, Viral; Enzyme Inhibitors; Influenza A Virus, H7N9 Subtype; Macaca fascicularis; Mutation; Neuraminidase; Nose; Orthomyxoviridae Infections; Pneumonia, Viral; Respiratory System; Selection, Genetic; Viral Proteins; Virus Replication

Topics: Administration, Topical; Anti-Infective Agents, Local; Betacoronavirus; Coronavirus Infections; COVID-19; Hospitalization; Humans; Hydrogen Peroxide; Mouth Mucosa; Nose; Pandemics; Pneumonia, Viral; Respiratory Mucosa; SARS-CoV-2

Topics: Bandages, Hydrocolloid; Coronavirus Infections; COVID-19; Humans; Masks; Nose; Pain; Pain Management; Pandemics; Pneumonia, Viral; Pressure; Pressure Ulcer

Topics: Adult; Betacoronavirus; Coronavirus Infections; COVID-19; Facial Injuries; Humans; Male; Nose; Occupational Injuries; Pandemics; Physicians; Pneumonia, Viral; Pressure Ulcer; Respiratory Protective Devices; SARS-CoV-2

With the spread of Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, its effect on society is amplified. We aimed to describe the viral detection results across different timepoints throughout the disease course.. A retrospective study of 301 confirmed COVID-19 patients hospitalized at Tongji Hospital in Wuhan, China, were included. Demographic characteristics of the patients were collected. Upper respiratory specimens (throat and/or nasal swabs) were obtained and analyzed by real-time RT-PCR for SARS-CoV-2 infection. Period of viral infection and the contagious stage were analyzed.. Of 301 hospitalized COVID-19 patients, the median age was 58 years and 51.2 % were male. The median period between symptoms presence and positive SARS-CoV-2 RT-PCR results was 16 days (IQR, 10-23, N = 301). The median period between symptoms presence and an effective negative SARS-CoV-2 RT-PCR result was 20 days (IQR, 17-24; N = 216). Infected patient ≥65 years old stayed contagious longer (22 days vs 19 days, p = 0.015). Although two consecutive negative results were confirmed in 70 patients, 30 % of them had positive viral test results for the third time. Using specimens from nasal swabs to run the RT-PCR test showed a higher positive rate than using specimens from throat swabs.. This large-scale investigation with 1113 RT-PCR test results from 301 COVID-19 patients showed that the average contagious period of SARS-CoV-2 infected patients was 20 days. Longer observation period and more than 2 series of negative viral test are necessary for patients ≥65 years.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Betacoronavirus; Child; China; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; COVID-19 Vaccines; False Negative Reactions; Female; Hospitalization; Humans; Male; Middle Aged; Nose; Pandemics; Pharynx; Pneumonia, Viral; Qualitative Research; Respiratory System; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; Sex Factors; Young Adult

Topics: Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Hospitals; Humans; London; Nose; Pandemics; Personnel, Hospital; Pneumonia, Viral; Polymerase Chain Reaction; SARS-CoV-2

To evaluate the reliability of self-collection for SARS-CoV-2 and other respiratory viruses because swab collections for SARS-CoV-2 put health workers at risk of infection and require use of personal protective equipment (PPE).. In a prospective study, patients from two states in Australia attending dedicated COVID-19 collection clinics were offered the option to first self-collect (SC) nasal and throat swabs (SCNT) prior to health worker collect (HC) using throat and nasal swabs (Site 1) or throat and nasopharyngeal swabs (Site 2). Samples were analysed for SARS-CoV-2 as well as common respiratory viruses. Concordance of results between methods was assessed using Cohen's kappa (κ) and Cycle threshold (Ct) values were recorded for all positive results as a surrogate measure for viral load.. Of 236 patients sampled by HC and SC, 25 had SARS-CoV-2 (24 by HC and 25 by SC) and 63 had other respiratory viruses (56 by HC and 58 by SC). SC was highly concordant with HC (κ = 0.890) for all viruses including SARS-CoV-2 and more concordant than HC to positive results by any method (κ = 0.959 vs 0.933). Mean SARS-CoV-2 E-gene and N-gene, rhinovirus and parainfluenza Ct values did not differ between HC and SCNT.. Self-collection of nasal and throat swabs offers a reliable alternative to health worker collection for the diagnosis of SARS-CoV-2 and other respiratory viruses and provides patients with easier access to testing, reduces exposure of the community and health workers to those being tested and reduces requirement for PPE.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Betacoronavirus; Child; Coronavirus Infections; COVID-19; Female; Humans; Male; Middle Aged; Nasopharynx; Nose; Pandemics; Pharynx; Pneumonia, Viral; Prospective Studies; Reproducibility of Results; SARS-CoV-2; Specimen Handling; Viral Load; Young Adult

In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies.. Prospective quantification of airborne aerosol generation during surgical and clinical simulation.. Cadaver laboratory and clinical examination room.. Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation.. Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (. Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.

Topics: Aerosols; Betacoronavirus; Cadaver; Coronavirus Infections; COVID-19; Endoscopy; Humans; Nose; Otorhinolaryngologic Surgical Procedures; Pandemics; Particle Size; Personal Protective Equipment; Pneumonia, Viral; Prospective Studies; Risk Factors; SARS-CoV-2

Topics: Aerosols; Betacoronavirus; Cannula; Coronavirus Infections; COVID-19; Humans; Hypoxia; Infection Control; Intubation; Nose; Oxygen; Pandemics; Pneumonia, Viral; Positive-Pressure Respiration; Risk Management; SARS-CoV-2; United States

While children, particularly infants, are susceptible to severe and critical COVID-19 disease, over 55% of pediatric cases are present in asymptomatic or mildly symptomatic children. Aerosolized SARS-CoV-2 viral particles remain viable for up to 3 hours, raising concern about risk to healthcare workers during aerosol generating procedures (APGs) in the airway and nasopharynx. Herein we describe the first case of a nasal foreign body in an asymptomatic child with SARS-CoV-2 infection. We discuss management of this child and highlight the importance of considering asymptomatic infection and preoperative testing when planning procedures of the airway in the COVID-19 era.

Topics: Asymptomatic Infections; Betacoronavirus; Child, Preschool; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Endoscopy; Female; Foreign Bodies; Humans; Infectious Disease Transmission, Patient-to-Professional; Nose; Pandemics; Pneumonia, Viral; Preoperative Care; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2

Since December 2019, a novel coronavirus SARS-CoV-2 has emerged and rapidly spread throughout the world, resulting in a global public health emergency. The lack of vaccine and antivirals has brought an urgent need for an animal model. Human angiotensin-converting enzyme II (ACE2) has been identified as a functional receptor for SARS-CoV-2. In this study, we generated a mouse model expressing human ACE2 (hACE2) by using CRISPR/Cas9 knockin technology. In comparison with wild-type C57BL/6 mice, both young and aged hACE2 mice sustained high viral loads in lung, trachea, and brain upon intranasal infection. Although fatalities were not observed, interstitial pneumonia and elevated cytokines were seen in SARS-CoV-2 infected-aged hACE2 mice. Interestingly, intragastric inoculation of SARS-CoV-2 was seen to cause productive infection and lead to pulmonary pathological changes in hACE2 mice. Overall, this animal model described here provides a useful tool for studying SARS-CoV-2 transmission and pathogenesis and evaluating COVID-19 vaccines and therapeutics.

Topics: Aging; Angiotensin-Converting Enzyme 2; Animals; Betacoronavirus; Brain; Coronavirus Infections; COVID-19; CRISPR-Cas Systems; Cytokines; Disease Models, Animal; Gene Knock-In Techniques; Lung; Lung Diseases, Interstitial; Mice, Inbred C57BL; Nose; Pandemics; Peptidyl-Dipeptidase A; Pneumonia, Viral; RNA, Viral; SARS-CoV-2; Stomach; Trachea; Viral Load; Virus Replication

Topics: Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Health Personnel; Humans; Nasopharynx; Nose; Pandemics; Patients; Pneumonia, Viral; SARS-CoV-2; Sensitivity and Specificity; Specimen Handling; Tongue; Turbinates

Topics: Betacoronavirus; Chemoprevention; Clinical Studies as Topic; Coronavirus Infections; COVID-19; Health Services Accessibility; Humans; Hydroxychloroquine; Nasopharynx; Nose; Pandemics; Pneumonia, Viral; Randomized Controlled Trials as Topic; SARS-CoV-2; Self Care; Sensitivity and Specificity; Specimen Handling; Tongue

Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes.. A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died.. In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC.. In our patient, COVID-19 related coagulopathy was associated with poor prognosis.

Topics: Acute Disease; Aged; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Disseminated Intravascular Coagulation; Doxycycline; Female; Fingers; Gangrene; Humans; Hydroxychloroquine; Nasal Cavity; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2; Severity of Illness Index

Topics: Adolescent; Age Distribution; Betacoronavirus; Child; Child, Preschool; Coronavirus Infections; COVID-19; Humans; Infant; Italy; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2

Since December 2019, over 80,000 patients with coronavirus disease 2019 (COVID-19) have been confirmed in China. With the increasing number of recovered patients, more attention should be paid to the follow-up of these patients.. In the study, 576 patients with COVID-19 discharged from hospital in Chongqing, China from January 24, 2020, to March 10, 2020 were evaluated by viral nucleic acid tests for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) to determine if they could be released from quarantine. Among the 576 patients, 61 patients (10.6%) had positive RT-PCR test results of SARS-CoV-2. We aimed to analyze the demographics, clinical characteristics and treatment of 61 patients.. These positive patients were characterized by older age, chronic medical illness and mild conditions. 38 (62.3%) patients who were asymptomatic without abnormalities on chest radiographs were found in the positive with COVID-19. Also, they showed positive results of stool or sputum specimens with negative results of nasal and pharyngeal swab specimens. The median duration of positive result of SARS-CoV-2 was varied from 3 days to 35 days in the patients discharged from hospital with no family member infection.. Multi-site screening of SARS-CoV-2 including nasal and pharyngeal swabs, stool and sputum specimens could be considered to improve the diagnosis, treatment and infection control in patients with COVID-19. Our findings provide the important information and clinical evidence for the improved management of patients recovered from COVID-19.

Topics: Adult; Aged; Betacoronavirus; China; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Feces; Female; Humans; Male; Middle Aged; Nose; Pandemics; Patient Discharge; Pharynx; Pneumonia, Viral; RNA, Viral; SARS-CoV-2; Sputum

Topics: Betacoronavirus; Coronavirus Infections; COVID-19; Disease Transmission, Infectious; Endoscopy; Humans; Nose; Pandemics; Pneumonia, Viral; Rhinitis; SARS-CoV-2; Sinusitis

Fibre-optic nasoendoscopy and fibre-optic laryngoscopy are high-risk procedures in the coronavirus disease 2019 era, as they are potential aerosol-generating procedures. Barrier protection remains key to preventing transmission.. A device was developed that patients can wear to reduce potential aerosol contamination of the surroundings.. This device is simple, reproducible, easy to use, economical and well-tolerated. Full personal protection equipment should additionally be worn by the operator.

Topics: Aerosols; Betacoronavirus; Body Fluids; Coronavirus Infections; COVID-19; Disease Transmission, Infectious; Endoscopy; Equipment Design; Humans; Laryngoscopy; Nose; Otolaryngologists; Pandemics; Personal Protective Equipment; Pneumonia, Viral; SARS-CoV-2; Surveys and Questionnaires

Topics: Cheek; Coronavirus Infections; COVID-19; Facial Injuries; Humans; Infectious Disease Transmission, Patient-to-Professional; Masks; Nose; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Skin

Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face.. This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy.. The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.

Topics: Betacoronavirus; Coronavirus Infections; COVID-19; Equipment Design; Facial Injuries; Humans; Nose; Pandemics; Patient Positioning; Pneumonia, Viral; Pressure; Prone Position; Respiration, Artificial; SARS-CoV-2; Surgical Sponges

A vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is needed to control the coronavirus disease 2019 (COVID-19) global pandemic. Structural studies have led to the development of mutations that stabilize Betacoronavirus spike proteins in the prefusion state, improving their expression and increasing immunogenicity

Topics: 2019-nCoV Vaccine mRNA-1273; Animals; Antibodies, Neutralizing; Betacoronavirus; CD8-Positive T-Lymphocytes; Clinical Trials, Phase III as Topic; Coronavirus Infections; COVID-19; COVID-19 Vaccines; Female; Lung; Mice; Mutation; Nose; Pandemics; Pneumonia, Viral; RNA, Messenger; RNA, Viral; SARS-CoV-2; Th1 Cells; Toll-Like Receptor 4; Viral Vaccines

Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this scenario, managing acute medical conditions, such as stroke, requires a timely treatment together with proper strategies that minimize the risk of infection spreading to health care workers and other patients. We report the case of a 79-year-old woman, who was admitted for a wake-up stroke due to occlusion of the left middle cerebral artery. She was treated outside the COVID-19-dedicated track of the hospital because she had no concomitant signs or symptoms suggestive of SARS-CoV-2 infection nor recent contact with other infected individuals. Post-mortem nasal and pharyngeal swab was positive for SARS-CoV-2 infection. We propose that hyperacute stroke patients should be tested for SARS-CoV-2 infection at admission and then managed as having COVID-19 until cleared by a negative result. We are aware that such measure results in some delay of the acute treatment of stroke, which could be minimal using well-exercised containment protocols.

Topics: Aged; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Delayed Diagnosis; Fatal Outcome; Female; Humans; Infarction, Middle Cerebral Artery; Infectious Disease Transmission, Patient-to-Professional; Nose; Occupational Exposure; Pandemics; Pharynx; Pneumonia, Viral; Predictive Value of Tests; Risk Factors; SARS-CoV-2; Severity of Illness Index

We prospectively compared health care worker-collected nasopharyngeal swabs (NPS) to self-collected anterior nasal swabs (ANS) and straight saliva for the diagnosis of coronavirus disease 2019 (COVID-19) in 354 patients. The percent positive agreement between NPS and ANS or saliva was 86.3% (95% confidence interval [CI], 76.7 to 92.9%) and 93.8% (95% CI, 86.0 to 97.9%), respectively. The percent negative agreement was 99.6% (95% CI, 98.0 to 100.0%) for NPS versus ANS and 97.8% (95% CI, 95.3 to 99.2%) for NPS versus saliva. More cases were detected by the use of NPS (

Topics: Adolescent; Adult; Aged; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Female; Health Personnel; Humans; Male; Middle Aged; Molecular Diagnostic Techniques; Nasopharynx; Nose; Pandemics; Pneumonia, Viral; Saliva; SARS-CoV-2; Self Care; Specimen Handling; Young Adult

Topics: Asthma; Betacoronavirus; Coronavirus Infections; COVID-19; Humans; Hypersensitivity; Nose; Pandemics; Peptidyl-Dipeptidase A; Pneumonia, Viral; SARS-CoV-2

PCR of upper respiratory specimens is the diagnostic standard for severe acute respiratory syndrome coronavirus 2 infection. However, saliva sampling is an easy alternative to nasal and throat swabbing. We found similar viral loads in saliva samples and in nasal and throat swab samples from 110 patients with coronavirus disease.

Topics: Adult; Aged; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Female; Humans; Male; Middle Aged; Nose; Pandemics; Pharynx; Pneumonia, Viral; Saliva; SARS-CoV-2; Viral Load

Recently discovered respiratory viruses were detected in 19 (9.2%) of 205 nasal swab specimens from children in Brazil with respiratory illnesses. Five each were positive for human metapneumovirus (HMPV) alone and human bocavirus (HBoV) alone, 3 for human coronaviruses (HCoV-HKU1 or -NL63) alone, and 6 for more than 1 recently discovered virus.

Topics: Adolescent; Bocavirus; Brazil; Child; Child, Preschool; Coronaviridae; Female; Humans; Infant; Male; Metapneumovirus; Nose; Pneumonia, Viral; Respiratory Tract Infections; Virus Diseases; Viruses

Intranasal infection of BALB/c mice with the WR strain of vaccinia virus leads to pneumonia, profound weight loss and death. Five days after intranasal inoculation, virus from untreated mice was recovered from 11 organs, tissues and whole blood. The highest titres [>10(8) plaque forming units (pfu)/g] were in lungs and nose/sinus tissue, with about 10(7) pfu/g in spleen and blood. Seven other organs contained 30- to > or = 50-fold lower amounts of virus. Mice infected with the related cowpox virus (for comparative purposes) had the majority of virus located in the respiratory tract. The vaccinia mouse model was used to study the efficacy of cidofovir treatments on the infection. Subcutaneous injections of 30 or 100 mg/kg/day, given on days 1 and 4 after virus challenge, reduced mortality by 60-100%. However, lung virus titres on days 2-5 were reduced no more than 10-fold by these treatments. A moderate improvement in drug efficacy occurred with daily treatments for 5 days. The efficacy of cidofovir also increased as the virus challenge dose decreased, where subcutaneous or intraperitoneal treatment routes showed similar degrees of protection. Although it has been known for many years that the WR strain of vaccinia virus can cause lethal infections by intranasal route, its application to antiviral therapy represents a new model for studying anti-orthopoxvirus agents.

Topics: Administration, Intranasal; Animals; Antiviral Agents; Cidofovir; Cowpox virus; Cytosine; Disease Models, Animal; Drug Evaluation, Preclinical; Injections, Intraperitoneal; Injections, Subcutaneous; Lung; Mice; Mice, Inbred BALB C; Nose; Organ Specificity; Organophosphonates; Organophosphorus Compounds; Paranasal Sinuses; Pneumonia, Viral; Spleen; Vaccinia; Vaccinia virus; Viral Load; Viremia

Although cytomegalovirus (CMV) infections are common throughout the world, little is known about the means of person-to-person transmission. To determine whether infection could be established by a respiratory route, studies were conducted in a murine CMV (MCMV) model by using intranasal inoculation. The infectious dose which resulted in pulmonary and systemic infection of half the mice was 100 plaque-forming units of MCMV. Here, infection was subclinical, but virus replicated in the lungs and subsequently disseminated via the blood to other organs within 7 days. The serum immunofluorescence antibody titer peaked by day 21. None of these mice died, although focal peribronchial interstitial pneumonitis was found in infected animals. In mice given greater than or equal to 10(4) plaque-forming units of MCMV intranasally, severe diffuse interstitial pneumonitis resulted uniformly, closely resembling that seen in immunocompromised patients and in newborn infants, and 20% of the animals died. Normal pulmonary architecture was obliterated by sheets of histiocytes, many containing MCMV intranuclear inclusions, and by accumulation of proteinaceous fluid in the interstitial and alveolar spaces. Of relevance to human disease, these experiments show that MCMV as a sole pathogen can cause severe interstitial pneumonitis in normal mice and that subclinical systemic infection results from respiratory inoculation of small amounts of virus.

Topics: Animals; Antibodies, Viral; Cytomegalovirus; Cytomegalovirus Infections; Female; Lung; Mice; Nose; Pneumonia, Viral

After intranasal instillation into ferrets, the "swine" influenza virus A/New Jersey/8/76(Hsw1 N1) had a 50% minimal infectious dose similar to that of previously tested A/PR/8-A/England (H3 N2) recombinants virulent and attenuated for man. A/New Jersey produced only a mild upper respiratory tract infection. However, higher titres of virus were recovered from the lungs over a longer period than experienced previously with Asian and Hong Kong virus strains. There was a diphasic pyrexia the second and higher peaks of which correlated with peak titres of virus in lung macerates. These results suggest that A/New Jersey has a pneumotropic potential in ferrets and, if the animal model is valid, possible in man.

Topics: Animals; Carnivora; Disease Models, Animal; Ferrets; Fever; Humans; Influenza A virus; Influenza, Human; Lung; Nose; Pneumonia, Viral; Virulence

Topics: Administration, Intranasal; Animals; Cattle; Cattle Diseases; Conjunctivitis; Herpesviridae; Herpesviridae Infections; Immunity, Active; Lung; Male; Nose; Pneumonia, Viral; Respiratory Tract Infections; Trachea

Topics: Adenoviridae Infections; Ampicillin; Anal Canal; Bronchiectasis; Child; Child, Preschool; Cloxacillin; Complement Fixation Tests; Female; Finland; Follow-Up Studies; Gastroenteritis; Heart Diseases; Hemorrhagic Disorders; Hepatomegaly; Humans; Infant; Kidney Diseases; Male; Meningism; Meningoencephalitis; Nose; Parasympatholytics; Penicillins; Pneumonia, Viral; Pulmonary Fibrosis; Radiography

Topics: Air Conditioning; Anti-Bacterial Agents; Bacterial Infections; Cross Infection; Escherichia coli; Haemophilus influenzae; Humans; Influenza, Human; Nose; Pharynx; Pneumonia; Pneumonia, Viral; Pseudomonas aeruginosa; Staphylococcus; Sterilization; Streptococcus pneumoniae; Tetracycline