Translational Medical Research Commons^™

The Role Of Rapid Diagnostic Point Of Care Igg/Igm Antibody Tests In The Diagnosis Of Sars-Cov-2 Infection, Nishita Tripathi, Daniya Sheikh, Dawn Balcom

The University of Louisville Journal of Respiratory Infections

Background: Current testing of symptomatic patients for SARS-CoV-2 involves the use of nucleic acid amplification tests, also known as genetic, RNA, or polymerase chain reaction (PCR), to detect viral RNA. The initial use of point of care (POC) antibody tests, also known as serological tests, in the management of SARS-CoV-2 infection was limited. In this review, we determine the significance of POC antibody serological tests and explore their possible role in the diagnosis and management of patients infected with the SARS-CoV-2 virus.

Methods: A literature search was conducted in Google Scholar, PubMed, and Embase, supplemented by searching the Centers for …

Gastrointestinal Symptoms In Patients With Covid-19, Mohammed Abbas, Rafik Elbeblawy, Islam Gadelmoula, Suvarna Rekha, Bettina Sinanova, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: Though coronavirus disease 2019 (COVID-19) is predominantly a respiratory illness, a growing number of studies reported gastrointestinal (GI) symptoms among these patients. We examined the incidence of GI symptoms in patients with COVID-19 and GI symptoms as the initial presentation of the disease.

Methods: We examined peer-reviewed studies in English of patients with COVID-19 that reported GI symptoms. We searched PubMed and Google Scholar for articles published up to June 30, 2020, by using the keywords ``COVID-19,'' ``Coronavirus,'' ``severe acute respiratory syndrome coronavirus 2,'', ``SARS-CoV-2,'' ``gastrointestinal tract,'' ``gastrointestinal diseases,'' and ``gastrointestinal symptoms and signs.'' Studies with fewer than 30 …

Gastrointestinal Sars Cov-2 Infection And The Dynamic Of Its Detection In Stool, Rafik Elbeblawy, Mohammed Abbas, Islam Gadelmoula, Akshitha Kolla, Bettina Sinanova, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: SARS-CoV-2 has been strongly associated with respiratory illnesses; however the incidence of SARS-CoV-2 infection of the gastrointestinal tract is not fully clear. We examined the frequency of positive stool SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) in COVID-19 patients, duration of stool viral shedding after the viral clearance of respiratory samples, and the association of SARS-CoV-2 infection with gastrointestinal symptoms.

Methods: We did a search in PubMed and Google Scholar of studies published in the English language before June 30th, 2020. Search queries included: “COVID-19”, “SARS-CoV-2”, and “stool SARS-CoV-2 RT-PCR”. We excluded studies with less than 8 patients from our …

Covid-19 Is Associated With Increased Severity In Pregnant Women, Zahid Imran, Vidyulata Salunkhe, Ahmed A. Eladely, Ahmed Abdelhaleem, Satya Durugu, Daisy Sangroula

The University of Louisville Journal of Respiratory Infections

Introduction: The COVID-19 pandemic originated in China in late 2019; the number of cases is increasing with 2,104,346 cases and 116,140 deaths in the United States as of June 16, 2020. Pregnant women are a vulnerable population in epidemics or pandemics. This review is designed to look in detail at the severity of COVID-19 in pregnant women compared to non-pregnant women of reproductive age.

Methods: Literature searches on PubMed, Google Scholar, the Lancet, and Web of Science were conducted.

Results: We found evidence of increased risk for severe disease and distinctive symptoms among pregnant women diagnosed with COVID-19 compared …

The Incidence Of Common Respiratory Viruses During The Covid-19 Pandemic: Results From The Louisville Covid-19 Epidemiology Study, Brian C. Bohn Pharmd, Bcidp, Ashley M. Wilde Pharmd, Bcps-Aq Id, Sarah E. Moore Pharmd, Matthew Song Pharmd, Bcidp, Clayton J. Patross Pharmd, Bcps, Alan D. Junkins Phd, D(Abmm), Paul Schulz Md, Julio A. Ramirez Md Facp

The University of Louisville Journal of Respiratory Infections

Introduction: Social distancing has been utilized during the COVID-19 pandemic to reduce the spread of SARS-CoV-2; it is also expected to reduce the spread of common respiratory viruses.

Methods: This retrospective, descriptive study assessed the rate of positivity of common respiratory viruses from a commercially available respiratory pathogen panel across a five-hospital health system during four-week periods within March to April of 2019 and 2020.

Results: During the four-week period in 2019, the percent positivity of common respiratory viruses from week 1 to week 4 decreased from 6 to 32% among the four included viruses. In the comparator period in …

Anesthesia Services In The Time Of Covid, James Chen, Daisy Sangroula, Katelyn Williams, Sydney Pham, Ozan Akca, Jiapeng Huang, Sean Clifford

The University of Louisville Journal of Respiratory Infections

Our hospital is a 400-bed, Level-1 trauma center with 78 intensive care unit (ICU) beds serving the greater Louisville metropolitan area. The COVID-19 pandemic forced our hospital to re-evaluate our core business operations and to develop a coherent response to a fluid situation. Between March 15 and May 15, 2020, the University of Louisville Hospital admitted more than 100 COVID-19 inpatients; approximately 30 were admitted to the ICU, and most required endotracheal intubation. The following review describes our Department of Anesthesiology \& Perioperative Medicine foci, actions, and rationale during the COVID-19 pandemic. While we hope not to experience another pandemic …

Severe Covid-19, Arpan H. Chawala, Shivam Gulati, Bettina Sinanova, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: There is substantial variation in the clinical characteristics and outcomes of severe coronavirus disease (COVID-19), making it difficult to do an optimal assessment of this condition. We reviewed the current English literature to identify the findings concerning the baseline characteristics and health outcomes of patients with severe COVID-19, primarily those with acute respiratory distress syndrome (ARDS).

Methods: We examined only studies that assessed patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with at least one of the following severity criteria: treated in the intensive care unit (ICU), ARDS, and/or invasive …

Is Sars-Cov-2 A Neurotropic Virus And A Potential Facilitator Of Cns Infection For Other Pathogens?, Jose Bordon

The University of Louisville Journal of Respiratory Infections

No abstract provided.

The Importance Of Cycle Threshold Values In The Evaluation Of Patients With Persistent Positive Pcr For Sars-Cov-2: Case Study And Brief Review, Jose Bordon, Donghoon Chung, Priya Krishnan, Ruth Carrico, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Some patients recover from COVID-19, but their reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 remains persistently positive. In the evaluation of these patients, it is important to define the cycle threshold (Ct) value of the RT-PCR test. This article will present a case study, address relevant findings and interpretation of the RT-PCR test, and explain the use of Ct values in defining when a healthcare worker may return to work. Our current approach is to allow health care workers with persistently positive RT-PCR to return to work if the Ct value is greater than 35.

Covid-19 Surveillance Testing Of Healthcare Personnel Drives Universal Masking Practice, Paul S. Schulz, Ashley M. Wilde, Steve T. Hester, Jim Frazier, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Health care professionals (HCP) are at increased risk of COVID-19 infection due to the unpredictable clinical presentation of COVID-19 disease, limited SARS-CoV-2 testing, personal protective equipment (PPE) shortages, and the inherent inability to distance from patients. Infected HCP may infect others, including coworkers, leading to a simultaneous increase in the number of infections and decrease in the availability of HCP in a community. Due to PPE shortages, many healthcare systems have faced difficult decisions regarding utilization of PPE to protect HCP, patients, and the communities they serve. We describe Norton Healthcare’s success utilizing surveillance COVID-19 testing of HCP to inform …

Why Every Hospital Needs A Covid-19 Clinical Case Review Team, Ashley M. Wilde, Paul Schulz, Brian C. Bohn, Sarah E. Moore, Matthew Song, Clayton J. Patross, Bryan Denham, Jim Frazier, Steve T. Hester, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

A hospital’s response to a global pandemic requires a coordinated effort to provide consistent guidance as information rapidly changes. In the early months of the COVID-19 pandemic, diagnosis and subsequent containment was challenging due to unfamiliarity with disease presentation, unknown reverse transcription-polymerase chain reaction sensitivity, and inconsistent access to testing supplies. A centralized COVID-19 clinical case review team can provide guidance on test interpretation, isolation, resource coordination and more.

The Nurse Practitioner In The Time Of Covid, Julie Marfell, Lynn Kelso

The University of Louisville Journal of Respiratory Infections

No abstract provided.

An Overview Of Current Clinical Trials Of Agents For The Treatment And Prevention Of Covid-19 In The United States, Kenneth Schot Hannan, William P. Mckinney

The University of Louisville Journal of Respiratory Infections

Introduction: Given the rapid worldwide spread of SARS-CoV-2 and the attendant risks for severe complications and mortality, numerous clinical trials for its treatment and prevention have been generated in a short period. This report focuses on the categories of the wide spectrum of agents being studied in the United States and the intensity of effort involved with each so that clinicians may consider whether suggesting enrollment may be appropriate for their patients.

Methods: A search was completed of the ClinicalTrials.gov database on May 28, 2020, for all such trials underway as of that date in the US. A total 190 …

Vaccine-Preventable Diseases In The Time Of Covid, Thaddeus Zajdowicz, Margan Zajdowicz

The University of Louisville Journal of Respiratory Infections

No abstract provided.

The Strengths, Weaknesses, Opportunities And Threats (Swot) Analysis Of The Severe Acute Respiratory Syndrome Coronavirus 2 Of Covid-19, Michael Oluyemi Babalola Ph.D

The University of Louisville Journal of Respiratory Infections

Introduction: SARS-CoV-2 is the etiologic agent of Coronavirus Disease 2019 (COVID-19), a highly contagious, emergent, acute, viral pneumonia that emanated sporadically in Wuhan, China, in December 2019. COVID-19 became a pandemic in February 2020, leading to 4,942,687 confirmed cases and over 321,987 deaths and grounding several economies around the world as of May 2020. Although global researchers, epidemiologists, virologists, and medical professionals rose steadily to contain the disease, in-depth knowledge of the virus and concerted efforts to combat it are still evolving. This research sought to elucidate the biological Strengths, Weaknesses, Opportunities, and Threats to SARS-CoV-2, with a view to …

False-Negative Sars-Cov-2 Reverse Transcriptase Polymerase Chain Reaction (Rt-Pcr) Is An Important Consideration For Patient Management And Infection Prevention: A Case Report From The Louisville Covid-19 Epidemiology Study, Matthew Song Pharmd, Bcidp, Ashley M. Wilde, Sarah E. Moore Pharmd, Brian C. Bohn Pharmd, Clayton J. Patross, Bryan Denham, Paul Schulz, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

We report a case of false-negative SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) on a nasopharyngeal swab. Treating clinicians and infection preventionists should maintain a high suspicion for COVID-19 in the appropriate clinical setting despite negative test results. Utilization of chest computed tomography (CT) should be strongly considered in the diagnostic work-up for suspected COVID-19, particularly in areas with limited RT-PCR availability.

Concomitant Invasive Pneumococcal Disease In A Patient With Covid-19 – A Case Report From The Louisville Epidemiology Study, Clayton J. Patross, Brian C. Bohn Pharmd, Sarah E. Moore Pharmd, Paul Schulz, Matthew Song Pharmd, Bcidp, Ashley M. Wilde, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

A 60-year-old male presented to the emergency department (ED) with a 1–2 day history of confusion, headache, and subjective fever. Because he had met with a contact two days prior to admission who had recently traveled from the Bahamas, a COVID-19 nasopharyngeal (NP) and oropharyngeal (OP) polymerase chain reaction (PCR) test was ordered. He was diagnosed with bacterial meningitis based on presenting neurologic symptoms and the identification of Streptococcus pneumoniae from blood cultures. The COVID-19 NP and OP test returned positive, although he never developed shortness of breath, cough, other respiratory symptoms, diarrhea, abdominal pain, nausea, vomiting, or any change …

A Comparison Efficacy Study Of Commercial Nasopharyngeal Swabs Versus A Novel 3d Printed Swab For The Detection Of Sars-Cov-2, Forest W. Arnold, Gerald Grant, Phillip F. Bressoud, Stephen P. Furmanek, Donghoon Chung, Nadine Sbaih, Dipan Karmali, Meredith Cahill, George Pantalos

The University of Louisville Journal of Respiratory Infections

Introduction: The large volume of diagnostic tests required by the response to the COVID-19 pandemic resulted in a shortage of commercial nasopharyngeal swabs. In an effort to alleviate the shortage, swabs created by 3D printing may be a solution.

Methods: We designed and produced 3D printed swabs and sought to compare their ability to detect SARS-CoV-2 in patients admitted for COVID-19 or who were suspected of having COVID-19.

Results: A total of 30 patients were swabbed with a commercial and a 3D printed swab. Results matched in 27 of 30 patients (90%). Two patients were discordant with a positive commercial …

Stroke Management In The Time Of Covid, Marwa Elnazeir, Siddharth Narayanan, Kerri Remmel

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Covid-19 Radiological Library, Forest W. Arnold, Tracy Vanmeter, Lachlan Smith, Danny Mcgrath, Matthew Grassman, Nishant Patel, William Mattingly

The University of Louisville Journal of Respiratory Infections

No abstract provided.

A Patient With Escherichia Coli Bacteremia And Covid-19 Co-Infection: A Case Report For The Louisville Covid-19 Epidemiology Study, Sarah E. Moore Pharmd, Ashley M. Wilde Pharmd, Bcps-Aqid, Matthew Song Pharmd, Bcidp, Brian C. Bohn Pharmd, Clayton J. Patross Pharmd, Bcps, Bryan Denham Md, Paul Schulz, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Patients with COVID-19 may have co-infections with other microorganisms. Here we report a case of a patient with an Escheria coli bacteremia secondary to a urinary tract infection, who experienced fevers while on active antimicrobial therapy. The patient was eventually tested for COVID-19 and found to be positive. This case emphasizes the need to suspect COVID-19 even in patients with documented bacterial infection.

Sars-Cov-2 And Bacterial Co-Infection, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Life In The Time Of Covid, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Healthcare Workers In The Time Of Covid, Julio A. Ramirez, Ruth Carrico

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Abo Blood Group Type And Susceptibility To Covid-19 Infection, G. Rafael Fernandez-Botran

The University of Louisville Journal of Respiratory Infections

Since December 2019, the SARS-CoV-2 (COVID-19) pandemic has extended its reach over most of the world, infecting over four million people and causing well over 300,000 deaths so far.[1] A significant percentage of infected patients develop severe symptoms and life-threatening conditions. While COVID-19 infection can affect all ages, available evidence points to older age and pre-existing comorbidities, such as hypertension, diabetes, and coronary heart disease, as important risk factors related to increased mortality rates.[2-4] Moreover, recent reports from China and the U.S. have suggested that susceptibility, and perhaps even mortality, to COVID-19 infection might be influenced by the ABO blood …

Implementation Of The Louisville Covid-19 Surveillance Protocol: Experiences From The University Of Louisville Center Of Excellence For Research In Infectious Diseases [Cerid], Ruth Carrico, Dawn Balcom, William Johnson, Amr Aboelnasr, Mutasem Abuhalaweh, Stephen Furmanek, Montray Smith, Amanda Lasnik, Donghoon Chung, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

The lack of available testing for SARS-CoV-2 has been one of the primary challenges in the development and implementation of a comprehensive approach to infection prevention and transmission in the United States (US). In response to the need for increased testing capacities and capabilities, the University of Louisville (UofL) Division of Infectious Diseases Center of Excellence for Research in Infectious Diseases (CERID) initiated the Louisville Coronavirus Surveillance Program, a comprehensive approach to surveillance and testing of patients and healthcare workers. The first specimens were accepted on March 12, 2020, and parallel testing was done using a high-capacity testing process at …

Possible Role Of Tetracyclines On Covid-19: Recycling Well-Known Old Drugs From The Shelf, Martin Gnoni, Raul Vasquez-Gararatti, Angel Mena

The University of Louisville Journal of Respiratory Infections

We are in the midst of a pandemic due to the novel coronavirus SARS-CoV-2. Innovative therapies are in the lookup around the world. Recently, chloroquine and hydroxychloroquine in addition to azithromycin were proposed to be used in patients with severe disease even though strong evidence is lacking. We propose the use of tetracyclines in addition to anti-virals early in the curse of the disease in order to prevent the cytokine storm syndrome associated with COVID-19 and prevent ARDS. The proposed mechanisms of tetracyclines are: 1) anti-apoptotic properties; 2) decrease the Myeloperoxidase and ROS releaser from immune cells; 3) decrease neutrophil …

Depression Is Associated With Decreased Severity And Lower Mortality In Non-Elderly Hospitalized Adults With Influenza In The United States, Timothy L. Wiemken, Daniel Hoft, Jeffrey Scherrer

The University of Louisville Journal of Respiratory Infections

Background: Depression is associated with risk for chronic disease, though its relationship with infectious diseases is less understood. Depression may modify the clinical outcomes of patients with infectious diseases such as influenza via its association with inflammation. The objective of this study was to evaluate the relationships between depression and clinical outcomes in non-elderly adults with influenza infection.

Methods: This was a secondary analysis of the Nationwide Inpatient Sample database, years 2012–2016. Hospitalized adults aged 18–65 admitted during each influenza season were included. Depression status was documented via ICD-10 codes. The association between depression and clinical outcomes (e.g., …

How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Copd Exacerbation Caused By Sars-Cov-2: A Case Report From The Louisville Covid-19 Surveillance Program, Forest W. Arnold, Kamran Mahmood, Angeline Prabhu, Darmaan Aden, Anupama Raghuram, Mark Burns, Leslie A. Beavin, Donghoon Chung, Kenneth E. Palmer, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

A 53-year-old male with a history of chronic obstructive pulmonary disease (COPD) on home oxygen presented to the hospital with worsening shortness of breath plus cough. He was admitted to the intensive care unit for COPD exacerbation and respiratory failure. A routine evaluation was performed, including a nasopharyngeal swab for a respiratory viral panel, which was negative. His symptoms improved over 48 hours, after which time a surveillance test for SARS-CoV-2 returned as positive. After clinical improvement, he was discharged to home isolation.