Persistent Viral Presence Determines the Clinical Course of the Disease in COVID-19
Persistent Viral Presence Determines the Clinical Course of the Disease in COVID-19
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DOI：
10.1016/j.jaip.2020.06.015
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发表时间：
2020-09-01
影响因子：
9.4
通讯作者：
Qin, En-Qiang
中科院分区：
文献类型：
--
作者：
Chang, De;Zhao, Peng;Qin, En-Qiang
背景技术背景：2019冠状病毒病（COVID-19）的临床管理取决于了解导致疾病严重程度的潜在因素。在缺乏有效的抗病毒疗法的情况下，目前正在使用其他宿主免疫调节疗法，如靶向炎症反应，但没有明确的有效性证据。由于炎症是宿主抗病毒机制的重要组成部分，靶向炎症的治疗可能会对病毒清除和疾病结局产生不利影响。目的：了解病毒的持续存在是否是COVID-19期间疾病严重程度的关键决定因素，并确定某些患者的病毒再激活是否与感染性病毒颗粒相关。方法：患者的数据可用，包括疾病发作，病毒持续时间，炎症标志物（如IL-6和C-反应蛋白）的测量，胸部成像，疾病症状及其持续时间等。进行后续测试，以确定是否病毒阴性状态持续后，他们的recovery.RESULTS：我们的数据显示，持续存在病毒（>16天）的患者有更严重的疾病结果，包括广泛的肺部受累和呼吸支持的要求。两名死于COVID-19的患者在死亡时病毒呈阳性。四名患者表现出病毒阳性状态的后续测试，这些患者的样本被送往病毒培养设施，病毒文化不能建立。结论：这些数据表明，病毒的持久性是疾病严重程度的关键决定因素。可能损害病毒清除的疗法可能会损害宿主从COVID-19中的恢复。(C)2020年美国过敏，哮喘和免疫学学会。
BACKGROUND: The clinical management of coronavirus disease 2019 (COVID-19) is dependent on understanding the underlying factors that contribute to the disease severity. In the absence of effective antiviral therapies, other host immunomodulatory therapies such as targeting inflammatory response are currently being used without clear evidence of their effectiveness. Because inflammation is an essential component of host antiviral mechanisms, therapies targeting inflammation may adversely affect viral clearance and disease outcome.OBJECTIVE: To understand whether the persistent presence of the virus is a key determinant in the disease severity during COVID-19 and to determine whether the viral reactivation in some patients is associated with infectious viral particles.METHODS: The data for patients were available including the onset of the disease, duration of viral persistence, measurements of inflammatory markers such as IL-6 and C-reactive protein, chest imaging, disease symptoms, and their durations among others. Follow-up tests were performed to determine whether the viral negative status persists after their recovery.RESULTS: Our data show that patients with persistent viral presence (>16 days) have more severe disease outcomes including extensive lung involvement and requirement of respiratory support. Two patients who died of COVID-19 were virus-positive at the time of their death. Four patients demonstrated virus-positive status on the follow-up tests, and these patient samples were sent to viral culture facility where virus culture could not be established.CONCLUSIONS: These data suggest that viral persistence is the key determining factor of the disease severity. Therapies that may impair the viral clearance may impair the host recovery from COVID-19. (C) 2020 American Academy of Allergy, Asthma & Immunology.