Search

Purpose To investigate the prevalence and epidemiological risk factors of olfactory and/or taste disorder (OTD), in particular isolated OTD, in patients with laboratory-confirmed COVID-19 infection. Methods We conducted a retrospective and cross-sectional study. Patients with laboratory-confirmed COVID-19 infection were recruited from the National Centre for Infectious Diseases (NCID) Singapore between 24 March 2020 and 16 April 2020. The electronic health records of these patients were accessed, and demographic data and symptoms reported (respiratory, self-reported OTD and other symptoms such as headache, myalgia and lethargy) were collected. Results A total of 1065 patients with laboratory-confirmed COVID-19 were recruited. Overall, the prevalence of OTD was 12.6%. Twelve patients (1.1%) had isolated OTD. The top three symptoms associated with OTD were cough, fever and sore throat. The symptoms of runny nose and blocked nose were experienced by only 29.8 and 19.3% of patients, respectively. Multivariate analysis demonstrated that the female gender, presence of blocked nose and absence of fever were significantly associated with OTD (adjusted relative risks 1.77, 3.31, 0.42, respectively). All these factors were statistically significant. Conclusion Patients with COVID-19 infection can present with OTD, either in isolation or in combination with other general symptoms. Certain demographic profile, such as being female, and symptomatology such as the presence of blocked nose and absence of fever, were more likely to have OTD when infected by COVID-19. Further studies to elucidate the pathophysiology of OTD in these patients will be beneficial.

The human microbiome comprises a complex ecosystem of microbial communities that exist within the human body, the largest and most diverse of which are found within the human intestine. It has been increasingly implicated in human health and diseases, demonstrably playing a critical role in influencing host immune response, protection against pathogen overgrowth, biosynthesis, and metabolism. As our understanding of the links between the gut microbiota with host immunity and infectious diseases deepens, there is a greater need to incorporate methods of modulating it as a means of therapy or infection prevention in daily clinical practice. Traditional antimicrobial stewardship principles have been evaluated to assess their impact on the gut microbiota diversity and the consequent repercussions, taking into consideration antibiotic pharmacokinetic and pharmacodynamic properties. Novel strategies of selective digestive decontamination and fecal microbiota transplantation to regulate the gut microbiota have also been tested in different conditions with variable results. This review seeks to provide an overview of the available literature on the modulation of the gut microbiota and its implications for infection control and antimicrobial stewardship. With increased understanding, gut microbiota profiling through metataxonomic analysis may provide further insight into modulating microbial communities in the context of infection prevention and control.

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.

PURPOSE: To report bilateral follicular conjunctivitis in two confirmed Coronavirus (COVID-19) patients with the presence of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens. PARTICIPANTS AND METHODS: Two unrelated patients with confirmed SARS-CoV-2 infection and bilateral acute conjunctivitis were examined. Conjunctival swabs were assessed for the presence of SARS-CoV-2 by quantitative real-time polymerase chain reaction (RT-PCR) and viral culture. RESULTS: Both patients developed eye redness 3 days after the onset of COVID-19 symptoms. Slit lamp examination showed bilateral acute follicular conjunctivitis, which was resolved within 6 days. RT-PCR demonstrated the presence of viral RNA in conjunctival specimens from both eyes, which was unrelated to viral RNA from throat swabs. CONCLUSION: SARS-CoV-2 may cause ocular manifestations such as viral conjunctivitis. Conjunctival sampling may be useful for infected patients with conjunctivitis and fever. Precautionary measures are recommended when examining infected patients throughout the clinical course of the infection.

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 SARS-CoV-2 positive cases and 564 controls, accounting for the time course of illness at point of assessment. Clinical differentiators of cases and controls were used to derive model-based risk scores. Significant symptoms included abdominal pain, cough, diarrhea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5°C and 37.9°C, and temperature above 38°C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, we firstly used leave-one-out cross-validation, which confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. Secondly, in a separate ongoing prospective study of 237 COVID-19 and 346 primary care patients presenting with symptoms of acute respiratory infection, the baseline model had a sensitivity of 0.57 and specificity of 0.89, and in retrospective notes review of 100 COVID-19 cases diagnosed in primary care, sensitivity was 0.56. A web-app based tool has been developed for easy implementation as an adjunct to laboratory testing to differentiate COVID-19 positive cases among patients presenting in outpatient settings.

Background A recent genome-wide association study (GWAS) including 253 Chinese individuals from Singapore with B-cell Non-Hodgkin Lymphoma (B-NHL), a new susceptibility locus, rs6773853 was identified between BCL6 (B-cell lymphoma protein 6) and LPP (lipoma preferred partner) on chromosome 3q27. This was significantly associated with an increased risk of B-NHL; Odds ratio (OR) per-copy of the risk allele = 1.44 and diffuse large B-cell lymphoma (DLBCL) OR = 1.47. The aims of this study were to determine the prognostic significance of rs6773853 in a case-only analysis of B-NHL patients and to determine if there were any differences in patients and tumor characteristics in B-NHL patients with rs6773853 locus present and absent. Methods Genome-wide genotyping to identify germline mutations from DNA of patients' blood samples have been described. Patient, tumour and treatment data were obtained from clinical and pathology databases as well as electronic and hardcopy of medical records. Fluorescent in-situ hybridization testing for BCL6 translocations using breakapart probes were performed on tumor samples whenever possible. Patients were compared in a two-way (homozygous wild-type [WT] versus presence of 1 or more copies of the risk allele of rs6773853) and three-way (homozygous WT versus heterozygous carrier versus homozygous variant of rs6773853) manner. Prognostic factors were analyzed first by univariate analysis. A multivariate Cox regression model was then fitted including all factors showing statistical significance on univariate analysis to identify the best predictors of overall survival. Results Clinical and pathologic data were available for 245 B-NHL patients in whom GWAS was performed. The minor allele of rs6773853 locus was identified in 127 patients: 100 were homozygous and 27 were heterozygous carriers. The WT genotype was present in 118 patients. There were no statistically significant differences in the clinical and tumor characteristics or treatment received in both 2-way (Table 1) and 3-way analyses. On univariate analysis, age >60 years, ECOG 2–4, B symptoms, advanced stage, aggressive B-NHL, 2 or more extra-nodal sites, elevated LDH, high-risk IPI and a personal history of another cancer were associated with a poorer OS. On multivariate analysis the presence of rs6773853 locus was independently associated with a poorer OS. (Table 2) The frequencies of BCL6 translocations were 17.9% (7/39) and 20.8% (10/48) in the B-NHL with rs6773853 locus absent and present respectively. Conclusions The rs6773853 susceptibility locus to B-NHL is independently prognostic of a poorer OS. This may be related to its close proximity to BCL6, the transcriptional repressor that tightly regulates the germinal centre reaction, although exploratory analysis showed that rs6773853 did not confer a greater risk of BCL6 translocations. Further functional studies and fine mapping will investigate the role of BCL in the tumorigenesis of these B-NHL patients with rs6773853. Disclosures: No relevant conflicts of interest to declare.