SARS-CoV-2 Transmission and Outcome in Neuro-rehabilitation patients hospitalized at Neuroscience Hospital in Italy SARS CoV 2 in severe neurological patients
Main Article Content
Keywords
Keywords: SARS CoV 2, neurological patients, enoxaparin , neurological damage, Infection, Coronavirus
Abstract
ABSTRACT
Introduction: Patients admitted to intensive neurorehabilitation facilities following neurological damage who developed SARS-CoV-2 infection during hospitalization have not yet been reported. Such patients are elderly, with severe disabling neurological syndromes, more likely have significant underlying comorbidities and develop fatal complications during the disease. We reported clinical features, underlying comorbidities, laboratory and radiological findings, treatment and outcome of severely disabled neurological patients with SARS-CoV-2 infection.
Methods: We retrospectively analyzed a group of 14 patients affected by severe neurological damage previously admitted to the Neurorehabilitation Unit of Neuromed Research Institute in Pozzilli, Italy, who developed confirmed COVID-19 during a SARS-CoV-2 outbreak occurred on March, 2020.
Results: One out of 14 patients (7%) died after developing a severe acute respiratory distress. The remaining patients did not present any symptom or laboratory or radiological signs of the disease; neither new neurological deficit nor worsening of the pre-existing clinical manifestations were observed. Thirtheen patients had underlying comorbitidies (93%), the most frequent being hypertension (11 patients, 78.5%) and diabetes mellitus type II (7 patients, 50%). Long before infection, all patients were already under anticoagulant therapy with enoxaparin.
Conclusions: In 13 out of 14 patients, the infection was asymptomatic; this is particularly intriguing considering their severe neurological clinical profile. According to the pivotal role played by inflammation and activation of blood coagulation in the pathogenesis of COVID-19, the anti-inflammatory and anticoagulant properties of enoxaparin, administered much earlier and during infection, could have favored an extremely benign disease course in these patients at high risk of poor outcome.
Keywords: SARS CoV 2, neurological patients, neurological damage, Infection, Coronavirus
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References
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1- Lu H, Stratton CW, Tang YW (2020) Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle. J Med Virol Jan 16. htpps://doi.org/10.1002/jmv.25678 [Epub ahead of print]
2- Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, et al (2020) Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect 9:221-236. https://doi.org/10.1080/22221751.2020.1719902
3- Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579:270-273. https://doi.org/10.1038/s41586-020-2012-7
4- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med Jan 24. https://doi.org/10.1056/NEJMoa2001017 [Epub ahead of print]
5- Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al (2020) Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet Jan 30. https://doi.org/10.1016/S0140-6736(20)30251-8 [Epub ahead of print]
6- Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al (2020) The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol Mar 2. https://doi.org/10.1038/s41564-020-0695-z [Epub ahead of print]
7- Grasselli G, Pesenti A, Cecconi M (2020) Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. March 13. https://doi.org/10.1001/jama.2020.4031 [Epub ahead of print]
8- Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al (2020) Neurological Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China: a retrospective case series study. JAMA Neurol Apr 10. https://doi.org/ 10.1001/jamaneurol.2020.1127 [Epub ahead of print]
9- Filatov A, Sharma P, Hindi F, Espinosa PS (2020) Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy. Cureus March 21. 12:e7352. https:doi.org/10.7759/cureus.7352 [Epub ahead of print]
10- Zhao H, Shen D, Zhou H, Liu J, Chen S (2020) Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol Apr 1. htpps:doi.org/10.1016/S1474-4422(20)30109-5 [Epub ahead of print]
11- Haigh R, Tennant A, Biering-Sorensen F, Grimby G, Marincek C, Phillips S, et al (2001) The use of outcome measures in physical medicine and rehabilitation within Europe. J Rehabil Med 33:273–278. https://doi.org/ 10.1080/165019701753236464
12- Italian Society of Infectious and Tropical Diseases (SIMIT) (2020) Guidelines on therapeutic and supportive management for patients with COVID-19 coronavirus infection. https://www.eahp.eu/sites/default/files. Accessed April 1 2020
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15- Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zou W (2020) Single-Cell RNA expression pro?ling of ACE2, the putative receptor of Wuhan 2019-nCoV. BioRxiv. https://doi.org/10.1101/2020.01. 26.919985
16- Hoffmann M, Kleine-Weber H, Kru?ger N, Mu?ller M, Drosten C, Po?hlmann S (2020) The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells. bioRxiv. https://doi.org/10.1101/2020.01.31.929042
17- Wong CK, Lam CW, Wu AK, Ip WK, Lee NL, Chan IH, et al (2004) Plasma in?ammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol 136:95– 103. https://doi.org/10.1111/j.1365-2249.2004.02415.x
18- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020 395:497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
19- Fung SY, Yuen KS, Ye ZW, Chan CP, Jin DY (2020) A tug-of-war between severe acute respiratory syndrome coronavirus 2 and host antiviral defence: lessons from other pathogenic viruses. Emerg Microbes Infect 9:558-570. https://doi.org/10.1080/22221751.2020.1736644.
20- Yang M (2020) Cell pyroptosis, a potential pathogenic mechanism of 2019-nCoV infection. SSRN. https://doi.org/10.2139/ssrn. 3527420
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23- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395:507-513. https:// doi.org/10.1016/S0140-6736(20)30211-7
24- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al (2020) Clinical characteristics of 138 hospitalization patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. https://doi.org/10.1001/jama.2020.1585 [Epub ahead of print]
25- Liu R, Han H, Liu F, Lv Z, Wu K, Liu Y, et al (2020) Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta 505:172-175. https://doi.org/10.1016/j.cca.2020.03.009
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30- Di Gennaro F, Pizzol D, Marotta C, et al. Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health. 2020;17(8):2690. Published 2020 Apr 14. doi:10.3390/ijerph17082690
31- Wu Z, McGoogan JM (2020) Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72?314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. https://doi.org/10.1001/jama.2020.2648 [Epub ahead of print]
32- Onder G, Rezza G, Brusaferro S (2020) Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. https://doi.org/10.1001/jama.2020.4683 [Epub ahead of print]
33- Tang N, Li D, Wang X, Sun Z (2020) Abnormal Coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18:844847. https://doi.org/10.1111/jth.14768
34- Yin S, Huang M, Li D, Tang N (2020) Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. J Thromb Thrombolysis. https://doi.org/10.1007/s11239-020-02105-8 [Epub ahead of print]
35- Luo W, Yu H, Gou J, Li X, Sub Y, Li J, et al (2020) Clinical Pathology of Critical Patient with Novel Coronavirus Pneumonia (COVID-19). Preprints. https://www.preprints.org/manuscript/202002.0407/v4
36- Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al (2020) Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi 28;41(0):E006. https://doi.org/10.3760/cma.j.issn.02532727.2020.0006 [Epub ahead of print]
37- Tang N, Bai H, Chen X, Gong J, Li D, Sun Z (2020) Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. https://doi.org/10.1111/jth.14817 [Epub ahead of print]
38- Shastri MD, Stewart N, Eapen M, Peterson GM, Zaidi ST, Guven N, et al (2020) Opposing Effects of Low Molecular Weight Heparins on the Release of Inflammatory Cytokines from PBMC of Asthmatics. PLoSOne 10: e0118798. https://doi.org/10.1371/journal.pone.0118798
39- Gurwitz D (2020) Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics. Drug Dev Res. https://doi.org/10.1002/ddr.21656 [Epub ahead of print]
40- Diaz JH (2020) Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. J Travel Med. https://doi: 10.1093/jtm/taaa041. [Epub ahead of print]