Dataset: 11.1K articles from the COVID-19 Open Research Dataset (PMC Open Access subset)
All articles are made available under a Creative Commons or similar license. Specific licensing information for individual articles can be found in the PMC source and CORD-19 metadata.
More datasets: Wikipedia | CORD-19
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
This rare case of adult-onset KD suggests that the disease can be concurrent Coxsackievirus A4 infection. Although KD is an acute childhood disease, with fever as the main sign, it should be considered in the differential diagnosis also when adult patients present with unexplained fever and a rash.
Recreational activities such as camping and visiting rural and agricultural areas lead to increased risk to exposure to the bacterium that causes tularemia. Typically found in the Northern Hemisphere, the number of infected cases are underestimated and underreported. Outbreaks have been reported on Martha’s Vineyard (Massachusetts, USA), Sweden and Finland in the last 15 years.
Francisella tularensis is the bacterium responsible for what is a potentially fatal multi-systemic disease. Reservoirs of transmission are via ticks, biting flies, aerosol, water exposure and food. There are 4 identified subtypes and clinical presentation depends on biotype, method of transmission and port of entry. There are 6 major clinical presentations: ulceroglandular, glandular, oculoglandular, oropharyngeal, pneumonic and typhoidal. Pulmonary features may consist of lobar pneumonia, pulmonary effusions, infiltrates and hilar lymphadenopathy. Mortality in untreated pneumonic tularemia can be up to 60%.
Early diagnosis and treatment is key to prognosis, but isolation of the bacterium is hazardous and time consuming and most laboratories do not accept samples for culture. Agglutination and enzyme-linked immunosorbent assay (ELISA) tests are the diagnostic tests of choice. Aminoglycosides are bactericidal against F. tularensis and WHO recommend a 10-day course.
As an aside, F. tularensis subspecies tularensis (Type A) is one of the most infectious pathogens known to man, and these properties have led to tularemia being identified as a potential weapon of bioterrorism.
Pertussis and diphtheria are vaccine-preventable pulmonary infections; poor vaccine uptake has led to a recent increase in cases in developed countries. It is important, therefore, to take a full vaccination history in returned travellers who present with pulmonary symptoms.
Pertussis is a worldwide endemic-epidemic disease with outbreaks most likely during summer/autumn time. Pertussis is thought to still cause around 63,000 deaths per year in children under 5 years of age, although there is uncertainty over these estimates in view of the paucity of reliable surveillance data.
Recently, there has been an increase in the number of adolescent and young adults being diagnosed in some high-income countries, likely due to decreased vaccination uptake rates and a change in the vaccine itself. It is thought that the acellular vaccine currently used appears to have a short-lived immunity leading to increased infection rates. Macrolide antibiotics are given to affected individuals to prevent further spread of pertussis.
Diphtheria presents as an acute infectious disease affecting the upper pulmonary tract caused by toxins produced by the bacterium. Characteristic features are membranous pharyngitis with fever, enlarged anterior cervical lymph nodes and edema of the soft tissues of the neck. This manifestation may lead to airway obstruction. The bacterium has a short incubation period but untreated individuals may remain infectious for up to 4 weeks. Both pertussis and diphtheria are potentially fatal but easily preventable.
Several clusters of MERS-CoV cases have been reported, mainly among household members and health care workers (HCWs), suggesting that transmission is through close contact. The largest cluster reported so far has been in 23 HCWs in a hospital in Al Hasa, Kingdom of Saudi Arabia (KSA), while the largest family cluster has been in three infected brothers from Riyadh, KSA,. The basic reproductive rate for MERS-CoV has still not been determined with certainty. Using two transmission scenarios, Breban et al. reported an R0 of 0.60 and 0.69. Cauchemez et al. reported a similar R0 at 0.63, but warned that in the absence of infection control measures, R0 may range from 0.8–1.3 and could lead to a self-sustaining transmission. Propensity for the MERS-CoV to replicate in the lower respiratory tract may account for the observed limited transmission. The United States Centers for Disease Control and Prevention (CDC) recommends standard contact and airborne precautions with the use of an N-95 mask when caring for an infected patient.
The etiology of KD remains unclear, although the clinical features suggest that a viral or bacterial infection may be a trigger.11 KD has features similar to those of other childhood infectious diseases. For example, similar to measles and adenovirus infection, KD has the clinical features of fever and rash. The epidemiological features including age distribution, seasonal prevalence, and occurrence of community outbreaks with geographical spread also suggest a transmissible childhood disease.12 However, an infectious agent has not yet been identified. Adenovirus, herpesvirus, Epstein–Barr virus, human coronavirus New Haven, measles virus, rotavirus, dengue virus, and retrovirus are putative etiological agents of KD. These are commonly found pathogens.13 However, the reason why only some patients infected with these viruses develop KD is unknown. A report demonstrated coinfection with Coxsackievirus B3 in a patient with KD.13
In 2008–2017, morbidity of Class B infectious diseases showed a significant downward trend, from 185.34/100,000 in 2008 to 54.36/100,000 in 2017 (χ2trend = 11,093.22, p < 0.05), with an annual morbidity of 90.39/100,000; morbidity of Class C infectious diseases showed a fluctuating upward trend, from 1352.97/100,000 in 2008 to 2549.03/100,000 in 2017 (χ2trend = 97,595.69, p < 0.05), with an average annual morbidity rate of 2412.47/100,000 (Table 1).
The top 5 reported Class B infectious diseases were dysentery, scarlet fever, measles, Influenza A (H1N1) and syphilis. The morbidity of measles, dysentery and syphilis showed a decline (measles: χ2trend = 10,156.59, p < 0.05; dysentery: χ2trend = 6301.75, p < 0.05; syphilis: χ2trend = 3376.99, p < 0.05); and that of scarlet fever was on the rise in recent years (χ2trend = 4185.20, p < 0.05). Influenza A (H1N1) was classified as a Class B infectious disease in 2009; 5805 cases of influenza A (H1N1) were reported in 2009, ranking first among Class B infectious diseases reported in the same year. This disease showed a decline in 2010 (χ2 = 5126.04, p < 0.05), and the number of cases reported was between 3 and 259 in 2010–2013. Since 1 January 2014, it was removed from Class B to Class C under the management of existing influenza (Figure 1).
The top 5 reported Class C infectious diseases were hand-foot-and-mouth disease (HFMD), other infectious diarrheal diseases, mumps, influenza and acute hemorrhagic conjunctivitis, among which the morbidity of HFMD, other infectious diarrheal diseases, and influenza were on the rise, while the morbidity of acute hemorrhagic conjunctivitis and mumps were decreasing year by year. In 2010, 11,789 cases of acute hemorrhagic conjunctivitis were reported, and thereafter the number of cases reported decreased rapidly (Figure 2).
Fever is often the major and initial symptom of COVID-19, which can be accompanied by no symptom or other symptoms such as dry cough, shortness of breath, muscle ache, dizziness, headache, sore throat, rhinorrhea, chest pain, diarrhea, nausea, and vomiting. Some patients experienced dyspnea and/or hypoxemia one week after the onset of the disease 8. In severe cases, patients quickly progressed to develop acute respiratory syndrome, septic shock, metabolic acidosis, and coagulopathy. Patients with fever and/or respiratory symptoms and acute fever, even without pulmonary imaging abnormalities, should be screened for the virus for early diagnosis 39-41.
A demographic study in late December of 2019 showed that the percentages of the symptoms were 98% for fever, 76% for dry cough, 55% for dyspnea, and 3% for diarrhea; 8% of the patients required ventilation support 42. Similar findings were reported in two recent studies of a family cluster and a cluster caused by transmission from an asymptomatic individual 43,44. Comparably, a demographic study in 2012 showed that MERS-CoV patients also had fever (98%), dry cough (47%), and dyspnea (55%) as their main symptoms. However, 80% of them required ventilation support, much more than COVID-19 patients and consistent with the higher lethality of MERS than of COVID-19. Diarrhea (26%) and sore throat (21%) were also observed with MERS patients. In SARS patients, it has been demonstrated that fever (99%-100%), dry cough (29%-75%), dyspnea (40%-42%), diarrhea (20-25%), and sore throat (13-25%) were the major symptoms and ventilation support was required for approximately 14%-20% of the patients 45.
By February 14, the mortality of COVID-19 was 2% when the confirmed cases reached 66,576 globally. Comparably, the mortality of SARS by November 2002 was 10% of 8,096 confirmed cases 46. For MERS, based on a demographic study in June 2012, the mortality was 37% of 2,494 confirmed cases 47. An earlier study reported that the R0 of SARS-CoV-2 was as high as 6.47 with a 95% confidence interval (CI) of 5.71-7.23 48, whereas the R0 of SARS-CoV only ranged from 2 to 4 49. A comparison of SARS-CoV-2 with MERS-CoV and SARA-CoV regarding their symptoms, mortality, and R0 is presented in Table 1. The above figures suggest that SARS-CoV-2 has a higher ability to spread than MERS-CoV and SARS-CoV, but it is less lethal than the latter two 6. Thus, it is much more challenging to control the epidemic of SARS-CoV-2 than those of MERS-CoV and SARS-CoV.
Ejection fraction and fractional shortening were not significantly different between group 1 and group 2. There were no significant differences in late diastolic myocardial velocity (A') (5.6±2.7 cm/s vs. 6.2±2.6 cm/s), early diastolic myocardial velocity (E') (9.9±2.2 cm/s vs. 11.6±6.1 cm/s), systolic myocardial velocity (S') (5.6±1.2 cm/s vs. 6.2±1.4 cm/s), IVRT (41.0±11.7 ms vs. 46.0±12.6 ms), and left LVET (236.4±78.9 ms vs. 210.4±80.2 ms) between group 1 and group 2 (Table 4).
However, IVCT (61.4±8.9 ms vs. 49.5±15.9 ms) and Tei index (0.44±0.06 vs. 0.34±0.07) were significantly higher in group 2 compared with group 1.
Coronary artery abnormality was more frequent in group 2 compared with group 1 (70.5% vs. 40.4%, not shown in the Table 4), and coronary artery diameter was significantly higher in group 2 compared with group 1 (3.3±1.1 mm vs. 2.7±0.9 mm) (Table 4).
As a novel disease, COVID-19 has just started to manifest its full clinical course throughout thousands of patients. In most cases, patients can recover gradually without sequelae. However, similar to SARS and MERS, COVID-19 is also associated with high morbidity and mortality in patients with severe cases. Therefore, building a prognosis model for the disease is essential for health-care agencies to prioritize their services, especially in resource-constrained areas. Based on clinical studies reported thus far, the following factors may affect or be associated with the prognosis of COVID-19 patients (Table 3):Age: Age was the most important factor for the prognosis of SARS 99, which is also true for COVID-19. COVID-19 mainly happened at the age of 30-65 with 47.7% of those patients being over 50 in a study of 8,866 cases as described above 37. Patients who required intensive care were more likely to have underlying comorbidities and complications and were significantly older than those who did not (at the median age of 66 versus 51) 34, suggesting age as a prognostic factor for the outcome of COVID-19 patients.Sex: SARS-CoV-2 has infected more men than women (0.31/100,000 versus 0.27/100,000), as described above 37.Comorbidities and complications: Patients with COVID-19 who require intensive care are more likely to suffer from acute cardiac injury and arrhythmia 34. Cardiac events were also the main reason for death in SARS patients 55,65,99. It has been reported that SARS-CoV-2 can also bind to ACE2-positive cholangiocytes, which might lead to liver dysfunctions in COVID-19 patients 100. It is worth noting that age and underlying disease are strongly correlated and might interfere with each other 55.Abnormal laboratory findings: The C-reactive protein (CRP) level in blood reflects the severity of inflammation or tissue injury and has been proposed to be a potential prognostic factor for disease, response to therapy, and ultimate recovery 101. The correlation of CRP level to the severity and prognosis of COVID-19 has also been proposed 101. In addition, elevated lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine kinase (CK) may also help predict the outcome. These enzymes are expressed extensively in multiple organs, especially in the heart and liver, and are released during tissue damage 102,103. Thus, they are traditional markers for heart or liver dysfunctions.Major clinical symptoms: Chest radiography and temporal progression of clinical symptoms should be considered together with the other issues for the prediction of outcomes and complications of COVID-19.Use of steroids: As described above, steroids are immunosuppressant commonly used as an adjunctive therapy for infectious diseases to reduce the severity of inflammatory damage 104. Since a high dosage of corticosteroids was widely used in severe SARS patients, many survivors suffered from avascular osteonecrosis with life-long disability and poor life quality 105. Thus, if needed, steroids should be used at low dosage and for a short time in COVID-19 patients.Mental stress: As described above, during the COVID-19 outbreak many patients have suffered from extraordinary stress as they often endured long periods of quarantine and extreme uncertainty and witnessed the death of close family members and fellow patients. It is imperative to provide psychological counseling and long-term support to help these patients recover from the stress and return to normal life 66.
There were no significant differences in positive rates of PCR between group 2 and group 3 (72.7% vs. 78.0%). Group 2 had a higher positive rate for adenovirus than group 3 (54.5% vs. 30.0%, p=0.027). The control group had a significantly higher positive rate for viral PCR for parainfluenza virus 3 (0% vs. 24.0%, p=0.001). For other various viruses including coronavirus, parainfluenza virus (1 and 2), influenza (A and B), respiratory syncytial virus (A and B), rhinovirus (A, B, and C), metapneumo virus, and bocavirus, there were no significant differences in positive rates of respiratory virus PCR (Table 3).
Streptococcus pyogenes (Group A streptococcus) is a common pathogen responsible for a number of human suppurative infections, including pharyngitis, impetigo, pyoderma, erysipelas, cellulitis, necrotizing fasciitis, toxic streptococcal syndrome, scarlet fever, septicemia, pneumonia and meningitis. It also causes non-suppurative sequelae, including acute rheumatic fever, acute glomerulonephritis and acute arthritis. Scarlet fever, characterized by a sore throat, skin rash and strawberry tongue, is most prevalent in school children aged four to seven years old. This disease was listed as a notifiable disease in Taiwan until 2007; as such, all cases of scarlet fever had to be reported to the public heath department. According to our records, however, only 9% of the medical centers, regional hospitals and district hospitals in central Taiwan reported cases of scarlet fever to the health authorities between 1996 and 1999. The number of scarlet fever cases is therefore likely to be significantly underreported. Scarlet fever outbreaks frequently occur in young children at day-care centers, kindergartens and elementary schools and also occur in adults upon exposure to contaminated food.
Genotyping bacterial isolates with various methods is frequently used to compare the genetic relatedness of bacterial strains and provides useful information for epidemiological studies. In a previous study, we used emm (gene of M protein) sequencing, vir typing and pulsed-field gel electrophoresis (PFGE) typing to analyze a collection of streptococcal isolates from scarlet fever patients and used these data to build a DNA fingerprint and emm sequence database for long-term disease surveillance. Vir typing has since been abandoned in our lab because it has lower discriminatory power than PFGE and the protocol is difficult to standardize with conventional agarose gel electrophoresis. In contrast, the PFGE protocol for S. pyogenes has been standardized in our laboratory, and a second enzyme, SgrAI, has been found to replace SmaI for analysis of strains with DNA resistant to SmaI digestion. Since PFGE is highly discriminative and emm sequencing provides unambiguous sequence information regarding emm type, we adopted these two genotyping methods to characterize streptococcal isolates and build a Streptococcus pyogenes DNA fingerprint and sequence database for the long-term study of scarlet fever and other streptococcal diseases.
The number of scarlet fever cases in central Taiwan fluctuated greatly between 2000 and 2006. Relative to the number of scarlet fever occurrences in 2000, occurrences increased in 2001 and doubled in 2002, but dramatically dropped in 2003. The number of occurrences increased again since 2004. In this study, we characterized 1,218 isolates collected between 2000–2006 by emm sequencing and PFGE. The bacterial genotyping data and the epidemiological data collected via the Notifiable Disease Reporting System (established by Taiwan Centers for Disease Control (Taiwan CDC)) were used to examine the significant fluctuation in the number of scarlet fever cases between 2000 and 2006.
Influenza illness is especially problematic in the elderly, infants, and individuals with chronic diseases, while RSV is mainly hazardous in infants. When assessing the age distribution of HCoV infection, we noted that HCoVs mainly infected infants and young children. More than fifty percent of HCoV-positive cases were in the 0–10 age group (Figure 2) while the remaining groups were around ten percent and below (Figure 2). HCoV-229E prevalence was low at all ages and absent in the 31–40 and 70+ age groups (Figure 2), probably due to its low prevalence compared to HCoV-OC43 and HCoV-NL63 (Figure 1A).
Data on entero-hemorrhagic E.coli infections has been collected since it was designated as a notifiable infectious disease in 2000. One case in 2000, 11 in 2001, and 8 in 2002 were reported, and the incidence has increased since 2003, when surveillance of hemolytic uremic syndrome was implemented and the monitoring was reinforced. Except for 118 cases in 2004, about 50 cases have been reported yearly (Fig. 2)5). Among the 58 cases reported in 2008, 32 cases were men and 26 women, indicating that there was no significant difference between genders, and 24 cases (41.4%) were reported between June and August6).
For the past decade, the total number of reported cases was 486 and patients aged <10 years and 10 to 19 years accounted for 59.9% (291 cases) and 14.2% (69 cases), respectively5).
To get an insight about the seasonality of the viruses, we covered a full year survey on hospitalized patients since July 2015 to June 2016. Similar to the HCoV-positive cases in the community during the winter season, in hospitalized patients HCoV-OC43 (49.7%) and HCoV-NL63 (23.1%) constituted the majority while HCoV-229E (4.6%) was the minority. However, While HCoV-HKU1 was absent in the survey of the population, it infected many hospitalized patients (22.6% among HCoV-positive cases). HCoV-HKU1 was absent from our previous survey probably due to summer seasonality (Figure 4). In addition, HCoV-OC-43 was most prevalent during the winter months while HCoV-HKU1 was detected mainly in spring and summer months.
SARS is believed to be transmitted through respiratory aerosols, which were released while an SARS patient coughs or sneezes. Viral infection will spread from the droplets of cough or sneeze of an infected patient are propelled in surroundings via air and will infect the nearby people who are nearby through several ways like mouth, nose or eyes. The virus also can spread by touching infected surfaces, and then touching the mouth, nose, or eye (Centers for Disease Control and Prevention, 2014).
In South Korea, there are currently several major EIDs, such as HPAI infection, SFTSV infection, MERS-CoV infection, and DENV/ZIKV-associated diseases, that could pose great risks to public health in the near future. Since 2003, outbreaks of HPAI virus have been alarming, because they have caused significant economic loss and public health concerns.32 The HPAI virus can undergo rapid evolution by gene mutation, reassortment, and homologous recombination in avian species and vertebrate reservoir hosts.33 Although there is no evidence thus far to suggest a direct transmission of HPAI virus to humans in Korea, concerns remain due to the potential for avian influenza viruses circulating in poultry to become transmissible between species and to directly infect humans. In addition, due to the recent increase in zoonotic infections in poultry and persistent human infections in China, influenza A (H7N9) virus has remained a public health threat. Moreover, in February 2013, cases of human infection with a novel, lowly pathogenic H7N9 virus were reported in the Anhui and Shanghai regions of eastern China, and as of April 2017, the total number of H7N9 cases has exceeded 1344, with 511 deaths.3435
The emergence of new unknown virus in conjunction with high fatality rate of the disease has led to major public health and international concern. The WHO guidelines apply a relatively sensitive definition of suspected cases and emphasize the importance of a high index of clinical suspicion for diagnosis owing to the high mortality rate. Some countries, especially those in endemic regions, have developed their own preparedness and response plans which are based on WHO and Centers for Disease Control and Prevention (CDC)’s recommendations. The Oman’s Ministry of Health implemented a national plan which was based on strengthening five pillars of action, including: (1) public health surveillance and contact management. Field visits were conducted to every confirmed case by the national public health services and exposed individuals were monitored for 14 days after the last exposure; (2) building laboratory capacity, including diagnostic capacity with primers for MERS-CoV testing, and training laboratory personnel on triple-packing and shipment of samples. Furthermore, training to first responders and intensivists on how to collect nasopharyngeal samples; (3) infection prevention and control, including mask-fit testing for all healthcare workers who could be involved in patient care; (4) case management; and (5) risk communication. The government of the Republic of Korea summoned a Rapid Response Team following the outbreak in their country. The team was composed of infectious disease specialists and infection control professionals, and they established national guidelines for the diagnosis and management of MERS-CoV infection. Together with the epidemiology investigation team of the local government, control strategies were discussed, which included: (1) contact tracing; (2) surveillance of polymerase chain reaction testing of healthcare workers and patients according to their level of contact; (3) preemptive isolation of pneumonia cases; (4) environmental disinfection; and (5) cleaning and enforcing the use of personal protective equipment (PPE) among healthcare providers. The possibility of MERS-CoV occurring in Israel is high given Israel’s geographic location in the Middle East and the thousands of Israeli Moslems who make the pilgrimage to Mecca (the Hajj) each year. Therefore, the Israel Ministry of Health (IMOH) has drafted preparedness guidelines that generally follow the CDC guidelines, although the CDC did not include Israel among the countries at risk. These guidelines recommend laboratory evaluation for all healthcare workers with a severe acute respiratory illness of unknown etiology, and in cases of clusters of severe respiratory symptoms of known etiology. In addition, the approval of the public health services is required before any case may be designated a suspected MERS-CoV infection, thereby ensuring early involvement on a national level in every instance of the disease. Information regarding MERS-CoV was disseminated by the distribution of leaflets and placement of informative posters at Ben-Gurion International Airport and three land-border crossings between Israel and Jordan.
SARS, also known as “atypical pneumonia”, was the first well documented HCoV-caused pandemic in human history and the etiological agent is SARS-CoV, the third HCoV discovered 14,15. The first case of SARS can be traced back to late 2002 in Guangdong Province of China. The SARS epidemic resulted in 8,096 reported cases with 774 deaths, spreading across many countries and continents. Apart from the super-spreaders, it was estimated that each case could give rise to approximately two secondary cases, with an incubation period of 4 to 7 days and the peak of viral load appearing on the 10th day of illness 14,15.
Patients infected with SARS-CoV initially present with myalgia, headache, fever, malaise and chills, followed by dyspnea, cough and respiratory distress as late symptoms 14,15. Lymphopenia, deranged liver function tests, and elevated creatine kinase are common laboratory abnormalities of SARS 14,15. Diffuse alveolar damage, epithelial cell proliferation and an increase of macrophages are also observed in SARS patients 31. Approximately 20-30% of patients subsequently require intensive care and mechanical ventilation. In addition to lower respiratory tract, multiple organs including gastrointestinal tract, liver and kidney can also be infected in these severe cases, usually accompanied with a cytokine storm, which might be lethal particularly in immunocompromised patients. The virus was first isolated from the open lung biopsy of a relative of the index patient who travelled to Hong Kong from Guangzhou 14,15. Since then, tremendous efforts have been dedicated to HCoV research.
Acute upper respiratory infection (URI) is the most common disease among adults, who generally experience an acute URI two to five times a year. According to data from the United States (US), acute URI is associated with a high disease burden, accounting for 40% of work absence among adult workers and 10% of outpatient and emergency department visits. Acute URI refers to acute infection of the nose, sinus, pharynx, middle ear, larynx and epiglottis, airway, and bronchus. The common cold is the most frequent URI. However, these infections are clinically diagnosed based on the predominant symptoms, according to the anatomical location with the most severe infiltration. In other words, URIs are classified into pharyngitis and tonsillitis (characterized by sore throat), laryngitis or epiglottitis (characterized by hoarseness), and rhinosinusitis (characterized by sinus-related symptoms). In some cases, otitis media, tracheitis, and bronchitis are also classified as acute URI.
The common cold may be caused by various pathogenic viruses. Symptoms include mild fever, nasal discharge, nasal congestion, sneezing, sore throat, cough, and muscle ache. Common cold usually resolves naturally, requiring only symptomatic therapy in certain cases; antibiotic use is not warranted. It is well known that use of antibiotics for the common cold is not only ineffective in reducing complications such as bacterial infection but also increases medical costs by inducing side effects and resistance to antibiotics. Avoidance of antibiotic use for the common cold is an important national healthcare issue that must be stressed to prevent antibiotic abuse; it is also used as a quality index for health care institutions.
About 5–15% of tonsillitis in adults is caused by bacteria, such as Streptococcus pyogenes (Group A beta-hemolytic streptococci), and 0.5–2% of patients may develop acute bacterial rhinosinusitis after a viral respiratory infection. About 10% of acute bronchitis may be caused by bacteria such as Bordetella pertussis, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. Therefore, appropriate use of antibiotics is required for some cases of acute URI.
Randomized controlled trials (RCTs) are rare for upper respiratory infectious diseases, and study findings are controversial in many cases, hampering evidence-based care that references a standardized care guideline. Even existing evidence-based guidelines in other countries feature varying stances.
In this context, the Korean Society for Chemotherapy, Korean Society of Infectious Diseases, Korean Society of Otorhinolaryngology-Head and Neck Surgery, Korean Association of Otorhinolaryngologists, Korean Association of Family Medicine, Korean Medical Practitioners Association, and National Evidence-Based Healthcare Collaborating Agency have developed a guideline for antibiotic use in adults with upper respiratory infection. This guideline aims to promote the appropriate use of antibiotics by primary care physicians for the care of upper respiratory infection.
Hepatitis A was included in category I notifiable infectious diseases under the "Law for Control and Prevention of Infectious Diseases" in the version revised on December 30, 20102). Since hepatitis A was officially followed up from 2001, exact data enabling us to examine the previous incidence do not exist. However, according to a published report7), among all patients who had been hospitalized in the department of pediatrics over 10 years from 1968 to 1977, patients with hepatitis A accounted for 2.5% (1.7 to 3.9%) on the average. A similar trend continued until the early 1980s, and sharply decreased thereafter, and increased again in 19968).
According to the sentinel surveillance system started from 2001, hepatitis A incidence showed a sharply increasing trends for several years, with less than 400 cases in 2001 to 2004, about 800 in 2005, 2,000 in 2006 to 2007, 7,900 in 2008, and 15,000 in 2009, and then tended to decrease from 2010 with 7,700 cases5) (Table 2), but the actual incidence is expected to be several folds higher8). Moreover, there was huge difference in incidence between regions, such that the incidence was 75 to 80% in Seoul, Gyeonggido and Incheon areas but the incidence was much lower in Gyeongsangbukdo and Gyeongsangnamdo areas, including Daegu and Busan5).
Regarding the age of cases, most occurrences were reported in patients in their 10s and 20s, and few cases occurred in patients in their 30s in 1990s. However, most occurrences during 2001 to 2007 were reported in patients in their 20s, followed by those in their 30s and 10s, and the order of the ages of occurrence was the 30s, 20s, 40s, and 10s after 20085).
Hepatitis A vaccine has still not been included in the national immunization program, but since its first use in the end of 1997, it is currently expected to be vaccinated in about 70% of infants and toddlers.
The first HCoV-229E strain was isolated from the respiratory tract of patients with upper respiratory tract infection in the year of 1966 27, and was subsequently adapted to grow in WI-38 lung cell lines 28. Patients infected with HCoV-229E presented with common cold symptoms, including headache, sneezing, malaise and sore-throat, with fever and cough seen in 10~20% cases 29. Later in 1967, HCoV-OC43 was isolated from organ culture and subsequent serial passage in brains of suckling mice 28. The clinical features of HCoV-OC43 infection appear to be similar to those caused by HCoV-229E, which are symptomatically indistinguishable from infection with other respiratory tract pathogens such as influenza A viruses and rhinoviruses 28.
Both HCoV-229E and HCoV-OC43 are distributed globally, and they tend to be predominantly transmitted during the season of winter in temperate climate 2. Generally, the incubation time of these two viruses is less than one week, followed by an approximately 2-week illness 28. According to a human volunteer study, healthy individuals infected with HCoV-229E developed mild common cold 30. Only a few immunocompromised patients exhibited severe lower respiratory tract infection.
A guideline developed by the guideline development committee was presented at the Korean Society of Chemotherapy in April 2017, and expert opinions were collected. Based on the discussion, revisions were made to the guideline in a meeting among the members of the development committee. Opinions from other expert groups were additionally collected, based on which the guideline was finalized.
During the period of 2008–2017, a total of 32 types and 1,994,740 cases of notifiable diseases in children aged 0–14 years, including 266 deaths, were reported in Zhejiang Province, with an annual average morbidity rate of 2502.87/100,000 and an annual average mortality rate of 0.33/100,000. There were no cases and deaths involving plague, cholera, infectious atypical pneumonia, human infection with avian influenza, polio, anthrax, diphtheria and filariasis. No Class A infectious diseases were reported. Twenty-two types and 72,041 cases of Class B infectious diseases were reported, including 138 deaths; 10 types and 1,922,699 cases of Class C infectious diseases were reported, including 128 deaths.
Of 4,128 patients who were screened in the FRIDU, 114 patients were admitted to the resuscitation area due to clinical instability during FRIDU screening; three of these patients died in the ED. One of the 3 underwent cardiac arrest in the FRIDU and was moved to the resuscitation zone in the ED while cardiopulmonary resuscitation was performed. Twenty-nine of the 114 patients were discharged or referred elsewhere in the resuscitation area (Fig. 1) and were excluded from the analysis due to limited clinical and laboratory data. The 85 hospitalized patients who deteriorated during FRIDU screening are described in Table 5.
Of the 85 patients, 17 (20%) had contagious diseases and 37 (44%) were male. Most patients had fever (n = 64, 75%) and/or dyspnea (n = 66, 78%). Twenty-seven patients (32%) had septic shock, 33 (38%) had respiratory failure, 10 (12%) had heart failure, and 15 (18%) had an illness with an unknown cause.
The CDC defines a laboratory-confirmed case of MERS-CoV as a patient with a positive PCR from a respiratory sample, and a probable case as a patient who had close contact with a confirmed case but inconclusive laboratory evidence. The incubation period for the presentation of MERS-CoV symptoms is 2–14 days and it remains unknown whether patients are infectious during the incubation period. The average age of presentation is 50 years, with a male predominance.
Clinically, MERS-CoV causes symptoms of upper and lower RTIs. The severity of symptoms varies widely. Most asymptomatic cases have been discovered through screening after contact with a known case. Presenting signs and symptoms may include high-grade fever, non-productive cough, dyspnea, headache, myalgia, nausea, vomiting, and diarrhea that may precede the respiratory symptoms,. Renal failure has been frequently reported, yet no conclusive evidence of a direct viral invasion of renal tissues exists,,. Notably, most patients who developed complications had coexisting medical co-morbidities. Laboratory findings on admission may include leukopenia, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase levels. MERS-CoV can also cause severe pneumonia with acute respiratory distress syndrome (ARDS), requiring mechanical ventilation and intensive care admission. To date, there is still a lack of surgical and pathological information from patients infected with MERS-CoV, which hampers full understanding of the pathogenesis. Lastly, co-infection with other respiratory viruses and with community-acquired bacteria has been also reported in MERS-CoV patients,,.