Severe COVID-19 tied to prolonged cough, sputum production in long COVID

News brief


Woman coughing
RollingCamera / iStock

study of long-COVID patients in Japan links severe infection to persistent cough and sputum production.

A team led by researchers from Keio University in Tokyo enrolled hospitalized adults diagnosed as having COVID-19 from January 2020 to February 2021 in a 26-center study. They collected clinical hospital data and patient-reported outcomes from questionnaires and smartphone apps for 12 months after release.

The research was published yesterday in Respiratory Research.

Results highlight need for prevention

At 3, 6, and 12 months, rates of wet and dry cough were similar, but the proportion of patients producing sputum without coughing rose over time compared with those with both sputum production and coughing.

At all follow-up visits, analyses of cough and sputum production identified the risk factors for persistent symptoms as the use of intermittent mandatory ventilation (IMV), smoking, and older age.

These findings emphasize that a preventive approach ... [is] highly recommended for patients with risk factors for severe infection to avoid persistent respiratory symptoms.

At 12 months, severe COVID-19 was associated with cough and sputum production based on imaging findings, kidney and liver abnormalities, pulmonary blood clots, and higher levels of lactate dehydrogenase (indicating organ or tissue damage), Krebs von den Lungen-6 (indicating lung inflammation or damage), and hemoglobin A1c (indicating elevated blood glucose).

The study authors wrote, "These findings emphasize that a preventive approach including appropriate vaccination and contact precaution and further development of therapeutic drugs for COVID-19 are [sic] highly recommended for patients with risk factors for severe infection to avoid persistent respiratory symptoms."

CWD confirmed in Yellowstone National Park for first time

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Yellowstone National Park and the Wyoming Game and Fish Department (WGFD) announced yesterday that chronic wasting disease (CWD) has been confirmed for the first time in the park, which involves an adult mule deer found dead.

mule deer buck
Mark Gunn/Flickr cc

In a National Park Service statement, officials said WGFD had in March captured the deer near Cody, roughly 50 miles to the east, and fitted it with a GPS collar as part of a population dynamics study. The collar indicated that the deer died in the middle of October. It was found on the Promontory, a land mass that separates the south and southeast arms of Yellowstone Lake.

Increased monitoring and other steps

Samples were positive for CWD on multiple tests that were conducted by the WFGD's Wildlife Health Laboratory. As a result, park officials are stepping up collaboration with the WGFD and other agencies to identify Yellowstone areas at increased risk for CWD, increasing monitoring of the park's deer and other cervids, and increasing the investigation of carcass identification and sampling.

The park also said that, based on the detection, it is revising its 2021 CWD surveillance plan, which it expects to complete in 2024.

CWD was first detected in mule deer in southeastern Wyoming in 1985 and was first found in elk in the state the following year, according to the WGFD. Over the past two decades the disease has spread westward, affecting most of the state, especially mule deer.

deer location map
The deer was found on a land mass between two arms of Yellowstone Lake. Credit: Google Maps

CWD is a prion disease similar to bovine spongiform encephalopathy ("mad cow" disease). The prion causes fatal neurologic disease in cervids. So far, no infections in humans have been found, but health officials urge people to avoid eating meat from infected animals and to take precautions when field-dressing or butchering animals.

Major poultry producers agree to antimicrobial stewardship principles

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Young broiler chickens
USDA / Bob Nichols

A multinational collection that includes some of the biggest names in poultry production has signed on to an effort to reduce the need for the use of antimicrobials on farms.

The 11 organizations—including Cargill Inc., Tyson Foods, McDonalds, the British Poultry Council, Chicken Farmers of Canada, and the Animal Husbandry Association of Vietnam—announced yesterday that they'll adopt antimicrobial stewardship principles developed by the Transformational Strategies for Farm Output Risk Mitigation (TRANSFORM) project. They join 8 other organizations that have already endorsed the principles. Collectively, the 19 organizations represent over 30% of global poultry production.

By advancing science-based antimicrobial use stewardship principles, we are able to create an ecosystem where animal health improves, the need for antibiotic use decreases, and animal production increases.

By committing to these principles, the organizations are agreeing to take a risk-based approach around each instance of antimicrobial use and to adopt farm management practices that improve animal health and reduce the need for antimicrobials. The TRANSFORM principles also call for poultry producers to use antimicrobials only in compliance with national authorizations, and to use medically important antibiotics only under a supervising veterinarian's diagnosis and oversight.

Reducing the risk of zoonotic diseases, AMR

TRANSFORM is a collaboration between Cargill, the International Poultry Council, and Heifer International and is part of the US Agency for International Development's Global Health Security Program. The project is working in Kenya, India, and Vietnam to increase the capacity of small- and large-scale farmers, governments, and agribusinesses to prevent emerging zoonotic diseases and mitigate antimicrobial resistance (AMR).

"By advancing science-based antimicrobial use stewardship principles, we are able to create an ecosystem where animal health improves, the need for antibiotic use decreases, and animal production increases," Annie Kneedler, Chief of Party for TRANSFORM, said in a press release. "These collective efforts contribute to the Global Health Security Agenda goals of reducing the risk of antimicrobial resistance and zoonotic diseases, lessening their impacts on the health of humans around the world."

UK surveillance report shows rise in bloodstream infections, antibiotic use

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A new surveillance report from the United Kingdom's Health Security Agency (HSA) shows substantial increases in rates of priority pathogens and antimicrobial use with the lifting of COVID-19 pandemic mitigations.

Data from the English Surveillance Programme for Antimicrobial Use and Resistance (ESPAUR) show a 11.7% increase in patient episodes of bloodstream infections (BSIs) and/or fungemia from 2018 to 2022. The most common causes of monomicrobial BSIs were Escherichia coli (20.9%) and Staphylococcus aureus (7.7%). The incidence of Candidemia increased by 22.7%

The estimated overall burden of antimicrobial resistance (AMR)—measured by the number of BSIs resistant to at least one antibiotic—decreased by 1.6%, and 4.6% for BSIs caused by priority pathogens. But the AMR burden in BSIs varied by region, with London (the highest) having twice the rate of resistant BSIs as southwest England (the lowest). In addition, there was a significant increase in the percentage of E coli and Klebsiella pneumoniae BSIs that were resistant to piperacillin/tazobactam—a critical drug for patients with severe drug-resistant infections.

While White ethnic groups had the highest percentage of BSIs, the proportion that were resistant was nearly double in Asian ethnic groups compared with White ethnic groups (34.6% vs 18.7%)

First increase in antibiotic use since 2014

Meanwhile, total antibiotic consumption in the United Kingdom saw its first increase since 2014, climbing by 8.4% from 2021 to 2022, to a rate of 17.4 defined daily doses per 1,000 population per day. The increase was observed in all healthcare settings except for dental care, with general practice continuing to be by far the biggest contributor for antibiotic prescribing (80.2%). Notably, general practice penicillin prescribing rose by 18.5%, driven in part by an outbreak of invasive group A streptococcal infections and scarlet fever.

Antibiotic use in secondary care increased by 6.3% in 2022 but remained below 2018 levels, a trend driven by reductions in outpatient prescribing.

The authors of the report say the increase in antibiotic use in the community is most likely related to increased healthcare demands in 2022 following the removal of many pandemic-related mitigations.

CDC updates advice for preventing, treating anthrax

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Arthur Friedlander / NIAID

The US Centers for Disease Control and Prevention (CDC) has updated its recommendations for the postexposure prevention and treatment of Bacillus anthracis infection (anthrax).

The CDC based the updates on systematic reviews of studies involving in vitro antimicrobial drug activity against B anthracis, in vivo antimicrobial drug efficacy for postexposure prevention and treatment, in vivo and human antitoxin efficacy for prevention or treatment, and survival after antimicrobial drug prevention and treatment of localized anthrax, systemic anthrax, and anthrax meningitis.

Expanded list of alternative drugs

The updates to the 2014 guidelines on naturally occurring anthrax, published today in Morbidity and Mortality Weekly Report, include an expanded list of alternative antimicrobial drugs to use if first-line drugs are contraindicated, not tolerated, depleted, or ineffective after a bioterroristic release of aerosolized B anthracis or a multidrug-resistant genetically engineered strain of the bacterium.

The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.

The CDC also issued new recommendations on the diagnosis and treatment of anthrax meningitis and its comorbid, social, and clinical predictors.

No changes were made to previously published CDC recommendations describing critical care measures and clinical assessment tools or procedures for anthrax or to Advisory Committee on Immunization Practices recommendations for the use of anthrax vaccine.

"The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis," the study authors wrote.

Quick takes: Climate change impact, dengue in Bangladesh, hypervirulent recombinant coronavirus in cats

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  • The Lancet yesterday released its annual report on the health effects of climate change, which said impacts are surging worldwide, with vulnerable groups—seniors and infants—experiencing twice as many heatwave days than between 1986 and 2005. Destructive weather events in 2021 threatened water safety and food production and put 127 million people at risk for moderate to severe food insecurity. The experts also said the changing climate is accelerating the spread of infectious diseases caused by microbes such as Vibrio bacteria that have expanded their reach as waters warm on the world's coastlines, putting 1.4 billion people at risk. In a statement today, the World Health Organization (WHO) said it strongly supports the Lancet Countdown Report call to action, which comes ahead of the United Nations Climate Change Conference in the United Arab Emirates that begins November 30.
  • Bangladesh is still in the grips of a record dengue outbreak, with deaths topping 1,500, according to government figures and media reports. Just today, the country reported 24 new deaths, putting the total at 1,520. Officials also reported 1,623 more hospitalizations across the country. So far, nearly 290,000 people have been infected by the mosquito-borne virus. Bangladesh's outbreak, which began in June, has been fueled by an earlier-than-usual start to the season, with unusually high temperatures, rainfall, and humidity that have resulted in increased mosquito populations, the WHO said in an August statement.
  • In a recent preprint study, scientists from Cyprus and their international collaborators reported a novel highly pathogenic recombinant canine-feline alphacoronavirus that has triggered a rapidly spreading outbreak of feline infectious peritonitis in Cyprus. The recombinant virus is 97% similar to pantropic canine coronavirus CB/05, and examination of isolates from cats suggests a role of direct transmission in the spread of the virus among cats of all ages. The researchers proposed naming the virus FCoV-23. They said Cyprus has a large population of stray cats that are often relocated to other parts of Europe, and they note that the new virus has already been identified in a cat imported to the United Kingdom. The group said similar recombinations have happened before in Europe, thought the cause of the hypervirulent strain is unclear. "One possible explanation is the 'right mutation, right time, right place' theory," they wrote.

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