Prolonged SARS-CoV-2 shedding tied to in-hospital delirium, death by 6 months

Persistent SARS-CoV-2 shedding in hospitalized COVID-19 patients is tied to a higher risk of in-hospital delirium and death by 6 months, according to a study published this week in GeroScience.

A team led by Northwestern University researchers retrospectively evaluated viral shedding in 2,518 COVID-19 patients hospitalized in Illinois from Mar 5 to Aug 9, 2020. A total of 959 patients were tested for SARS-CoV-2 using polymerase chain reaction (PCR) at least once 14 or more days after their initial positive test, 405 (42.2%) of whom were still shedding virus. Average age of patients who underwent repeat testing was 59.4 years.

Prolonged viral shedding was linked to male sex, higher body mass index, diabetes, chronic kidney disease, and corticosteroid treatment during initial COVID-19 hospitalization. After adjustment for factors such as severity of respiratory dysfunction, shedding remained linked to in-hospital delirium (odds ratio [OR], 2.45) and death by 6 months (OR, 2.43). Of persistent shedders, 56% experienced delirium.

Relative to nonshedding patients, shedders were more often men (53.8% vs 47.1%) and had more repeat tests (median, 4 vs 3), but nonshedders were tested for a longer time (median, 131.5 vs 64.0 days after the initial positive result).

The last positive PCR test in persistent shedders was obtained at a median of 34.6 days after initial testing, but 49 (12.1%) still tested positive 90 or more days later. A total of 111 (27.4%) had a positive repeat test after a negative repeat test at a median of 53.4 days after their initial test. One patient was still shedding SARS-CoV-2 at 269 days.

"Many studies, even pre-dating the COVID-19 pandemic, suggest that patients who are delirious during hospitalization are more likely to have long-term cognitive issues and may experience accelerated cognitive decline with aging," senior author Eric Liotta, MD, said in a Northwestern Medicine press release. "As such, patients with persistent viral shedding may warrant closer surveillance and monitoring for development of complications following COVID-19."
May 11 GeroScience study
May 11 Northwestern Medicine
press release


Omicron COVID-19 variant tied to croup in children

Boston Children's researchers have found evidence that the COVID-19 Omicron variant is more likely to cause croup in children that previous SARS-CoV-2 iterations, according to a study today in Pediatrics.

The investigators noted that, from Mar 1, 2020, to Jan 15, 2022, 75 children were diagnosed as having COVID-19–associated croup at Boston Children's Hospital. Of those, 61 (81%) were diagnosed during the Omicron period. One child tested positive for rhinovirus in addition to SARS-CoV-2.

Children with croup have a swollen larynx and trachea, often accompanied by a barking-type cough and difficulty breathing.

Nine of the 75 children (12%) were hospitalized (7 during Omicron; 2 pre-Omicron), and they spent a median of 1.7 days in the hospital. Four of them required intensive care. The rest were treated in the emergency department.

All but two patients were treated with dexamethasone. Hospitalized patients received a median of six dexamethasone and eight racemic epinephrine doses.

The study authors wrote that the data present "compelling evidence" that Omicron causes croup. The variant's tendency to affect the upper airway may help explain the connection, they added. They concluded, "Further research is needed to characterize the underlying mechanisms of COVID-19-associated croup, differences in clinical features from other viral etiologies, and appropriate management strategies."
May 13 Pediatrics study

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