354. SARS-CoV-2 Viral Viability Culture and Sequencing from Immunocompromised Patients with Persistently Positive SARS-CoV-2 PCR Results

Background Immunocompromised (IC) patients (pts) can have prolonged SARS-CoV-2 PCR positivity, even after resolution of COVID-19 symptoms. This study aimed to determine if viable virus could be detected in samples collected > 21 days after an initial positive (pos) SARS-CoV-2 PCR in IC pts. Methods We obtained 20 remnant SARS-CoV-2 PCR pos nasopharyngeal swabs from IC pts (bone marrow or solid organ transplant, high dose steroids, immunosuppressive medications) with a pos repeat PCR within the previous 30 days. The repeat specimens were cultured on Vero-hACE2-TMPRSS2 cells and incubated for 96 hours to assess viral viability. Viable RNA and infectious virus in the cultured cells were measured by qPCR and infectious plaque assays. RNA sequencing was performed on a HiSeq platform (Illumina). Samples also underwent SARS-CoV-2 antigen (Ag) testing (BD Veritor). Clinical data were extracted from the electronic health record by chart review. Results Pt characteristics are in Table 1. Viral cultures from the repeat specimen were negative (neg) for 18 pts and pos for 2 (Table 2). Pt 1 is a 60M treated with obinatuzumab 19 days prior to his first pos PCR test, with repeat specimen collected 21 days later (cycle threshold (Ct) not available). Pt 1 had a low viral titer (27 PFU/mL) & a D614G mutation on sequencing. Pt 2 is a 75M treated with rituximab 10 days prior to his first pos PCR test, with repeat specimen collected 23 days later (Ct 27.56/27.74). Pt 2 had a high viral titer (2e6 PFU/mL) and D614G, S98F, and S813I mutations. Demographics of Study Population (N=20) Characteristics of patients with a positive SARS-CoV-2 viral culture Conclusion 90% of specimens collected > 21 days after an initial pos SARS-CoV-2 PCR did not have viable virus detected on their repeat specimen. The 2 pts with pos viral cultures had active hematologic malignancies treated with an anti-CD20 mAb at the time of COVID-19 diagnosis. One pt had a high concentration of active, viable virus. No known variants of concern were noted in this cohort, collected in Q2 2020, though prolonged replication is a risk for variant development. Further data are needed about risk factors for persistent viable viral shedding & methods to prevent transmission of viable virus from IC hosts. Disclosures Victoria J. Fraser, MD, CDC Epicenters (Grant/Research Support)Cigna/Express Scripts (Other Financial or Material Support, Spouse is Chief Clinical Officer)Doris Duke Fund to Retain Clinical Scientists (Grant/Research Support, Research Grant or Support)Foundation for Barnes-Jewish Hospital (Grant/Research Support, Research Grant or Support)NIH (Grant/Research Support, Research Grant or Support) Victoria J. Fraser, MD, Centers for Disease Control and Prevention (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support; Cigna/Express Scripts (Individual(s) Involved: Spouse/Partner): Employee; Doris Duke Charitable Foundation (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support; National Institutes of Health (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support; The Foundation for Barnes-Jewish Hospital (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support Michael S. Diamond, MD, PhD, Carnival Corporation (Consultant)Emergent BioSolutions (Grant/Research Support)Fortress Biotech (Consultant)Immunome (Advisor or Review Panel member)Inbios (Consultant)Moderna (Grant/Research Support, Advisor or Review Panel member)Vir Biotechnology (Consultant, Grant/Research Support) Carey-Ann Burnham, PhD, BioFire (Grant/Research Support, Other Financial or Material Support)bioMerieux (Grant/Research Support)Cepheid (Consultant, Grant/Research Support)Luminex (Grant/Research Support)Roche (Other Financial or Material Support) Carey-Ann Burnham, PhD, BioFire (Individual(s) Involved: Self): Grant/Research Support; bioMerieux (Individual(s) Involved: Self): Grant/Research Support, Scientific Research Study Investigator, Speakers’ bureau; Cepheid (Individual(s) Involved: Self): Consultant, Grant/Research Support, Scientific Research Study Investigator; Luminex (Individual(s) Involved: Self): Scientific Research Study Investigator Hilary Babcock, MD, MPH, FIDSA, FSHEA, Nothing to disclose

Multiplatform assessment of saliva for SARS-CoV-2 molecular detection in symptomatic healthcare personnel and patients presenting to the emergency department

Background Saliva has garnered great interest as an alternative specimen type for molecular detection of SARS-CoV-2. Data are limited on the relative performance of different molecular methods using saliva specimens and the relative sensitivity of saliva to NP swabs. Methods To address the gap in knowledge, we enrolled symptomatic healthcare personnel (n = 250) from Barnes-Jewish Hospital/Washington University Medical Center and patients presenting to the Emergency Department with clinical symptoms compatible with COVID-19 (n = 292). We collected paired saliva specimens and NP swabs. The Lyra SARS-CoV-2 assay (Quidel, San Diego, CA) was evaluated on paired saliva and NP samples. Subsequently we compared the Simplexa COVID-19 Direct Kit (Diasorin, Cypress, CA) and a modified SalivaDirect (Yale) assay on a subset of positive and negative saliva specimens. Results The positive percent agreement between saliva and NP samples using the Lyra SARS-CoV-2 assay was 63.2%. Saliva samples had higher SARS-CoV-2 cycle threshold values compared to NP swabs (p < 0.0001). We found a 76.47% (26/34) positive percent agreement for Simplexa COVID-19 Direct Kit on saliva and a 67.6% (23/34) positive percent agreement for SalivaDirect compared to NP swab results. Conclusion These data demonstrate molecular assays have variability in performance for detection of SARS-CoV-2 in saliva.

Seroprevalence of SARS-CoV-2 Antibodies in Children and Adults in St. Louis, Missouri, USA

ABSTRACT Reported coronavirus disease 2019 (COVID-19) case counts likely underestimate the true prevalence because mild or asymptomatic cases often go untested. Here, we use a sero-survey to estimate the seroprevalence of IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the St. Louis, MO, metropolitan area in a symptom-independent manner. Five hundred three adult and 555 pediatric serum/plasma samples were collected from patients presenting to Barnes-Jewish Hospital or St. Louis Children’s Hospital between 14 April 2020 and 12 May 2020. We developed protocols for in-house enzyme-linked immunosorbent assays (ELISAs) using spike and nucleoprotein and used the assays to estimate a seroprevalence rate based on our samples. Overall IgG seropositivity was estimated to be 1.71% (95% credible interval [CI], 0.04% to 3.38%) in pediatric samples and 3.11% (95% CI, 0.92% to 5.32%) in adult samples. Seropositivity was significantly lower in children under 5 years of age than in adults, but rates between adults and children aged 5 or older were similar. Of the 176 samples tested from children under 4 years of age, none were positive. IMPORTANCE This study determined the percentages of both children and adult samples from the greater St. Louis metropolitan area who had antibodies to SARS-CoV-2 in late April to early May 2020. Approximately 1.7 to 3.1% of the tested individuals had antibodies, indicating that they had previously been infected by SARS-CoV-2. These results demonstrate that the extent of infection was about 10 times greater than the number of confirmed cases at that time. Furthermore, it demonstrated that by 5 years of age, children were infected to an extent similar to that of adults.

Lévy Lajos életrajza

Lajos Lévy (Budapest, 1875 - London, April 7, 1961) was not a practising psychoanalyst, nevertheless, he played an important role in the history of Hungarian psychoanalysis. He studied medicine at the universities of Budapest, Vienna and Tübingen. After graduating, he was engaged in Heidelberg for a few years. Returning home, he became a student and friend of Béla Székács at Rókus Hospital, served for a while for the Worker's Insurance Institute then he was appointed to the chief internist of Mária Valéria Military Hospital and Zita Military Hospital. Since 1928 he was employed by the most developed Hungarian health facility of that age, the Jewish Hospital, where he served first as a chief physician, later on however he headed the whole institute. While having recognised the importance of electrocardiography, he was among the first physicians who arranged an electrocardiographic laboratory in Hungary. He was the editor of the progressive medical weekly Gyógyászat, on pages of which he propagated successfully the psychoanalysis and psychosomatics. After his retirement (1945) he suffered from depression. Later on, he emigrated to the UK to his brother and sister. His 6000-volume library was nationalised. He died in London from heart disease. This study is the ever published and most detailed biography of Lajos Lévy.

Development of hospital business in pre-Soviet Mikolaiv

From the very beginning of formation of Mikolaiv as the center of shipbuilding and command of the Black Sea fleet and ports medical aid to builders of the shipyard and the city, workers of admiralty, military men and inhabitants of the city was provided by sea hospital. With the growth of the civilian population, there was a need for a city hospital, which was established in 1838. Gradually expanding to 35, 80, 150 beds, the hospital still did not meet the needs of the city. In 1890, the city authorities built their own premises, further expansion and arrangement of which, formed a powerful hospital with experienced staff. A worthy addition to it was the Jewish hospital, which since 1866 operated in the city in the pre-Soviet period.

A case of ruptured uterus during pregnancy

(Reported in the Society of Odessa Doctors on January 14, 1895).On the evening of September 6, 1894, a pregnant woman was admitted to the gynecological department of Dr. Yuzefovich at the Odessa Jewish Hospital, which I temporarily supervised, with symptoms of septic peritonit on the 5th day after the onset of the disease. In the hospital, after the diagnosis of rupture of the pregnant uterus was made, laporatomia and amputation of the ruptured uterus were performed. The patient died on the 8th day after the operation. The gap in this case, as we will see further from the given history of the disease, occurred without any mechanical stroke, such as: fall, shock, etc. In view of the fact that the ruptures of the pregnant uterus occur extremely rarely and ethiology without ruptures occurring from outside dark, I think it is not uninteresting to report the incident I have observed. This case is also of interest in the therapeutic relationship, the patient received proper help only on the 8th day from the onset of the disease. It can be said with more or less certainty that if this gap had been identified during the onset of the developing disease, then, with proper assistance, it would have been possible to prevent the onset of a lethal outcome.

Vaginal cancer arising from cancer of the body of the uterus by autoinoculation

On April 1, 1892, a 27-year-old patient F. S. was admitted to the gynecological department of the Jewish hospital in Warsaw, severely anemic and emaciated, with complaints of bleeding from the genitals. The last, 6th birth was 4 months ago, which ended well with a living full-term baby.