Infectious SARS-COV Flashcards
4 genera of COV
alpha - bats and rodents
beta - bats and rodents sars cov2
delta - birds
gamma -birds
SARS-COV came from
Himalayan palm civet
MERS COV came from
Dromedary camel
SARS COV2
Disease
Transmitted from horse-shoe bat > civet cat > human
COVID19
SARSCOV2 transmission
Human to human transmission through respiratory droplet
Virus in urine/saliva
Fecal sample anal swab
Fomites
Which specimen will hield highest RT PCR positivity among COVID19?
Bronchoalveolar lavage
Not nasal, nasopharyngeal nor oropharyngeal
RT PCR +
Broncheoalveolar lavage 93%
Sputum 72%
Nasal swab 93%
SarsCOV2 proteins used by RT PCR
Envelope Nucleocaspid Spike protein - corona RdRp - RNA dependent RNA polymerase ORF1 gene
Cyto threshold required to produce immunofluorescence in RT PCR
40 cut off
The lower the ct, the higher the viral RNA load
A ct value less than 40 is
RT PCR +
Clinical signs and symptoms of COVID19
Fever DRY Cough SOB Muscle ache Confusion Headache Sore throat Rhinorrhea
Unique symptom which is a predictor of covid positivity
Anosmia
Mild classification of COVID
No signs of pneumonia
Moderate classification
Signs of non-severe pneumonia (fever, dyspnea, cough)
RR <30/minute, SpO2 >92% on RA
Mild classif mx
Home isolation for 14d
If elderly, admit if with unstable/uncontrolled comorb conditions
Give sx tx and supportive care
Empiric antibiotic not needed
Moderate mx
Admit to COVID19
Chest xray
RT PCR
Severe classification
Severe pneumonia
Fever, cough, dyspnea
RR >30
Severe respi distresscor SPO2 less than 92
Critical phase
In sepsis or shock
Started severe within 1 week now worsening with progressive infiltrate in xray or CT
Respi failure not explained by cardiac failure of fluid overload
Dose of dexamethasone given as adjunct for covid 19 patients requiring O2 on mechanical ventilation
6 mg IV x 10 days
Tocilizumab adverse effect
Dyslipidemia for 3 years
Baseline total cholesterol, TAG, LDL are elevated predisposing to pancreatitis
Others Hepatotoxicity GI distress Myelosupression - agranulocytopenia Pancreatitis Reactive TB and Hep Anaphylaxis
Combination of Hydroxychloroquine with Azithromycin (Macrolide) induces
Prolonged QT interval
Fata arrhythmia
Recombinant humanized anti-human IL-6 receptor monoclonal antibody
Binds sIL-6R and mIL-6R and inhibits signal transduction
Currently used mainly for rheumatoid arthritis
Tocilizumab
Recommended for compassionate use and clinical trial
