The upper respiratory tract is compromised in the early period of COVID-19, but SARS-CoV-2 tropism at the cellular level is not fully defined. Unlike recent single-cell RNA-Seq analyses indicating uniformly low mRNA expression of SARS-CoV-2 entry–related host molecules in all nasal epithelial cells, we show that the protein levels are relatively high and that their localizations are restricted to the apical side of multiciliated epithelial cells. In addition, we provide evidence in patients with COVID-19 that SARS-CoV-2 is massively detected and replicated within the multiciliated cells. We observed these findings during the early stage of COVID-19, when infected ciliated cells were rapidly replaced by differentiating precursor cells. Moreover, our analyses revealed that SARS-CoV-2 cellular tropism was restricted to the nasal ciliated versus oral squamous epithelium. These results imply that targeting ciliated cells of the nasal epithelium during the early stage of COVID-19 could be an ideal strategy to prevent SARS-CoV-2 propagation.

This study was designed to investigate the clinical significance of hypoalbuminemia as a marker of severity and mortality in patients with Scrub typhus.

Lee CS, et al. J Korean Med Sci. 2012 Dec;27(12):1472-1478. http://dx.doi.org/10.3346/jkms.2012.27.12.1472

We report a multidrug-resistant strain of Leclercia adecarboxylata responsible for catheter-related bacteremia in a 47-year-old female with breast cancer. The isolated strain was resistant to several β-lactams, aminoglycosides, and folate pathway inhibitors and harbored bla _TEM-1 and bla _CTX-M group 1 and intl1 genes ( dfrA12-orfF-aadA2 ) as genetic determinants for resistance. Based on a review of the L. adecarboxylata literature, there have been only 4 reports of antibiotic-resistant strains. To our knowledge, this is the first report of an L. adecarboxylata strain with simultaneous resistance to β-lactams, aminoglycosides, and sulfonamides.

Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm3; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm3; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9–96.4%) and a specificity of 96.1% (95% CI, 93.8–97.6%) for SFTS. This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.

A 71-year-old man presented to the emergency department with a 2-day history of fever and excruciating pain in his left hand that had developed 12 hours after eating raw seafood. He had a history of type 2 diabetes mellitus and hypertension and was undergoing hemodialysis for end-stage renal disease. At the time of presentation, hemorrhagic bullae measuring 3.5 by 4.5 cm had developed on the palm of his left hand (Panel A), and erythematous swelling with confluent tense bullae and ecchymoses had developed on the dorsum of the hand and forearm (Panel B). Surgical intervention was performed urgently, and Vibrio vulnificus was isolated from the bullae. Postoperatively, the patient received intravenous ceftazidime and ciprofloxacin. V. vulnificus can cause skin infections after wound exposure to contaminated seawater, as well as primary septicemia through the consumption of contaminated raw or undercooked seafood. Patients with immunocompromising conditions, including chronic liver disease and cancer, are at increased risk for infection and complications. Despite treatment, the skin lesions progressed to deep necrotic ulcers, and amputation of the left forearm was performed 25 days after presentation. The patient did well after the surgery and was discharged home.