“Pneumonia Causes, Symptoms, and Treatment - HealthCentral.com” plus 3 more

“Pneumonia Causes, Symptoms, and Treatment - HealthCentral.com” plus 3 more

Pneumonia Causes, Symptoms, and Treatment - HealthCentral.com

Posted: 21 Apr 2021 01:57 PM PDT

We've got the doctor-approved scoop on causes, symptoms, treatments, and a ton of other facts and tips that can make navigating this common lung illness easier.

Maybe you had what you thought was a cold, and it's not getting better. Or maybe you were doing fine and suddenly got walloped with a high fever, chills, cough, and stabbing pain when you breathe in. What's going on? You might have pneumonia, a common lung infection that can strike anyone, though young children and older adults are at highest risk. The symptoms can range from mild to life-threatening, but the very good news is that pneumonia is highly treatable, and most people get better within a few weeks. Here's what you need to know about this condition.

Pneumonia

Frequently Asked Questions

How dangerous is pneumonia?

It can be quite dangerous. In an average pre-COVID year, pneumonia affected millions of people in the U.S., sent about 1.3 million to the emergency room, and killed more than 50,000, according to the National Center for Health Statistics. But COVID has driven those numbers much higher, at least for the time being. Pneumonia is even deadlier in less-developed countries. Globally, it's the leading cause of death in children under age 5, killing some 800,000 children in 2017 alone (the last year for which full stats are available), according to the World Health Organization. The bulk of those deaths were in South Asia and sub-Saharan Africa.

How long does pneumonia last?

It depends on what type you have and how quickly it's diagnosed and treated. Most cases of viral pneumonia are relatively mild and clear up within a week or two. In fact, if the infection develops slowly, you may not even be aware that you have it. Bacterial pneumonia is often more serious, especially if it's left untreated, which can lead to scarring of lung tissue or allow the infection to spread to other vital organs. Once you're treated, recovery from bacterial pneumonia may take anywhere from 10 days to several weeks.

Who should get the pneumonia (pneumococcal) vaccine?

The CDC recommends the pneumococcal vaccine for all adults ages 65 and over and all kids under 2, as well as children and younger adults with certain medical conditions. There are two types of pneumococcal vaccine: Prevnar 13 (or PCV13) and Pneumovax 23 (PPSV23). Talk with your doctor about which you should have (or if you should get both). The vaccine protects you against the most common type of bacterial pneumonia—not viral pneumonia or other types of pneumonia, like fungal pneumonia.

What's hospital-acquired pneumonia?

It's a dangerous form of pneumonia that can strike people who've been in the hospital for some other condition. It happens most often in individuals who are in the intensive care unit (ICU). Though it's less common than community-acquired pneumonia (pneumonia that develops in non-health-care settings), hospital-acquired pneumonia is the deadliest of any hospital-acquired infection, with mortality rates of up to 33%.

What Is Pneumonia?

Pneumonia is actually an umbrella term for a range of infections that attack your lungs' air sacs (alveoli) and surrounding tissue. It can cause breathing trouble and flu-like symptoms, and can be a serious health risk for some people if left untreated.

To understand how pneumonia works, it helps to know a bit of lung anatomy: Each of your lungs has a main tube, called a primary bronchus (plural bronchi; also called airways), that carries air into it from your trachea, or windpipe. Each of the bronchi branches off into progressively smaller bronchi, which in turn branch off into thousands of even smaller airways called bronchioles, ending in millions of tiny air sacs called alveoli. The alveoli are covered with tiny blood vessels (capillaries) that carry oxygen to the cells of your body and return carbon dioxide to your lungs to be exhaled.

When you have pneumonia, the alveoli become inflamed and fill up with fluid or pus. This leads to impaired breathing, fever, and other symptoms, like cough (though not everyone with pneumonia gets a cough—it's tricky that way). The infection may affect a single section, or lobe, of your lung, in which case it's called lobar pneumonia; or it may happen in several lobes, called multilobar pneumonia. If the inflammation also involves your bronchi, it's called bronchopneumonia. Pneumonia might affect one lung (unilateral pneumonia), or it might strike both lungs (bilateral pneumonia).

Types of Pneumonia

There are two main types of pneumonia: viral (caused by a virus) and bacterial (caused by, you guessed it, bacteria). It's possible to have both types at the same time or one right after the other. For example, you could have pneumonia due to the flu, which is caused by a virus (influenza), and then develop bacterial pneumonia. Some experts call this "co-infection." A third and much rarer kind of pneumonia, called fungal pneumonia, is caused by breathing in spores from certain fungi (mold).

Anyone can develop pneumonia, but in order to get it two things have to happen: One, you need to be exposed to a microorganism, a.k.a. germ (typically a virus or bacteria; much more on this below); and two, that germ has to be able to get past your body's usual defenses and into your lower respiratory tract—that is, your lungs. For this reason, pneumonia is more common in certain people than others, namely adults over 65 (whose immune systems are weakened by age), infants and young children (whose immune systems are not yet fully developed), and people with weakened immunity due to a medical condition or medication.

Before the coronavirus (COVID-19) pandemic, several million people in the U.S. got pneumonia in an average year, with about 1.3 million sick enough to go the emergency room and more than 50,000 dying from it, according to the CDC. It was the eighth leading cause of death among U.S. adults in 2017. But COVID-19 has exploded those numbers: Between January 2020 and April 2021, the government estimates that more than 260,000 people in the U.S. died from pneumonia related to COVID-19 alone.

What Are the Symptoms of Pneumonia?

Symptoms of pneumonia can range from super mild to severe, depending on lots of factors—your age, your overall health, whether your pneumonia is bacterial or viral, how long you have it before you get treated, and whether you're a smoker, for example. It's possible to have such a mild infection that you don't even know you have it. (This is sometimes referred to as "walking pneumonia.")

Interestingly, older adults and people with weakened immune systems often have fewer and milder symptoms of pneumonia than younger adults, even though the illness is more dangerous for them. Older adults often have no fever, for example, and they may not have noticeable respiratory symptoms. Instead, a sudden change in mental status, like confusion or loss of awareness, can be a warning sign of pneumonia in this age group. It's not entirely clear why different age groups manifest pneumonia differently.

Not only do pneumonia symptoms vary widely in severity, but they can also overlap those of other respiratory illnesses, like colds, the flu, and now, COVID (all of which can also lead to pneumonia!). Consider all of that and it's no wonder that pneumonia is one of the hardest infections to diagnose. That being said, here are the main symptoms you should look out for. Where a symptom applies mainly to one type of pneumonia or manifests differently between types, we've noted that.

  • Chest pain that's sharp or stabbing. It might get worse when you breathe in or cough.

  • Chills, possibly bad enough that they make you shake

  • Cough. In viral pneumonia, the cough might be dry, especially early in the infection. With bacterial pneumonia the cough is often what experts call "productive," meaning you cough up phlegm. It may be green or yellowish-tan in color or even bloody. As viral pneumonia worsens, it can progress to a productive cough. Even after you recover, the cough from pneumonia can linger for weeks or longer.

  • Fever (over 100°F and sometimes as high as 105°F; high fever that comes on suddenly is more common in bacterial than viral pneumonia. As a general rule, you should call your doc if you have over 102°F or, if you're immunocompromised, 100.4°F).

  • Mental confusion (more common in people over 65)

  • Muscle pain or headache (more common in viral pneumonia)

  • Nausea and vomiting (more common in young children)

  • Rapid pulse—think a substantial increase over your usual resting heart rate—and/or rapid breathing (more common in children and younger adults)

  • Shortness of breath

  • Sore throat (more common in viral pneumonia)

  • Weakness and fatigue

Also worth noting: Viral pneumonia tends to come on slowly at first, with symptoms developing over several days. Bacterial pneumonia, in contrast, usually comes on fast and strong.

When Pneumonia Is an Emergency

In severe cases, pneumonia can cause you to have extreme difficulty breathing or develop a blue tinge to your fingernails, lips, or other skin areas. This is an indication that the level of oxygen in your blood is dangerously low. If you (or your child, or someone you are with) experience these symptoms, don't wait to talk to your doctor: Call 911 immediately. In addition, young children whose symptoms are preventing them from drinking enough fluids (evidenced by a dry mouth or not wetting their diapers regularly) should be taken to the ER because they may need intravenous fluids.

Is It Pneumonia or COVID?

Here's something you may be wondering at this point: How do you know if you have pneumonia or COVID? Or both? Or neither, and you actually have, say, the flu? The answer is, it's really hard to tell—which is why if you're having the symptoms discussed in this section, it's important to see your doctor so you can get the right diagnosis.

As long as COVID is active, that almost definitely will entail having a COVID test, since the virus can cause symptoms that overlap those of pneumonia, like fever and coughing, as well as actually lead to pneumonia (in which case it's called SARS-CoV-2 pneumonia or COVID-19 pneumonia; SARS-CoV-2 is the name of the new coronavirus that causes COVID).

Plus, having COVID makes your lungs vulnerable to infection by any number of bacteria that normally wouldn't affect you. (This is true of all viruses, which is why bacterial pneumonia often follows a bout of the flu or a bad cold.) In other words, having COVID is a big risk factor for pneumonia…and since we know that COVID is highly contagious and can affect many organ systems other than the lungs, it's important to know if you're infected with it (whether or not you currently have pneumonia) so you can be monitored and isolate if needed. Similarly, if you experience pneumonia symptoms during a month when the flu (influenza) virus is circulating, your doctor will probably recommend a flu test.

Get the Full Story on COVID

What Causes Pneumonia?

Like other infections, pneumonia is caused by microorganisms, or teeny tiny germs. Three types of microorganisms can cause pneumonia: viruses, bacteria, and fungi. The most common by far are viruses and bacteria. Some examples of bacteria that cause pneumonia are Streptococcus pneumonia, Mycoplasma pneumoniae, and Staphylococcus aureus (a.k.a. "staph"). Viruses that cause pneumonia include influenza (yep, the same virus that causes flu), respiratory syncytial virus (RSV; this mainly affects babies and young kids), and coronaviruses, including the SARS-CoV-2 (COVID) virus. You can breathe in these germs from the air—say, if a person with pneumonia coughs near you—or by touching a surface or object that an infected person touched or coughed on. Or you could have an existing upper respiratory infection, like the flu or a cold (both caused by viruses), and the germs spread into your lungs, causing pneumonia.

In other cases, bacteria that normally live in your nose and throat without causing trouble can take advantage of a weakened immune system (from a recent illness, a chronic illness, or an immune-suppressing medication, say) to migrate downward into your lungs. Experts call this an "opportunistic infection."

Sometimes, a person with pneumonia has both a viral and a bacterial infection at the same time. For example, in a large study a few years ago by the Centers for Disease Control and Prevention (CDC), called the Epidemiology of Pneumonia in Communities (EPIC) study, 7% of children hospitalized with pneumonia had both a virus and a bacterium detected in samples of their sputum (phlegm) or blood, and the actual rate of such "co-infection" may have been higher, since some of the samples didn't return conclusive results.

Much less commonly, pneumonia can be caused by a fungus (a.k.a. mold). This kind of pneumonia mainly strikes people who are immunocompromised or who live in regions of the U.S. where certain fungi grow in the soil. A fungus called Pneumocystis jiroveci, for example, sometimes infects the lungs of people with untreated HIV. In the Southwestern U.S., a fungus called Coccidioides can cause a kind of pneumonia known as "valley fever." (About 20,000 people in the U.S. get valley fever annually, according to the CDC.) Unlike bacterial and viral pneumonia, fungal pneumonia can't be spread from person to person. You get it by inhaling fungal spores that become airborne (from the wind, for example).

You can also develop pneumonia if you accidentally aspirate (inhale) food particles, saliva, or refluxed stomach acid into your airways (bronchi) and they spread into your lungs. The particles may have bacteria, viruses, or other microorganisms in them that then infect the lungs. This is called aspiration pneumonia.

With any type of pneumonia, the important question is: How likely are you to get it? And that depends in part on whether you have one or more of certain risk factors. Let's get to that now.

Pneumonia Risk Factors

A number of health-related factors can increase your chances of getting pneumonia. Some of them you can control; others you can't. They include:

Age

Being older than 65 or younger than two raises the likelihood of getting pneumonia. That's because these age groups have weaker immune systems, making them more vulnerable to infection.

Chronic Medical Conditions

In particular, having a chronic lung condition such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis increases your susceptibility to other lung problems, including pneumonia. You're also at heightened risk if you have sickle-cell anemia, heart disease, poorly controlled type 2 diabetes, chronic kidney disease, and some types of cancer.

Difficulty Swallowing or Coughing

Trouble swallowing (dysphagia) or a reduced ability to cough increase the risk that you'll accidentally inhale food or liquid particles into the airway from the throat, which can cause aspiration pneumonia. These problems can stem from a stroke, Parkinson's disease, a brain injury, or other neurological conditions. You can also experience dysphagia as a side effect of certain medications, including anticholinergics, antipsychotics, benzodiazepines, diuretics, and levodopa.

Heavy Alcohol Use

Drinking alcohol heavily over time weakens your immune system, making it harder for your body to fight off infections.

Hospitalization

The risk is highest if you're in the intensive care unit (ICU), especially if you are on a mechanical ventilator or sedated. Both make it difficult to cough, which increases the chance of getting pneumonia (see section above). And ventilators trap a variety of nasty germs that can infect the lungs.

Living in a Long-Term Care Facility

Germs spread quickly between residents in nursing homes and other long-term care facilities, including drug-resistant bugs like methicillin-resistant Staphylococcus aureus (MRSA), which can cause especially severe and hard-to-treat pneumonia. A recent research review from the University of Michigan notes that residents of long-term care facilities are also more likely to aspirate foods or fluids than elderly people living at home (because of feeding tubes, swallowing difficulties, medications, or other reasons), which can cause aspiration pneumonia.

Recent Major Surgery or Injury

Recovering from a big surgical procedure or traumatic injury often involves lying on your back for an extended period, which can allow fluid or mucus to pool in your lungs, giving bacteria a place to grow. A recent surgery or injury can also make it difficult to cough (see above).

A Recent Viral Respiratory Illness

A recent bout of the flu, common cold, or COVID-19 makes you vulnerable to pneumonia in a few ways. One, the microorganism that caused the original infection (such as the influenza virus, SARS-CoV-2, or a virus that causes colds) may spread to your lungs. Two, having any virus increases your chance of developing a "secondary" bacterial infection. This happens both because your immune system is already embattled from fighting the virus, making it less able to defend against bacteria, and because viruses can cause acute damage to the airways (bronchi) that leaves them open to a bacterial attack.

Smoking

Smoking causes damage to your lungs that makes them susceptible to infiltration by bacteria and viruses. In one very large meta-analysis, published in the journal PLoS One, smoking more than doubled the risk of getting pneumonia, compared to not smoking. Research also shows that smokers are more likely than non-smokers to die from pneumonia.

Weakened Immunity

People in this group include those living with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medication—for example, to treat an autoimmune condition (RA, MS, and IBD communities, we're talking to you) or because of an organ transplant. If you have compromised immunity, you have a higher risk of infections in general, including pneumonia.

How Is Pneumonia Diagnosed?

You should seek a doctor's opinion if you are having noticeable symptoms that you think might be pneumonia. Even if it starts off mild, pneumonia can quickly become dangerous in older adults, young children, and people who have an underlying medical condition or are immunocompromised—so if you're in one of those groups in particular, waiting too long can be risky. Another reason to see the doctor promptly: If untreated, bacterial pneumonia can lead to scarring of the lung tissue or spread to other vital organs.

Here's what to expect when you see the doctor.

Medical History and Exam

You'll be asked to describe your symptoms, including when they started and how quickly they came on. The doctor will also do a physical exam, including listening to your lungs with a stethoscope while you breathe in and out. The lungs of people with pneumonia sometimes make a crackling or bubbling sound (only detectable with a stethoscope), an indicator that there's fluid present. You'll probably also have your pulse checked to see if it's unusually fast.

Chest X-Ray

If the doctor suspects pneumonia based on your history and exam, he or she will likely order a chest X-ray next to look for evidence of the infection. Infected lungs may have cloudy sections on the X-ray where the alveoli are filled up with fluid rather than air, or there might be other physical signs of inflammation. The X-ray can also help the doctor see if your pneumonia is in one lung or both, and how much of each lung it's affecting. Sometimes, a chest X-ray isn't conclusive. If the doctor wants to see more than what the X-ray shows, you might get another imaging test like a CT scan. This is more likely if your symptoms are pretty serious.

Blood Tests

Depending on how sure the doctor is that a) you have pneumonia and b) what's causing it, he or she may do one or more tests on your blood, like a complete blood count to look for signs that your body is fighting an infection or a blood culture to look for the offending pathogen. (A blood culture is more likely if your symptoms are severe enough that you're hospitalized.) Knowing the identity of the microorganism infecting you can be useful to the doctor, since different antibiotics align with different bacteria.

Other Tests

Doctors sometimes use additional tests that can help determine whether you have pneumonia and/or what might be causing it. Here are a few examples:

  • A pulse oximeter test. This measures how much oxygen is in your blood, usually through a small sensor that's placed on your fingertip.

  • A COVID and/or flu test. These are done by swabbing your nostrils or your nasopharyngeal passages—the area way up there inside your nose where it meets the back of your throat. (If you've had a COVID test, you know a nasopharyngeal swab can be an uncomfortable experience.)

  • A sputum sample. If you are coughing up phlegm (sputum), you might be asked to produce some and spit it into a sample container in the doctor's office; it's then cultured (put into a petri dish) to see what grows. As with a blood culture, the purpose of sputum testing is to help the doctor identify the specific microorganism that's infecting you.

Despite the various tests available, here's the hard truth about pneumonia: It's challenging to diagnose. Blood cultures and sputum tests are often inconclusive; in the majority of cases, the offending pathogen isn't identified, according to recent guidelines for pneumonia diagnosis and treatment from the American Thoracic Society and Infectious Diseases Society of America, published in the American Journal of Respiratory and Critical Care Medicine.

Plus the tests can take a few days to come back and in the meantime, you need to start getting better. So the doctor generally has to make his or her best guess as to what's going on and what will best fix it. For this reason, some doctors don't bother getting a sputum sample or a blood culture. Sometimes, it's simply the fact that a medication is working (or not working) and you are improving (or not) that confirms whether the diagnosis was right and tells the doctor what to do next when it comes to treatment for your condition.

How Is Pneumonia Treated?

Unless your doctor determines that you need to be hospitalized (more on what would lead them to make this call below), you can probably recover from pneumonia at home with a combination of oral medication, rest, and self-care strategies. If your breathing is labored, your doctor might also prescribe breathing treatments (in which you inhale medication through a device called a nebulizer).

In theory, the oral drugs you get for pneumonia should be tailored to the cause—antibiotics if it's a bacterial infection, and other meds (or no meds) if it's viral. But in reality, don't be surprised if the doctor gives you antibiotics even if he or she doesn't know for sure that you have a bacterial infection. The experts we consulted said most doctors prescribe these medications—which include amoxicillin, doxycycline, azithromycin, and clarithromycin—for pneumonia across the board "just in case," since even if you have viral pneumonia it can be followed by or accompanied by a bacterial infection. And as we mentioned above, often it's not clear what the pathogen is, so antibiotics are used to cover the bases.

How Long Will I Be on Antibiotics for Pneumonia?

Traditionally, a course of antibiotics for pneumonia would be 10 days or maybe a week; but growing research suggests five days of the drugs can often knock out pneumonia (in both kids and adults) just as well as a longer course. For example, in a recent Canadian study in JAMA Pediatrics of 281 children with pneumonia, those who took amoxicillin for five days recovered comparably to those who took it for a full 10 days.

If the doctor determines that the flu (influenza) virus is causing your pneumonia, he or she might prescribe one of the same drugs given to flu patients, like Tamiflu (oseltamivir). These don't kill the virus, but if they're started within a few days of symptoms they can help slow the infection from spreading, which might make your illness shorter or less severe. Tamiflu is taken once a day for 10 days.

If you're diagnosed with COVID-19 pneumonia, talk with your doctor about which treatments make sense for you. In the rare cases where pneumonia turns out to be from a fungus, a doctor will probably prescribe an antifungal drug or possibly an antibiotic.

In addition to any formal treatments you get, these self-care strategies can aid your recovery or make you more comfortable while you get better.

  • Avoid alcohol. It weakens your immunity, the last thing you need right now.

  • Don't smoke. It's literally the worst thing you can do if you have pneumonia. Avoid secondhand smoke, too.

  • Ease coughing or a sore throat. Suck on lozenges or sip hot water with lemon and honey.

  • Loosen lung secretions. This makes them easier to cough up and spit out. The key to doing it is moisture: In addition to drinking plenty of fluids (see below), try using a cool-mist humidifier, taking a steamy shower, or sitting in a steamed-up bathroom.

  • Lower your fever. Over-the-counter (OTC) pain relievers like Advil or Motrin (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen) can all reduce fever. Follow the label directions, since taking too much of any of these meds can have risks. OTC pain relievers can also help ease a headache or muscle aches. Adults can take aspirin if they prefer. Aspirin should never be given to children.

  • Rest. It's important to take it easy until your fever and shortness of breath subside. If needed, see if someone can help with meals or household chores for a few days.

  • Stay hydrated. Drink plenty of water and other fluids (check your urine color; it should be clear or light yellow). Kids might also need an electrolyte-replenishing drink like Pedialyte; ask your pediatrician.

Will I Need To Be Hospitalized?

If you're very sick with pneumonia, or if pneumonia poses an extra-high danger to you (due to, say, your age or an underlying condition), you might need to be treated in the hospital. The groups most likely to fall into these categories are babies and young children, adults over the age of 65, people with weakened immune systems (due to HIV/AIDS, cancer treatment, or use of immunosuppressive medications, for example), and those with preexisting heart or lung disease. In the hospital, you will likely receive IV antibiotics, fluids, and supplemental (extra) oxygen, also called oxygen therapy. You might also get breathing treatments like the ones we mentioned earlier. As you recover, you can be switched from IV to oral antibiotics, which will enable you to go home sooner. People who are extremely sick with pneumonia sometimes need mechanical ventilation—that is, to be put on a ventilator.

How Can I Prevent Pneumonia?

The same steps that can help protect you from colds, flu, and coronavirus—which you should be a whiz at by now (thanks, 2020)—can also help you avoid pneumonia, which spreads similarly through respiratory droplets that are coughed into the air or onto surfaces. Wash your hands often with soap and water; if soap and water aren't available, use a hand sanitizer with at least 60% alcohol. Disinfect "high-touch" surfaces like doorknobs and counters; stay away from people you know are sick; and avoid touching your eyes, nose, and mouth without first washing or sanitizing your hands. As always, don't smoke, and stay away from secondhand smoke. Tobacco byproducts make you more susceptible to pneumonia and weaken your ability to fight the infection.

But these steps aren't all you can do.

Vaccines for Pneumonia

There are not one but two vaccines that can help you ward off pneumonia. The first is your annual flu shot: It not only can prevent the misery of the flu but also can protect you from influenza's potential complications, which include pneumonia.

If it's recommended for you, you should also get one or both of the two available pneumococcal (pneumonia) vaccines, which protect against infection by Streptococcus pneumonia, also known as Pneumococcus. This nasty bug is the most common cause of bacterial pneumonia. About 400,000 people in the U.S. are hospitalized for pneumococcal pneumonia each year, according to the CDC, and 5% to 7% die from it. The pneumonia vaccine also protects you from meningitis and life-threatening blood infections (sepsis) that are caused by the same bacteria. It doesn't protect you against any of the other types of pneumonia, though.

How Long Will It Take to Recover from Pneumonia?

Once you start treatment, you should experience improvement in your pneumonia symptoms pretty quickly, within 48 hours or so. But full recovery will take time. In general, you will probably feel better before you really are better; studies show people with pneumonia usually report improvement in their symptoms even before chest X-rays show positive changes. Remember to keep resting and take things slow while you are recovering. On average, it takes one to two weeks to get over viral pneumonia and 10 days to three weeks for bacterial. If you are older or have a chronic condition, recovery may take even longer. Even after the infection clears up, your cough may linger, and you may continue to feel tired for around a month.

Pneumonia can be scary and even life-threatening, but you can take comfort in this: Doctors have amassed a huge amount of knowledge about this illness and are learning more all the time. Once diagnosed, you have a very good chance of making a full recovery. Be patient, rest, and follow your doctor's instructions to give yourself the best shot at feeling well again soon.

Jamie Kopf

Meet Our Writer

Jamie Kopf

Jamie Kopf is a health journalist with 20 years of experience writing and editing for consumer magazines, websites, and newsletters. Most recently she served as the editor of BerkeleyWellness.com and as senior editor of the University of California, Berkeley Wellness Letter, produced in partnership with the UC Berkeley School of Public Health.

[Full text] Clinical Analysis of mNGS confirmed C. psittaci pneumonia | IDR - Dove Medical Press

Posted: 15 Apr 2021 05:17 PM PDT

Xin-Qi Teng,1,* Wen-Cheng Gong,2,* Ting-Ting Qi,1 Guo-Hua Li,1 Qiang Qu,3 Qiong Lu,1 Jian Qu1

1Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China; 2Department of Pharmacy, Jiangxi Cancer Hospital of Nanchang University, Jiangxi Cancer Center, Nanchang, Jiangxi, People's Republic of China; 3Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People's Republic of China

Correspondence: Jian Qu
Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, People's Republic of China
Tel +86-15973190614
Fax +86-731-85292128
Email [email protected]

Introduction: Chlamydia psittaci infection is a zoonotic infectious disease, which mainly inhaled through the lungs when exposed to the secretions of poultry that carry pathogenic bacteria. The traditional respiratory specimens or serological antibody testing is slow, and the false-negative rate is high. Metagenomic next-generation sequencing (mNGS) gives a promising rapid diagnosis tool.
Methods: We retrospectively summarized the clinical characteristics of five C. psittaci pneumonia patients diagnosed by mNGS, conducted a literature review summarizing the clinical characteristics of patients with C. psittaci pneumonia reported since 2010.
Results: Five C. psittaci pneumonia patients confirmed by mNGS aged from 36 to 66 years with three males. About 60% of patients had a history of contact with avian or poultry. All patients had a high fever over 38.5 °C, cough, hypodynamia, hypoxemia, and dyspnea on admission. Two patients had invasive ventilator support and extracorporeal membrane oxygenation support. Inflammatory index levels on admission and follow-up were all higher than normal values. Doxycycline or moxifloxacin and their combination therapy were used in patients. Four patients improved and were discharged, and one patient died due to multiple organ failures and disseminated intravascular coagulation. We summarized 19 articles including 69 C. psittaci pneumonia patients and patients in 11 publications were identified by mNGS, and most patients are treated with tetracycline and quinolone with good outcomes.
Conclusion: mNGS is a promising rapid diagnosis tool, which may increase the detection rate and shorten the diagnosis time of C. psittaci pneumonia. Further case-control studies are needed to confirm.

Introduction

Chlamydia psittaci pneumonia is caused by Chlamydia psittaci (C. psittaci), which can lead to severe pneumonia, adult respiratory distress syndrome, and even death.1 According to the sequence difference of C. psittaci outer membrane protein A gene (ompA), it can be divided into 10 genotypes, namely A-G, WC, E/B, and M56, among which genotype A is the main genotype that causes human infection.2 About 70% of respiratory tract infections caused by C. psittaci are asymptomatic or only with mild symptoms, but 30% of them are severe respiratory illnesses such as community-acquired pneumonia with atypical symptoms, bronchitis, and upper respiratory tract infections.3 Contacting with birds or poultry is regarded as the main risk factor for psittacosis.1 The clinical symptoms of C. psittaci infection are quite different and lack specificity, which ranges in severity from mild to severe. Since the clinical manifestations of C. psittaci are similar to influenza symptoms, and the extrapulmonary manifestations are similar to Legionella, it needs to be differentiated from influenza and Legionella.4 Recent publications also reported the co-infection of SARS-CoV-2 with Chlamydia,5–7 which makes infectious diseases more complex.

The culture of C. psittaci from respiratory secretions in special media is possible but difficult, and it is mainly performed in specialized laboratories only because of the high infectivity of this pathogen. Specific diagnostic testing is serological, which is regarded as the gold standard for C. psittaci pneumonia. Moreover, the micro-immunofluorescence test (MIF) is the most accurate serologic test for C. psittaci pneumonia but is also performed only in specialized laboratories. Polymerase chain reaction assay (PCR) is used to confirm the strong clinical suspicion of a possible diagnosis of psittacosis especially, to distinguish it from other chlamydial species.8 And complement fixation (CF) is also an acceptable diagnostic method. Detection methods for C. psittaci, such as PCR, CF, and MIF are not routinely available in most hospitals in China. Because of its non-specific symptoms and the limitations of traditional tests, C. psittaci pneumonia is easily underdiagnosed and misdiagnosed.9

Metagenomic next-generation sequencing (mNGS) can quickly and accurately identify potential pathogens, whether they are bacteria, fungi, viruses, or parasites.10 It is increasingly used for the diagnosis of infectious diseases, especially when traditional diagnostic methods have limitations.11 Studies have shown that mNGS is the most promising comprehensive diagnosis method for infection, especially for severe pneumonia.12 Recently, several studies have reported the application of mNGS in diagnosing C. psittaci pneumonia, two case reports describing 5 and 9 cases of C. psittaci diagnosed by mNGS13,14.

We retrospectively summarized the clinical characteristics of five C. psittaci pneumonia patients diagnosed by mNGS in our hospital. Besides, we conducted a literature review of patients with C. psittaci pneumonia reported since 2010, with the attention to summarize the diagnostic methods and anti-infective drugs. We also summarized the clinical outcome and history of exposure to avian or poultry of these infection patients to provide a reference for future C. psittaci pneumonia infection patients' diagnosis and treatment. We present the following article following the CARE reporting checklist.

Case Presentations

Patients' Information

We carried out a retrospective case series analysis of five patients admitted to the Second Xiangya Hospital of Central South University since 2018. We collected the clinical data of all patients confirmed to have C. psittaci pneumonia. Sex, age, clinical examination indexes such as procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), comprehensive computed tomography (CT), and arterial blood gas analysis were extracted from electronic medical records. The treatment of antibiotics, outcomes, and any relevant follow-up data were also collected.

The Ethics Committees of the Second Xiangya Hospital of Central South University (LYF-2020021) approved this study. Informed consent was obtained from patients and guardians. This study was carried out by the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All data were anonymized before analysis.

As the symptoms of the patients were sudden, some patients had no sputum and their blood oxygen saturation was low, we did not perform bronchoscopy for them on admission. The blood was used for performing mNGS testing on admission for all five patients, and only case 5 performed bronchoalveolar lavage fluid (BAFL) mNGS testing on admission. All five patients were positive for C. psittaci DNA fragments in the blood mNGS test. Moreover, BAFL mNGS of case 5 result showed Klebsiella DNA fragments. The median duration from admission to the mNGS pathogenic diagnosis of the 5 cases was 3 days (range from 2 to 4). The median of mNGS detection sequence number of C. psittaci was 217 (range from 175 to 289). No pathogenic microorganisms were found in the sputum, BAFL, and blood culture of the patient after admission to our hospital. We also conducted serological verification and PCR for five cases after an atypical pathogen was identified by mNGS. Serological detection of antibody to C. pneumoniae was positive only in case 2 and the PCR of C. pneumoniae was negative in all patients. While the serological detection of antibody, PCR, MIF, and CF of C. psittaci cannot be performed in our hospital.

There were three male and two female patients with a median age of 51 years (range from 36 to 66). 60% of patients had type 2 diabetes. Three of five patients had a history of contact with avian or poultry. All patients had a high fever over 38.5 °C, cough, hypodynamia, hypoxemia, and dyspnea. Two of five patients had a headache. In the course of treatment, two patients had invasive ventilator support and Extracorporeal Membrane Oxygenation (ECOM) support. The medium APACHE II was 17.6 (range from 8 to 22). Days from illness to respiratory failure were 4.8 (2–8) days.

Laboratory Test

mNGS was conducted using the following operational steps according to the company's operating procedures (The Beijing Genomics Institute, Beijing, China). Briefly, clinical samples (blood or BALF)) were collected by following the standards of aseptic processing procedures. Nucleic acid extraction was conducted and the extracted DNA was subjected to processes of interruption, end repair, library construction, and sequencing. The mapped data were processed for advanced data analysis. Lists of suspected pathogenic microorganisms were produced, which included the numbers of strictly mapped reads, coverage rates, and depth. The clinical diagnosis was determined by considering all the clinical manifestations, possible pathogens identified by mNGS, and other laboratory tests together. On admission and during the hospital, inflammatory markers such as PCT, CRP, ESR, kidney, and liver function index, CT, and X-ray data were detected according to the patients' condition.

Laboratory inspection parameters of the five patients on admission were shown in Table 2. Four patients had lower hemoglobin and the levels were 108.6 (range 68–148) g/L. The levels of CRP, PCT, and ESR on admission were all higher than normal values. Oxygen partial pressure and partial pressure of carbon dioxide of all patients were significantly lower than normal values.

Table 1 Clinical Characteristics of the Five C. Psittaci Pneumonia Cases

Table 2 Laboratory Inspections Parameters of the Five Patients on Admission

After admission, follow-up laboratory testing results showed that the levels of inflammatory markers including WBC, percentage of neutrophils, CRP, PCT, ESR were all higher than normal values (Table 1). Moreover, the values of CK, lactate dehydrogenase (LDH), ALT, and AST were all higher than normal values in all five patients. Three patients had hypokalemia and the potassium levels were range from 2.7 to 3.3 mmol/L.

Chest CT and X-ray of patients showed that lungs were exuding consolidation foci, bilateral pectoral effusions, consolidation. After treatment, the image of four patients improved compared with those on admission, and the patients' lung exudation, consolidation, and bilateral pleural effusion were less than before (Figures 1 and 2).

Figure 1 Chest computed tomography (CT) scans of a 66-year-old man with C. psittaci pneumonia. Lungs were exuding consolidation foci, bilateral pectoral effusions, consolidation on the 8th day of hospitalization (A). After treatment, on the 18th day of hospitalization (B), the image of four patients improved, and the patients' lung exudation, consolidation, and bilateral pleural effusion were less than before.

Figure 2 Chest X-ray of a 36-year-old pregnant female patient with C. psittaci pneumonia and died of septic shock, DIC, and multiple organ failure. (A) on the first day of hospitalization, (B) on the third day of hospitalization, (C) on the sixth day of hospitalization, (D) on the seventh day of hospitalization.

Treatment and Outcome

After C. psittaci pneumonia was confirmed, one of the three male patients received symptomatic anti-infective treatment with moxifloxacin (400mg ivgtt qd) and with adjuvant non-invasive ventilator therapy. The other two male patients received symptomatic anti-infective therapy with doxycycline (100mg po q12h) and were treated with high flow nasal cannula therapy. All three male patients were improved and discharged after more than 10 days of treatment. Two female patients were transferred to our hospital after invasive ventilator adjuvant treatment with tracheal intubation from other hospitals. They were treated with moxifloxacin (400mg ivgtt qd) combined with doxycycline (100mg po q12h) for symptomatic anti-infective therapy. The two female patients were treated with ECOM and ventilator adjuvant therapy due to their critical illness. One patient was removed ECOM after five days of treatment with blood oxygen saturation and oxygen partial pressure was significantly improved. After 3 days of consecutive treatment, the invasive ventilator was removed. The patient continued to receive treatment and was discharged from the hospital. Another 35-years old female patient (case 5) was critically ill and the disease progressed rapidly and finally die. One week before admission, the B-mode ultrasound showed that the patient was in early intrauterine pregnancy with a size of about 6 weeks, with no germ and heartbeat. The patient was transferred to the respiratory ICU of our hospital after oral endotracheal intubation with a high fever of 39 °C and blood oxygen saturation of 65%. Chest radiograph showed multiple exudative lesions in both lungs and pleural effusion on the right side. After admission, she was given meropenem combined with moxifloxacin and ganciclovir. On the third day after admission, mNGS of blood indicated C. psittaci, with a sequence number of 533. mNGS of BAFL indicated Klebsiella pneumoniae, with a sequence number of 175. Then the patient was given an injection of doxycycline. On the 7th day of admission, the patient's blood oxygen saturation was still 70% (through endotracheal intubation and invasive ventilator), and ECMO treatment was performed. On the 8th day of admission, the patient died due to septic shock, disseminated intravascular coagulation (DIC), and multiple organ failures.

Literature Review

We searched the databases including PubMed, EMBASE, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) from 1st Jan. 2010 to 1st Oct. 2020. The searching strategy was "Chlamydia psittaci" or "Chlamydia psittaci pneumonia". Dr. Jian Qu and Dr. Wen-Cheng Gong reviewed all relevant articles to identify potentially eligible studies. We conducted this literature review of patients with C. psittaci pneumonia to summarize the diagnostic methods and anti-infective drugs, and we also summarized the clinical outcome and history of exposure to avian or poultry of these infection patients to provide a reference for future C. psittaci pneumonia infection patients' diagnosis and treatment. The data about authors, reported time, number of cases, ethnics, history of exposure to avian or poultry, anti-infective drugs regiment, and clinical outcome were collected. We found 794 publications. After excluded the full text could not be found or provided no information we needed about C. psittaci pneumonia or no original data or the Chlamydia was not specified. Finally, 19 articles were enrolled in further review.

The summary of the detailed information was shown in Table 3. The articles were published from 2012 to 2020. With the development of detection technology, the number of articles reported tends to increase (Figure 3). Since 2019, there were 13 articles reported C. psittaci pneumonia and among them, 10 articles using mNGS to detect C. psittaci. There was a total of 69 C. psittaci pneumonia patients were reported and most patients had a history of exposure to avian or poultry. Most patients treated with doxycycline, moxifloxacin, meropenem, or their combinations, and three patients used ECOM support. Most of the patients' treatment improved and four patients died.

Table 3 Summary of Case Series and Case Report of C. psittaci Pneumonia

Figure 3 The summary of C. psittaci pneumonia literature review from 2010 to 2020 year.

Discussion

We retrospectively analyzed five cases of psittacosis pneumonia diagnosed using mNGS and summarized the clinical characteristics including disease progression, treatments, and outcomes, etc. Moreover, we also carried out a literature review that summarized the existing research and reports about C. psittaci pneumonia. In our study, five C. psittaci pneumonia patients confirmed by mNGS aged from 36 to 66 years with three males. 60% of patients had underlying diseases Type 2 diabetes. Three of these five patients had a history of contact with avian or poultry. All patients had a high fever over 38.5 °C, cough, hypodynamia, hypoxemia, and dyspnea on admission. Two patients had invasive ventilator support and ECOM support. The levels of CRP, PCT, and ESR on admission and follow-up were all higher than normal values. Doxycycline or moxifloxacin monotherapy was accounted for 1/5 (20%) and 2/5 (40%) patients, and combination therapy was accounted for 2/5 (40%) patients. Four patients improved and were discharged, and one patient died due to multiple organ failures and disseminated intravascular coagulation.

The lung manifestations are mainly cough, dry cough, shortness of breath, the rapid progress of lung disease, and occasionally acute respiratory distress syndrome (ARDS).15 In the five cases reported in this article, 3 patients had ARDS. And there were even case reports showing only abnormal liver function.16 In the initial auscultation, the lung lesions of C. psittaci pneumonia were often underestimated. The chest radiograph showed infiltrating patches with uneven density, which can seriously affect all lung lobes. CT of the lungs showed consolidation or ground glass-like changes, especially the lower lung, with pleural involvement and pleural effusion.17 After treatment, the patients' cough and fever improved, but the oxygenation index recovered slowly. According to the reporting of literature, the absorption of the lesion was slow, with an average absorption time of 6 weeks, up to 20 weeks.18 The laboratory inspection parameters of the five patients on admission showed that two patients had WBC > 10×109/L, and three cases had PCT > 10 ng/mL, and the chest radiology presented mainly consolidation. The mNGS detection of case 5 also showed Klebsiella pneumoniae infection in addition to C. psittaci infection, but there were no other bacteria was isolated in the other four cases. Although other bacteria were not found in culture, other bacterial coinfections cannot be ruled out because of the high WBC and PCT value, and the chest radiology characterized by consolidation. Especially, some patients were carried out invasive ventilator support or ECOM. Therefore, patients are at risk for hospital-acquired pneumonia and ventilator-associated pneumonia infection. Before admission, the community-acquired pneumonia was also treated with antibiotics such as cephalosporins and quinolones in other hospitals before the diagnosis of C. psittaci pneumonia.

According to the control requirements of C. psittaci issued by the National Public Health Veterinary Association, the confirmed diagnosis of human C. psittaci pneumonia only needs to meet one of the following two standards: 1). Isolate C. psittaci from respiratory specimens (sputum, pleural fluid, tissue, etc.) or blood specimens 2). Serological examination: Measure the C. psittaci IgG antibody in the acute and convalescent phases during the interval of 2–4 weeks, the convalescent phase is more than four times higher than the acute phase. If the patient meets one of the following two standards, it may be infected: 1). Serum examination, C. psittaci IgM ≥ 32; 2). C. psittaci DNA can be detected through PCR amplification of respiratory specimens (sputum, pleural fluid, tissue, etc.).19 Since C. psittaci is strictly intracellular parasitic, its direct isolation and cultivation are very difficult and cannot be carried out routinely. At present, the clinical presentation and the positive serological result using MIF with paired sera are the most often used diagnostic methods of C. psittaci.1 MIF20 and PCR gene expansion detection have become auxiliary detection of molecular biological diagnosis due to their high sensitivity and specificity.21 Although MIF is more sensitive and specific than complement fixation (CF) tests, the test still displays cross-reactivity with other Chlamydia species in some instances.22 PCR testing is not clinical laboratory improvement amendments validated currently. mNGS can be used to detect pathogens that cannot be detected by traditional methods.23 Patients introduced in this article were all severely infected when they were admitted to our hospital, with respiratory failure, and dry cough without sputum. Due to the high risk of bronchoscopy and difficulty in taking respiratory tract specimens, the blood or BAFL samples of patients were sent out for mNGS testing and finally reported C. psittaci infection. Early pathogenic diagnosis can greatly benefit patients, and of the 5 patients reported in this article, 4 patients improved and were discharged. Our literature review also found that with the development of technology, the number of C. psittaci detected increased year by year, and the articles reported C. psittaci pneumonia via mNGS increased year by year (Figure 3 and Table 3).

Tetracyclines, macrolides, and quinolones can interfere with DNA and protein synthesis, therefore, these three kinds of antibiotics can be used to treat C. psittaci.24 At present, both in China and other country, tetracyclines are the first choice for the treatment of C. psittaci pneumonia including tetracycline, doxycycline, and minocycline.25,26 In severe cases, doxycycline can be administered intravenously. The treatment of the patient in case 2 with doxycycline is also effective. Macrolide drugs such as azithromycin and fluoroquinolones have been confirmed to have antibacterial activity against C. psittaci in vitro,26,27 In particular, moxifloxacin has strong antibacterial activity against Chlamydia, and there are case reports at home and abroad that the use of fluoroquinolone drugs is effective.28–31 Given the lack of experience in the use of tetracyclines in our hospital, Chlamydia trachomatis, which is the same species as C. psittaci in my country, is highly resistant to tetracycline,32 so the treatment for case 1 patient used moxifloxacin and it was effective. After five patients were treated, four patients were improved and discharged. Among them, one patient was treated with moxifloxacin, two patients were treated with doxycycline, and the other two patients were treated with moxifloxacin plus doxycycline. Current C. psittaci Pneumonia treatment guidelines recommend the addition of macrolide or quinolone to the initial regimen of severe C. psittaci in any case. According to current reports, it is unclear whether combination medication is more effective than single medication for patients. Further case-control studies with larger samples are needed to find the optimal treatment.

In this article, we have searched the relevant literature. At present, most cases of human infection with C. psittaci are reported in scattered cases and details are listed in Table 3. With the development of detection technology, mNGS became a routine examination for etiology. Therefore, more and more C. psittaci pneumonia was diagnosed and treated according to guidelines. Our literature review summarized 19 articles including 69 C. psittaci pneumonia patients, Patients in 11 articles were identified by mNGS, including 9 articles were reported in China. In recent years, the reports of mNGS for C. psittaci pneumonia diagnosis have increased, especially in China. We found that most patients had a history of exposure to avian or poultry. Therefore, epidemiological data combined with mNGS detection is helpful for the early diagnosis of C. psittaci pneumonia. Most patients are treated with doxycycline, moxifloxacin, or their combinations. Three patients used ECOM support and they are all improved. Among these 69 patients in our literature review, 65 patients of C. psittaci pneumonia improved and four patients died. In the future, further case-control studies with a large sample size are needed to find better diagnostic methods and better anti-infective drugs.

Conclusions

The history of contact with avian or poultry and the typical symptoms (high fever over 38.5 °C, cough, hypodynamia, hypoxemia, and dyspnea) are important for C. psittaci pneumonia diagnosis. Moxifloxacin, doxycycline, or their combinations are effective treatment options for C. psittaci pneumonia. mNGS is a promising rapid diagnosis tool, which may increase the detection rate and shorten the diagnosis time of C. psittaci pneumonia. Further case-control studies are needed to confirm.

Abbreviations

C. psittaci, Chlamydia psittaci; PCR, polymerase chain reaction assay; CF, complement fixation; mNGS, Metagenomic next-generation sequencing; PCT, procalcitonin; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; CT, computed tomography; ECOM, Extracorporeal Membrane Oxygenation; LDH, lactate dehydrogenase; DIC, disseminated intravascular coagulation; ARDS, acute respiratory distress syndrome.

Data Sharing Statement

Not applicable.

Ethics Approval and Informed Consent

The Ethics Committees of the Second Xiangya Hospital of Central South University (LYF-2020021) approved this study. Informed consents were obtained from patients and guardians.

Acknowledgments

We thank the patients enrolled in our study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. All authors have read and approved the manuscript.

Funding

No funding or sponsorship was received for this study or publication of this article.

Disclosure

The authors report no conflicts of interest in this work.

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Rare COVID-19 complication is putting kids in Michigan's ICUs - The Detroit News

Posted: 12 Apr 2021 12:00 AM PDT

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John Elkhoury on his daughter's recovery from MIS-C including 6 days at Beaumont Hospital's ICU. The Detroit News

Macomb Township — When Michelle Elkhoury's 4-year-old daughter spiked a low-grade fever in mid-March, she didn't panic.

Juliana had been attending preschool virtually, and Michelle and her husband, John, had been working from home for a year while caring for 2-year-old daughter Alexandria. No one in the family showed signs of COVID-19 symptoms, the mother said.

Despite routine doses of Tylenol, Juliana's fever lasted for six days, and Michelle took her to the family's pediatrician twice. Elkhoury began to worry more when her rambunctious toddler spent an entire day napping on the couch instead of playing. Then, her lips turned bright red and rashes broke out on her hands and feet.

Juliana initially tested negative for COVID-19 and showed no signs of respiratory distress, but her condition quickly worsened. She was hospitalized on March 20.

As the arteries around her heart swelled, her kidneys began failing and her hemoglobin levels dropped, doctors diagnosed her with multisystem inflammatory syndrome in children, often referred to as MIS-C, a rare and dangerous malady found in kids ages 2 to 15, weeks after they contracted COVID-19.

Juliana, who spent nearly a week in the intensive care unit, is slowly recovering at home. But her fight last month with a syndrome that can limit blood flow and damage the heart, kidneys and other organs in kids came as Michigan's COVID-19 case rates for children under age 19 reached an all-time high and are now four times what they were a month ago.

"It was extremely serious and super scary as a parent because up until being admitted into the hospital, we had no idea that anyone in our house was even infected with COVID, let alone our 4-year-old daughter who wasn't in school," said Michelle, 36, of Macomb Township. 

"It was terrifying."

Juliana's doctor, Dr. Bishara Freij, chief of pediatric infectious disease at Beaumont Children's in Royal Oak, said the hospital is being aggressive in treating children diagnosed with the syndrome.

"At Beaumont, we're proactive. If a child looks like they have MIS-C, we are now just admitting them to the ICU because they invariably deteriorate after admission. When you admit them, they're either sick enough already, or will get sick enough shortly thereafter," Freij said.

"About 70% in Michigan have ended up in ICU with this diagnosis."

The Michigan Health and Hospital Association issued a statement Friday urging residents to vaccinate as COVID-19 pediatric cases have increased 237% since Feb. 19. Currently, 42 children are hospitalized in the state with COVID-19.

There have been 99 cases of the syndrome in Michigan and five deaths. The majority of cases are concentrated in lower southeast and west Michigan. Michigan ranks No. 20 of the states with the most known cases, according to the Centers for Disease Control and Prevention.

Nationally, there are 3,185 reported cases, resulting in 36 deaths.

CDC researchers conducted a study published Tuesday in JAMA Pediatrics that found in more than 1,000 cases, 75% of the patients did not experience coronavirus symptoms. But two to five weeks later, they became sick enough to be hospitalized.

Patients predominately have gastrointestinal and cardiovascular symptoms rather than respiratory. Almost all of the 1,733 patients in the study tested positive for COVID-19, "indicating that development of MIS-C was delayed by days to weeks after initial infection," researchers noted.

Doctors are still studying the disease, but, Freij said, the syndrome might be forming due to the body's immune response to the presence of the coronavirus.

"So the child gets infected, the immune response is supposed to help us clear this infection, but sometimes, the response is so exaggerated that this starts hurting us instead of just clearing the infected agent," he said. "So it's basically your body going into overdrive against the virus and as a result, you get this entity called MIS-C."

The infection rate of MIS-C is around 2% of all children, but with a surge of new cases in Michigan, especially in children, "2%, which does not sound very high, actually becomes a lot of people," said Freij, adding pediatric hospitalizations have been increasing over the last four weeks.

The good news is, if MIS-C recognized quickly, it's treatable. Doctors use intravenous immunoglobulin therapy, steroids and other anti-inflammatory drugs to reduce inflammation and protect the heart, kidneys and other organs from lasting damage, said Dr. Donna Farber, a professor of microbiology and immunology at Columbia University.

Warning signs

Juliana spiked a low-grade fever of 100.1 on March 13. The following day, Michelle Elkhoury took her to her pediatrician where she presented with glossy eyes and was complaining of stomach pain.

"We thought OK, she's just fighting a winter cold. They tested her for COVID and the flu and both were negative," Elkhoury said. "I thought maybe she had a (urinary tract infection) because her stomach was hurting. They took a sample and we went home. The next day, that Tuesday, again, she was just not herself. Fever back and forth through the night, not sleeping good, and during the day she just kind of wanted to lay around."

Juliana tested positive for a UTI and doctors prescribed antibiotics. Hours after taking the first antibiotic, Juliana spiked a fever of 102 degrees, Elkhoury said.

"We gave her Motrin and she fell back asleep," Elkhoury said. "When she woke up again around 6:30 p.m., her eyes were completely bloodshot. Her lips looked like she had just had a bright red cherry Popsicle, the palms of her hands and feet had like this blotchy red rash on them, and her fever went up to 105."

After returning to the doctor's office a second time, pediatricians said it could just be the UTI flaring up with a combination of the medicine. A strong dose of Tylenol reduced her fever.

Two days later, Juliana was in more pain and didn't have the energy to walk or eat. Pediatricians considered her rash hand, foot, and mouth disease, but Elkhoury believed it was something more.

"It seemed like we should have seen her getting better at six full days," Elkhoury said. "To other parents, if your child has a fever, they have a rash on their hands and feet, their eyes are bloodshot and glassy, I would say that's a huge indicator that they need to be seen by not just anyone — a medical physician."

Nearly a week after her fever first spiked, Juliana was admitted to the hospital, where she spent six days in the ICU.

Juliana eventually tested positive for COVID-19 while in the hospital. Her parents, meanwhile, were shocked to test positive for antibodies as both of them were asymptomatic, Michelle Elkhoury said. The child was eventually released from Beaumont Royal Oak on March 26 after she was cleared of the virus.

The young child loves to cook but hasn't been able to help out in the kitchen in a month. She is still recovering and only starting to get back to normal this past week by playing with her Barbies and Alexandria, her mother said.

"It took her a while, and it took time to get that confidence and strength back and last night saying, 'Look mommy I can run, I can run,'" Elkhoury tearfully said. "It's so sad because she was totally healthy before, this and it's hard to watch her relearn how to do basic things."

At her last checkup on April 2, "Juliana looked like a rose," said Freij, the pediatrician.

"Juliana is a good example of someone who got sick, quite badly. Her heart's ability to pump blood was very depressed, very poor," he said. "However, I am happy to report that her heart is normal and her function has returned completely. She's not completely done with her treatment, but it's outstanding she was able to recover quickly.

"While it is very scary, despite the gravity of the situation, I try to tell parents the outcome is still favorable even though it might be a rough ride to get to that point."

Lingering effects

Columbia's Farber told The Detroit News it's not clear how the rare virus is resonating with children.

"There is some research to suggest that it's linked ... to the type of tissue antigens that you have, that means there may be a genetic component that makes people more susceptible to it as well," Farber said.

"There is this blurring with Kawasaki disease, but the hallmarks to identify MIS-C are the very high fever, inflammation and the cardiac involvement, and those are very dangerous signs."

Doctors initially believed Juliana had Kawasaki disease, which causes inflammation in blood vessels. 

As Michigan's case rates for children 19 years old and younger continue to climb, Dr. Joneigh Khaldun, the state's chief medical executive, said Friday the state is investigating 991 active outbreaks. From January to March, there have been 291 outbreaks from youth sports resulting in 1,091 infections, she said.

The Michigan Hospital Association noted that "the long-term health impacts of COVID-19 or MIS-C can be devastating."

"We have seen heartbreaking stories of children on ventilators, experiencing amputation and more. Even one case is too many," the association said in a Friday release.

Vaccines are currently only available for those age 16 and older. Pfizer on Friday requested the U.S. Food and Drug Administration expand the emergency use of its vaccine to kids ages 12-15 after trials showed it was 100% effective in protecting against the virus. Pfizer has begun a trial testing its vaccine in children under 5 years old. Moderna began testing its vaccine on children under 12 years old last month.

"Once we reduce infection rates and vaccinate everyone else, fewer children will get sick," Farber said. "Even if vaccines don't release for children this year, getting everyone else vaccinated will protect the children."

srahal@detroitnews.com

Twitter: @SarahRahal_

Read or Share this story: https://www.detroitnews.com/story/news/nation/coronavirus/2021/04/12/rare-covid-19-complication-mis-c-kids-michigan-intensive-care-units/7122938002/

COVID-19 interactive map, case data, helpful links in Maryland - WBAL TV Baltimore

Posted: 19 Apr 2021 11:10 AM PDT

♪ >> I TOOK HER TO THE EMERGENCY ROOM, AND THEY SAID THAT'S AS FAR AS YOU CAN GO AND THAT WAS PRETTY MUCH GOODBYE AT THAT POINT. >> THOUSANDS OF MARYLANDERS DYING IN HOSPITALS ALONE. FAMILIES FORCED OUT OF THE WAITING ROOMS AND FORCED TO SAY GOODBYE OVER THE PHONE. THE FINAL TOLL OF THE CORONAVIRUS PANDEMIC, STILL YET TO BE SEEN. >> AND THEY WERE JUST THE SICKEST OF THE SICK. UM ... IT REALLY FELT LIKE BEING THERE FOR PEOPLE MATTERED. >> THOSE LOVED ONES CARED FOR IN THEIR FINAL HOURS BY ICU NURSES WHO ARE RISKING IT ALL FOR STRANGERS. HOW THE FRONT LINES HAVE CHANGED IN A YEAR AND THE LONG-AWAITED HOPE A VACCINE IS GIVING MEDICAL WORKERS. [CHEERING AND APPLAUDING] >> BUT WE ALSO GOT TO WITNESS EMOTIONAL MOMENTS LIKE THESE - PATIENTS RELEASED FROM THE HOSPITAL AFTER WEEKS ISOLATED IN ROOMS ALONE. JOIN US OVER THE NEXT HOUR, AS WE SHARE STORIES OF SUFFERING, SURVIVAL AND HOPE. THE PANDEMIC ONE YEAR LATER: A JOURNEY FROM PAIN TO PROMISE ♪ ♪ GOOD EVENING, AND THANKS FOR JOINING US. STAN: IT'S HARD TO BELIEVE IT'S BEEN A YEAR, SINCE THE "WORLD HEALTH ORGANIZATION" DECLARED CORONAVIRUS, A "PANDEMIC". AND WHILE THE PAST YEAR HAS BEEN EXTREMELY DIFFICULT ON VACCINES DO NOW OFFER "HOPE". DEBORAH: OVER THE NEXT HOUR, YOU WON'T HEAR FROM A LOT OF OFFICIALS TALKING ABOUT WHAT YOU HAVE ALREADY HEARD OUR GOAL IS TO BRING YOU PERSONAL STORIES OF LOSS, YES, BUT MORE IMPORTANTLY HOPE FOR A NEW SAFE, HEALTHY TOMORROW. STAN: WE BEGIN WITH I-TEAM LEAD INVESTIGATIVE REPORTER JAYNE MILLER. SHE SHOWS US WHERE WE STAND THE ONGOING STRUGGLES AND SHE OFFERS A GLIMPSE OF WHAT THE FUTURE MAY LOOK LIKE. REPORTER: LOCKERRED INTO OUR HOMES, THROWN OUT OF WORK, SICKENED AND MADE TO ENDURE TERRIBLE LOSS. SHE DIED APRIL 8th, 202. SHE WAS 51. BUT FOR CORONAVIRUS, HER HUSBAND SAID, SHE WOULD LIKELY BE WITH US TODAY. A MY WIFE WAS THE PICTURE OF HEALTH. NOT SICK. NOT FAILING. NO, NO, YOU KNOW, NOTHING WE WERE DEALING WITH. YEAH. IF NOT FOR THAT -- REPORTER: KI THE FIRST WAVE WHEN TESTING WAS SCARCE AND MEDICINE UNFAMILIAR WITH THE NEW RESPIRATORY VIRUS. >> OH, YOU GOT PNEUMONIA. THEY GAVE HER ANTI-BAY DOTTICCANCE SAID GO HOME. COME BACK IN A WEEK. REPORTER: SHE HE TOOK HER TO THE EMERGENCY ROOM AND NEVER WOULD LEAVE THE HOSPITAL. >> WE DONNED MASKS AND GLOVES AND TALK HER IN THE CAR AND MADE HER THEN IT BACKSEAT WHICH KNOW WAS PAINFUL, AND TOOK HER TO THE EMERGENCY ROOM, AND WE GOT HER TO THE FRONT DOOR AND THEY SAID THAT IS AS FAR Z YOU CAN GO. THAT WAS PRETTY MUCH GOOD-BYE AT THAT POINT. REPORTER: AS OF RAY DAY, MARCH 12th, 2021, 7848 PEOPLE HAVE DIED IN MARYLAND FROM CORONAVIRUS RELATED ILLNESS. 88% WERE 60 YEARS OR OLDER. BASED ON 2019. CORONAVIRUS WOULD BE THE THIRD LEADING CAUSE OF DEATH BEHIND HEART DISEASE AND CANCER. >> IN THE U.S., MORE THAN 500,000 PEOPLE HAVE DIED THE PANDEMIC AND MORE THAN 28 MILLION CASES HAVE BEEN REPORTED. THAT IS OBVIOUSLY AN ENORMOUS TRAGEDY ONE OF THE WORST PUBLIC HEALTH DAISES ON RECORD. WHEN WE TAKE A STEP BACK AND THINK ABOUT WHERE WE ARE. WHAM WE SUFFER INTERESTED OVER THE LAST YEAR, IT IS STRIKING. REPORTER: RIGHT NOW, NEW CORONAVIRUS CASES AVERAGE 831 PER DAY, A SHARP DROP FROM THE 3019 AVERAGE CASES PER DAY DIDN'T MID JANUARY. THIS WEEK, MARYLAND JOINS SOME OTHER STATES IN LIFTING SOME CORONAVIRUS RESTRICTIONS, PUBLIC HEALTH EXPERTS CAUTION, DON'T RUSH IT. >> I AM EXPECTING THAT IN THE SPRING, WE WILL CONTINUE TO NEED PUSH DOWN CASE COUNTS. RIGHT NOW, OUR CASELOADS ARE AROUND 20 CASE PER 100,000 PER DAY. THAT IS SHOW EPIDEEMOLOGIST THINK ABOUT IT IN THE U.S. I WOULD LIKE TO GET BELOW 10 AS GEL AND PREFERABLY LOWER. REPORTER: THE ECONOMIC IMPACT HAS BEEN HARSH AND MAY LAST SEVERAL YEARS. DONALD ROSS HAS BEEN ABLE TO KEEP THE CATERING BUSINESS GOING ONLY BY PIVOTING TO A MEAL DELIVERY BUSINESS. HI. >> HELLO. RIGHT ON TIME. I AM SURPRISED HOW MANY PEOPLE, SINGLE, FAMILIES, THAT THEN NEED OF COOKED MEAL, HEALTHY COOKED MEALS DELIVERED TO THEIR HOMES AND DAILY BASIS. SO I HAVE V BEEN DOING THREE-DAY, FOUR-DAY, FIVE-DAY MEAL PREP PLAN THAT HAS TAKEN OFF AND SUPPLEMENTED OUR INCOME BECAUSE ALL THE CATERING EVENTS HAVE BEEN CANCEL GOING INTO THIS YEAR. REPORTER: DONALD'S RIFE IS ALSO HAVE SMALLING BUSINESS OWNER LIKE MANY OTHER RETAIL AND PERSONAL SERVICE BUSINESSES? HEA HAD TO SHUT DOWN LAST MARCH AND ROPED IN MAY TO LIMITED CAPACITY RULES THAT CONTINUE. >> YOU MAKE ENOUGH TO PAY THE BILLS, BUT WE USED TO NORMAL ROTATION, WHERE YOU ARE DOING MORE THAN EIGHT PEOPLE A DAY. YOU ARE DOING UP TO 15 POPE, KNOW, THE INCOME CUT WAS CUT DRASTICALLY, BUT AS LONG AS WE CAN STILL WORK. I AM FINE. REPORTER: DECEMBER 2019, MARLEI REPORTED 2. 8 MILLION JOBS. IN DECEMBER 2020. THE STATE REPORTED ABOUT 2.6 MILLION. 124, 700 THROWS PANDEMIC. RY WAS A MEDICAL AUDITOR. REPORTER: AMANDA EDWARD HAS WITNESS OUT OF WORK FOR THERE LAMB FULL YEAR SHE IS NOW BATTLING THE STATE'S UNEMPLOYMENT SYSTEM TO COLLECT BENEFITS. HER NEXT JOB UNCERTAIN. HAS BEEN A HUGE STRUGGLE. I DON'T KNEE TO DO. YOU KNOW WHAT I MEAN? EVERYBODY SAYS, ASSISTANCE, AND HELP AND SAUL OF THAT STUFF. YOU CAN'T GET INTO TOUCH WITH NOBODY. ARE IS TRYING TO GET HELP NOW WITH THE ECONOMY EVERYTHING GOING ON. THE PANDEMIC HAS EXPOSED ANOTHER LAYER OF RACE DISPARITY. BLACK PEOPLE MAKE UP 31% OF THE STATE'S POPULATION. THEY REPRESENT 34.3% OF COVID DEATHS. AND THE GAP IS WIDE IN VACCINATIONS. TO DATE, 62.6% OF PEOPLE IN MARYLAND FULLY VACCINATED R WHITE. 15.5% ARE BLACK. TRY LOOK FORWARD. ADRIENNE HARPER, 11 MONTHS AFTER THE DEATH OF HIS WIFE IS NOW WORKING ON A CAMPAIGN TO URGE BLACK PEOPLE TO GET VACCINATED. >> I GOT A DOZEN FRIENDS WHO LOST THEIR PARENTS DOING THIS. ONE OF THE BEST FRIENDS IS ARKANSAS RIGHT NOW AND HIS MOTHER'S FUNERAL WAS YESTERDAY. ANOTHER GUY WAS WORKING WITH ME ON PROJECT IN THE MIDST OF THE PROJECT HIS SON DIED LAST THURSDAY. THEY BAR RID HIM SATURDAY. HA DO THE NEXT FEW MONTHS LOOK LIKE. DR. RIVER INTERESTS THE JOHNS HOPKINS CENTER FOR HEALTH SECURITY TELLS ME SHE THINKS CASE NUMBERS WOMEN PROVE THROUGH THE SPRING AND SUMMER AND CONCERNED ABOUT THE FALL DUE TO THE VARIANTS OF THE VIRUS NOW CIRCULATING. I AM JAYNE MILLER, WBAL, TV 11 YOU NEWS. >> THANK YOU. AS THE PANDEMIC CRIPPLED OUR NATION'S HEALTHCARE SYSTEM, HEALTH PROFESSIONALS STOOD FIRM ON THE FRONT LINES FIGHTING THIS INVISIBLE WAR. AND WITH WAR, SADLY, CAME HEARTACHE FOR THOUSANDS OF MARYLANDERS AS MANY PATIENTS SPENT THEIR LAST MOMENTS, NOT SURROUNDED BY FAMILY, BUT DOCTORS AND NURSES 11-NEWS' REPORTER TRE WARD SAT DOWN WITH A FRONT LINE NURSE TO TALK ABOUT WHAT HE'S EXPERIENCED OVER THE PAST YEAR. TRE: FOR THE LAST 14 YEARS, NURSE ANDREW ROWLINGSON HAS WORKED HERE AT THE UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL CENTER AS A BEDSIDE NURSE. BUT, IT WAS THE PAST YEAR WHERE HIS JOB WOULD BE CHALLENGED. [BEEPING HEART BEAT MACHINE >> KNOWING THAT THEIR FAMILIES WERE HOURS AND HOURS AWAY, AND THEY WERE JUST THE SICKEST OF THE SICK >> WORKING TO KEEP MAINTAIN LIVES. KNOW, WITH COVID HITTING. EVERYTHING SHUTTING DOWN. NOT BEING ABLE TO HAVE VISITORS. YOU FELT THAT LONELINESS, THAT PATIENTS CAN GO THROUGH HERE. REPORTER: NURSE ROWLINGSON SPENT THE 14-AREA CAREER. >> I REALLY CONNECTED WITH THE BEDSIDE AND INSPIRED BY THE PATIENTS AND THE WORK THAT YOU DO, BAITS REALLY, IT REALLY MATTERS. REPORT WHERE WERE WE PET INSIDE OF THE GARDEN. A JUST LITTER LAY SPACE FOR STAFF, FAMILY, PATIENTS EVEN ITS NAMESAKE. A THIS HAS ACTUALLY BEEN A PRETTY GREAT SPACE FOR EVERYBODY. >> HOPING NOT ONLY PATIENTS, BUT STAFF GET THROUGH SOME DARK TIMES. >> ON THROUGH COVID. THIS HAS BEEN AN ESCAPE TO BE OUT HERE. WE BROUGHT A HANDFUL DOWN HERE FROM THE CRITICAL CARE UNIT AND WE BROUGHT THEM DOWN HEAR AND IT HAS TURNED HE COURSE OF THE RECOVERIES AROUND. HE SAID THERE WERE TIMES WHEN RECOVERY WAS NOT AN OPTION AS THE PAST YEAR IN THE FACE SAW DEATH OVER. >> SOME CINEMAS WERE SO SICK CUE NOT TALK TO THE MAINTAIN. WITHIN HOURS OF THEM ARRIVING. YOU JUST KNEW THAT WERE NOT GOING TO MAKE IT. >> AND OVER. >> OVER. >> MAKING THAT PHONE CAL TO, NO HE, TO FAMILY YOU NEVER MET, TO LET THEM KNOW, YOU MADE IT HERE, BUT YOU KNOW, YOUR LOVED WINCE NOT GOING TO MAKE. YOU. >> A IT IS A HARD CONVERSATION. >> BUT THERE WAS ONCE SADNESS IN THE HALLWAYS, NOW LIVES OPTIMISM. THE FIRST DAY WE HAVE NO PATIENCES WITH CO SLIND ICU. WHICH IS PRETTY GREAT. >> AFTER YEARLONG BATTLE FIGHTING TO FEET THIS INVISIBLE OPPONENT. >> THERE WAS A LOT OF TALK EARLY ON WITH THIS SAYING NO ONE ASKED FOR THIS. THIS IS NOT WHAT NURSES SIGNED UP FOR. THIS IS WHAT DOCTORS SIGNED UP FOR OTHER ANYONE. IT IS WHAT WAS HANDED US TO AND INSPIRED BY JUST THE SHEER RESOLVE OF THE PEOPLE IN THE INDUSTRY WHO STOOD UP. SACK FY SACRIFICE SOD MUCH. >> HEROIC SACRIFICE STANG UP AGAINST EVER CHANGING DY SEES KEEP COUNTLESS PEOPLE LIVING ANOTHER DAY. >> THAT IS ONE OF THE THINGS THAT IS IMPRESSED ABOUT THIS INDUSTRIES THE RESILIENCE, JUST THE SHEER POWER OF THE PEOPLE TO MAKE, MAKE THINGS WORK TO OVERCOME THE OBSTACLE THAT WE FACE. ALL THE CHALLENGES TO NOT LENT AT SOLVING THE PROBLEMS THEN TRYING TO OVERCOME. >> REPORTING FROM TOWNSEND, T RE

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COVID-19 in Maryland: interactive map, case data, helpful links

What's New: Week of April 19, 2021The United States will likely move to resume Johnson & Johnson's COVID-19 vaccine this coming week, possibly with restrictions or broader warnings after reports of some very rare blood clot cases, according to Dr. Anthony Fauci.|| Vaccine Info | Where to get tested | Timeline ||Half of all adults in the U.S. have received at least one COVID-19 shot, the government announced Sunday, marking another milestone in the nation's largest-ever vaccination campaign but leaving more work to do to convince skeptical Americans to roll up their sleeves.As many states see spikes in COVID-19 cases, a doctor in Michigan said she's seeing an all-time high of kids with the virus, and she has seen two main symptoms.Don't see interactive map/graphs? Tap hereBy the numbers: Wednesday, April 21Number of confirmed cases : 438,789Number of persons tested negative : 3,286,372Total testing volume : 9,395,658Daily testing Volume : 27,330Number of confirmed deaths : 8,419Number of probable deaths : 186Currently hospitalized : 1,279Acute care : 979Intensive care : 300Ever hospitalized : 40,487Released from isolation : 10,115Statewide positivity rate (MDH): 5.28%More MDH data: Nursing home cases | School outbreaks | Contact tracing dataCases and Deaths Data BreakdownNote: Parenthesis = Number of confirmed deathsAsterisk = Number of probable deathsNH = Non-HispanicCASES, (DEATHS) & PROBABLE DEATHS* BY COUNTY:Allegany 6,734 (205) 1*Anne Arundel 41,610 (572) 14*Baltimore City 49,592 (980) 23*Baltimore County 61,567 (1,402) 35*Calvert 4,081 (75) 1*Caroline 2,237 (24) 0*Carroll 8,895 (226) 5*Cecil 5,875 (126) 2*Charles 10,328 (183) 2*Dorchester 2,628 (49) 1*Frederick 19,182 (305) 9*Garrett 1,952 (61) 1*Harford 15,700 (264) 4*Howard 18,497 (224) 6*Kent 1,289 (43) 2*Montgomery 69,049 (1,460) 46*Prince George's 81,701 (1,399) 29*Queen Anne's 2,853 (42) 1*St. Mary's 5,701 (123) 0*Somerset 2,520 (37) 0*Talbot 2,038 (36) 0*Washington 13,907 (268) 3*Wicomico 7,336 (152) 0*Worcester 3,517 (96) 1*Data not available 0 (67) 0*CASES, (DEATHS) & PROBABLE DEATHS* BY AGE:0-9 23,645 (3) 0*10-19 44,251 (6) 1*20-29 80,524 (37) 1*30-39 75,154 (85) 6*40-49 65,724 (238) 5*50-59 65,758 (686) 25*60-69 43,934 (1,379) 18*70-79 24,270 (2,155) 38*80+ 15,529 (3,828) 92*Data not available 0 (2) 0*CASES, (DEATHS) & PROBABLE DEATHS* BY GENDER:Female 229,303 (4,048) 91*Male 209,486 (4,371) 95*CASES, (DEATHS) & PROBABLE DEATHS* BY RACE AND ETHNICITY:African American (NH) 133,087 (2,930) 67*Asian (NH) 10,576 (295) 7*White (NH) 154,577 (4,288) 97*Hispanic 67,220 (759) 15*Other (NH) 20,511 (83) 0*Data not available 52,818 (64) 0*ZIP CODES WITH HIGHEST CASE COUNTS:20906 - Aspen Hill: 6,586 cases21740 - Hagerstown: 5,902 cases20783 - Adelphi: 5,343 cases20904 - Colesville: 4,976 cases20902 - Wheaton/Glenmont: 4,845 casesMore ZIP codes 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 does Maryland compare to other states?Mobile users tap here to see the interactive map.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HELPFUL LINKS GET TESTED: Where and how to get tested for coronavirus in MarylandCOVID-19 DATA: Johns Hopkins | Maryland Department of Health | en EspañolBALTIMORE DATA: Baltimore City coronavirus data, resourcesSCHOOL DASHBOARDS: Carroll | City | Baltimore Co. | HowardTIMELINE: See a comprehensive timeline of the coronavirus in MarylandWhat are the COVID-19 restrictions in Maryland? Gov. Larry Hogan lifted capacity limits and some COVID-19 restrictions, which took effect March 12.WHERE TO GET TESTEDShould I get tested for COVID-19? Where can I get a test in Maryland?The Centers for Disease Control and Prevention recommends you should consider taking a COVID-19 test if you:have symptoms of COVID-19.have had close contact (within 6 feet for a total of 15 minutes or more) with someone with confirmed COVID-19.have been asked or referred to get testing by their health care provider, local/external icon or state ​health department.Tap here for updated information on state testing sites, and see an map of testing locations.WHERE TO GET THE VACCINEClick here for more information about where to get the COVID-19 vaccine in Maryland.UNEMPLOYMENTApply for unemployment insurance online here, or call 410-949-0022.Click here to access the BEACON applicationIf you have questions about the new application, you can read the DOL's BEACON One-Stop FAQs.More information: How to apply for unemployment insuranceFOOD STAMPS (SNAP), MEDICAL ASSISTANCE, WICFAQ for SNAP and medical assistance and other social servicesInformation on WIC -- nutrition program for women, infants and children, administered through the Maryland Department of HealthFOOD, CASH, MEDICAL, ENERGY, EMERGENCY ASSISTANCESubmit food, cash, energy, emergency and aged/blind/disabled medical assistance applications online via the Department of Human Services website or the MyDHR portal. Medical Assistance applications for families, children and pregnant women should be submitted by visiting the Maryland Health Connection website. Those who need long-term care medical assistance should submit applications, redetermination applications and verifications through the My MDThink Portal. COVID SURVIVORS WEBSITEThe state launched an online registry for those who have recovered from the coronavirus."Each of the recovered coronavirus patients in Maryland has a story to tell and a role to play in our efforts to save lives and slow the spread of this virus," Hogan said April 10.COVID CONNECT will serve as a community platform to share experiences and to lend support to others who are coping with the recovery process.VOLUNTEERMarylanders can donate their time and talents by signing up for the Maryland Responds Reserve Medical Corps, donate blood and support local food banks, places of worship and other charitable organizations.SENIOR CITIZENSMaryland is helping to keep families connected with the nation's first-ever Senior Call Check Program. Participants who are 65 years or older will receive a call every day between 8 a.m. and 4 p.m., depending on which time window they choose. If they can't be reached, officials will call someone designated by the participant to check up on them.To register, call 866-50-CHECK or visit aging.maryland.gov to register.COVID-19 - What you should knowThe following information is from the CDC: The following symptoms may appear two to 14 days after exposure. This list does not include all possible symptoms. The CDC will continue to update this list as they learn more about the virus.Fever or chillsCoughShortness of breath or difficulty breathingFatigue Muscle or body achesHeadacheSore throatNew loss of taste or smellCongestion or runny noseNausea of vomitingDiarrheaReported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus cases. Emergency care for COVID-19 symptomsThe CDC says to look for emergency warning signs for coronavirus. If someone is showing any of these signs, seek emergency medical care immediately:Trouble breathingPersistent pain or pressure in the chestNew confusionInability to wake or stay awakeBluish lips or faceThis list is not all possible symptoms. Call your medical provider for any other symptoms that are severe or concerning to you. Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.Who is most at risk for COVID-19?Anyone can have mild to severe symptoms of COVID-19, according to the CDC.Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from the virus.Flu or COVID-19: What's the difference?Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone. That's when testing may be needed to help confirm a diagnosis.There are some key differences between flu and COVID-19. The CDC says it seems COVID-19 spreads more easily than flu and causes more serious illnesses in some people. It can also take longer before people show symptoms of COVID-19 and people can be contagious for a longer period of time than the flu. Know how to protect yourself and othersKnow what to do if you are sickGet more CDC coronavirus information here

What's New: Week of April 19, 2021

The United States will likely move to resume Johnson & Johnson's COVID-19 vaccine this coming week, possibly with restrictions or broader warnings after reports of some very rare blood clot cases, according to Dr. Anthony Fauci.

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|| Vaccine Info | Where to get tested | Timeline ||

Half of all adults in the U.S. have received at least one COVID-19 shot, the government announced Sunday, marking another milestone in the nation's largest-ever vaccination campaign but leaving more work to do to convince skeptical Americans to roll up their sleeves.

As many states see spikes in COVID-19 cases, a doctor in Michigan said she's seeing an all-time high of kids with the virus, and she has seen two main symptoms.

Don't see interactive map/graphs? Tap here

By the numbers: Wednesday, April 21

Number of confirmed cases : 438,789

Number of persons tested negative : 3,286,372
Total testing volume : 9,395,658
Daily testing Volume : 27,330
Number of confirmed deaths : 8,419
Number of probable deaths : 186
Currently hospitalized : 1,279
Acute care : 979
Intensive care : 300
Ever hospitalized : 40,487
Released from isolation : 10,115

Statewide positivity rate (MDH): 5.28%

More MDH data: Nursing home cases | School outbreaks | Contact tracing data

Cases and Deaths Data Breakdown

Note: Parenthesis = Number of confirmed deaths
Asterisk = Number of probable deaths
NH = Non-Hispanic

CASES, (DEATHS) & PROBABLE DEATHS* BY COUNTY:

Allegany 6,734 (205) 1*

Anne Arundel 41,610 (572) 14*

Baltimore City 49,592 (980) 23*

Baltimore County 61,567 (1,402) 35*

Calvert 4,081 (75) 1*

Caroline 2,237 (24) 0*

Carroll 8,895 (226) 5*

Cecil 5,875 (126) 2*

Charles 10,328 (183) 2*

Dorchester 2,628 (49) 1*

Frederick 19,182 (305) 9*

Garrett 1,952 (61) 1*

Harford 15,700 (264) 4*

Howard 18,497 (224) 6*

Kent 1,289 (43) 2*

Montgomery 69,049 (1,460) 46*

Prince George's 81,701 (1,399) 29*

Queen Anne's 2,853 (42) 1*

St. Mary's 5,701 (123) 0*

Somerset 2,520 (37) 0*

Talbot 2,038 (36) 0*

Washington 13,907 (268) 3*

Wicomico 7,336 (152) 0*

Worcester 3,517 (96) 1*

Data not available 0 (67) 0*

CASES, (DEATHS) & PROBABLE DEATHS* BY AGE:

0-9 23,645 (3) 0*

10-19 44,251 (6) 1*

20-29 80,524 (37) 1*

30-39 75,154 (85) 6*

40-49 65,724 (238) 5*

50-59 65,758 (686) 25*

60-69 43,934 (1,379) 18*

70-79 24,270 (2,155) 38*

80+ 15,529 (3,828) 92*

Data not available 0 (2) 0*

CASES, (DEATHS) & PROBABLE DEATHS* BY GENDER:

Female 229,303 (4,048) 91*

Male 209,486 (4,371) 95*

CASES, (DEATHS) & PROBABLE DEATHS* BY RACE AND ETHNICITY:

African American (NH) 133,087 (2,930) 67*

Asian (NH) 10,576 (295) 7*

White (NH) 154,577 (4,288) 97*

Hispanic 67,220 (759) 15*

Other (NH) 20,511 (83) 0*

Data not available 52,818 (64) 0*

ZIP CODES WITH HIGHEST CASE COUNTS:

20906 - Aspen Hill: 6,586 cases

21740 - Hagerstown: 5,902 cases

20783 - Adelphi: 5,343 cases

20904 - Colesville: 4,976 cases

20902 - Wheaton/Glenmont: 4,845 cases

More ZIP codes here

How does Maryland compare to other states?

Mobile users tap here to see the interactive map.

HELPFUL LINKS

What are the COVID-19 restrictions in Maryland?

Gov. Larry Hogan lifted capacity limits and some COVID-19 restrictions, which took effect March 12.

WHERE TO GET TESTED

Should I get tested for COVID-19? Where can I get a test in Maryland?

The Centers for Disease Control and Prevention recommends you should consider taking a COVID-19 test if you:

  • have symptoms of COVID-19.
  • have had close contact (within 6 feet for a total of 15 minutes or more) with someone with confirmed COVID-19.
  • have been asked or referred to get testing by their health care provider, local/external icon or state ​health department.

Tap here for updated information on state testing sites, and see an map of testing locations.

WHERE TO GET THE VACCINE

Click here for more information about where to get the COVID-19 vaccine in Maryland.

UNEMPLOYMENT

Apply for unemployment insurance online here, or call 410-949-0022.

If you have questions about the new application, you can read the DOL's BEACON One-Stop FAQs.

More information: How to apply for unemployment insurance

FOOD STAMPS (SNAP), MEDICAL ASSISTANCE, WIC

Information on WIC -- nutrition program for women, infants and children, administered through the Maryland Department of Health

FOOD, CASH, MEDICAL, ENERGY, EMERGENCY ASSISTANCE

Submit food, cash, energy, emergency and aged/blind/disabled medical assistance applications online via the Department of Human Services website or the MyDHR portal.

Medical Assistance applications for families, children and pregnant women should be submitted by visiting the Maryland Health Connection website. Those who need long-term care medical assistance should submit applications, redetermination applications and verifications through the My MDThink Portal.

COVID SURVIVORS WEBSITE

The state launched an online registry for those who have recovered from the coronavirus.

"Each of the recovered coronavirus patients in Maryland has a story to tell and a role to play in our efforts to save lives and slow the spread of this virus," Hogan said April 10.

COVID CONNECT will serve as a community platform to share experiences and to lend support to others who are coping with the recovery process.

VOLUNTEER

Marylanders can donate their time and talents by signing up for the Maryland Responds Reserve Medical Corps, donate blood and support local food banks, places of worship and other charitable organizations.

SENIOR CITIZENS

Maryland is helping to keep families connected with the nation's first-ever Senior Call Check Program. Participants who are 65 years or older will receive a call every day between 8 a.m. and 4 p.m., depending on which time window they choose. If they can't be reached, officials will call someone designated by the participant to check up on them.

To register, call 866-50-CHECK or visit aging.maryland.gov to register.

COVID-19 - What you should know

The following information is from the CDC: The following symptoms may appear two to 14 days after exposure. This list does not include all possible symptoms. The CDC will continue to update this list as they learn more about the virus.

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Congestion or runny nose
  • Nausea of vomiting
  • Diarrhea

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus cases.

Emergency care for COVID-19 symptoms

The CDC says to look for emergency warning signs for coronavirus. If someone is showing any of these signs, seek emergency medical care immediately:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face

This list is not all possible symptoms. Call your medical provider for any other symptoms that are severe or concerning to you. Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

Who is most at risk for COVID-19?

Anyone can have mild to severe symptoms of COVID-19, according to the CDC.

Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from the virus.

Flu or COVID-19: What's the difference?

Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone. That's when testing may be needed to help confirm a diagnosis.

There are some key differences between flu and COVID-19. The CDC says it seems COVID-19 spreads more easily than flu and causes more serious illnesses in some people. It can also take longer before people show symptoms of COVID-19 and people can be contagious for a longer period of time than the flu.

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