COVID-19-associated neutrophilia: Difference between revisions

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__NOTOC__
__NOTOC__
{{Main|COVID-19}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
{{SI}}
{{SI}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{FOA}}


{{SK}}  
{{SK}}WBC changes in COVID-19, SARS-COV2 related neutrophilia 


==Overview==
==Overview==
[[Coronavirus]] disease 2019 ([[COVID-19]]) first emerged in Wuhan,China in late 2019. On March 12, 2020, the [[World Health Organization]] declared the [[COVID-19]] outbreak a [[pandemic]]. There is no established system for the classification regarding [[COVID-19]] associated [[neutrophilia]]. Research suggests [[COVID-19]] associated [[neutrophilia]] could be the cause of the severe symptoms of [[COVID-19]], including [[acute respiratory distress syndrome]] ([[ARDS]]) and can be linked to the [[Neutrophil]] Extracellular Traps (NETs). [[Acute respiratory distress syndrome]] ([[ARDS]]), [[pulmonary inflammation]], thick [[mucus]] secretions in the airways, extensive [[lung]] damage, and blood clots are suggested to be a result of the action of [[Neutrophil|neutrophils]]. When [[Neutrophil|neutrophils]] detect [[Pathogen|pathogens]], they can expel their [[DNA]] in a web laced with toxic [[enzymes]] (called a Neutrophil Extracellular Trap) to attack them. These NETs capture and digest the unwanted [[pathogen]]. However, in cases of [[Acute respiratory distress syndrome|ARDS]], ([[COVID-19]] manifestation) they cause damage to the lungs and other organs. People of any age with certain underlying medical conditions are at increased risk for severe illness from [[COVID-19]]. Recent studies have shown the association of a high [[neutrophil]]-to-[[lymphocyte]] ratio (NLR) to severe forms of [[COVID-19]] disease.


==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
*[[Coronavirus]] disease 2019 ([[COVID-19]]) first emerged in Wuhan, China in late 2019.<ref name="urlWHO Western Pacific | World Health Organization">{{cite web |url=https://www.who.int/westernpacific/emergencies/covid-19 |title=WHO Western Pacific &#124; World Health Organization |format= |work= |accessdate=}}</ref>


The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
* On March 12, 2020, the [[World Health Organization]] declared the [[COVID-19]] outbreak a [[pandemic]].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
* There is no established system for the classification regarding [[COVID-19]] associated [[neutrophilia]].
 
OR
 
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
 
OR
 
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
*Study suggests [[COVID-19]] associated [[neutrophilia]] could be the cause of the severe symptoms of [[COVID-19]], including [[acute respiratory distress syndrome|acute respiratory distress syndrome (]][[Acute respiratory distress syndrome|ARDS]]). It can be linked to the Neutrophil Extracellular Traps (NETs).
 
*[[Acute respiratory distress syndrome]] ([[ARDS]]), [[pulmonary inflammation]], thick mucus secretions in the airways, extensive lung damage, and blood clots are suggested to be a result of the action of [[Neutrophil|neutrophils]]. When [[Neutrophil|neutrophils]] detect pathogens, they can expel their [[DNA]] in a web laced with toxic enzymes (Neutrophil Extracellular Trap) to attack them.
OR
*These NETs capture and digest the unwanted [[pathogen]], however, in cases of [[Acute respiratory distress syndrome|ARDS]] ([[COVID-19]] manifestation) they cause damage to the lungs and other organs.
 
*[[Neutrophilia]] as an indicator for severe disease:<ref name="CicculloBorghetti2020">{{cite journal|last1=Ciccullo|first1=Arturo|last2=Borghetti|first2=Alberto|last3=Zileri Dal Verme|first3=Lorenzo|last4=Tosoni|first4=Alberto|last5=Lombardi|first5=Francesca|last6=Garcovich|first6=Matteo|last7=Biscetti|first7=Federico|last8=Montalto|first8=Massimo|last9=Cauda|first9=Roberto|last10=Di Giambenedetto|first10=Simona|title=Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line|journal=International Journal of Antimicrobial Agents|year=2020|pages=106017|issn=09248579|doi=10.1016/j.ijantimicag.2020.106017}}</ref>
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
**Recent studies have shown the association of a high [[neutrophil]]-to-[[lymphocyte]] ratio (NLR) to severe forms of [[COVID-19]] disease.
 
**NLR >4 on admission has been linked to [[Intensive care unit|ICU]] admission.
OR
**[[COVID-19]] patients with severe disease presentation had a higher NLR on admission compared to patients with a milder [[COVID-19]] disease presentation.
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
* The [[SARS-CoV-2]] [[COVID-19]] viral infection is the known cause of [[neutrophilia]] associated disease in infected patients.


OR
==Differentiating COVID-19 related Neutrophilia from other Diseases==


Common causes of [disease] include [cause1], [cause2], and [cause3].
* [[COVID-19]] related [[neutrophilia]] starts acutely in the course of the disease, with other manifestations of the disease. [[Neutrophilia]] can occur in the following conditions:<ref name="WalkerWarnatz2006">{{cite journal|last1=Walker|first1=Ulrich A|last2=Warnatz|first2=Klaus|title=Idiopathic CD4 lymphocytopenia|journal=Current Opinion in Rheumatology|volume=18|issue=4|year=2006|pages=389–395|issn=1040-8711|doi=10.1097/01.bor.0000231908.57913.2f}}</ref>
 
**[[Acute (medicine)|Acute]] infections
OR
***[[Bacteria]] - Staphyloccoci, [[streptococci]], [[meningococci]]
 
***[[Virus (biology)|Virus]]- [[Varicella]], [[herpes zoster]]
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
***[[Fungi]]- [[Candida]], [[Coccidioides spp|coccidioides]]
 
**Non-infectious inflammation
OR
***[[Rheumatic fever]]
 
***[[Acute glomerulonephritis]]
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
***[[Collagen-vascular diseases]]
 
***[[Diabetic ketoacidosis]]
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
*The [[incidence]] of the [[coronavirus disease 2019]] ([[COVID-19]]) as of June 28, 2020 is approximately 9,843,073 cases worldwide with 495,760 deaths.<ref name="urlWHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard">{{cite web |url=https://covid19.who.int/?gclid=CjwKCAjw_-D3BRBIEiwAjVMy7NXI2vvO5rNBN-3aUwE4Lr3kcrhDJfoUkdlwlXtHXmTBoXBgseCGxRoCGpsQAvD_BwE |title=WHO Coronavirus Disease (COVID-19) Dashboard &#124; WHO Coronavirus Disease (COVID-19) Dashboard |format= |work= |accessdate=}}</ref>
 
*Patients of all age groups may develop [[COVID-19]]. However, the elderly and [[immunocompromised]] individuals are more likely to develop severe cases of [[COVID-19]].
OR
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].


OR
* People of any age with certain underlying medical conditions are at increased risk for severe illness from [[COVID-19]]. These medical conditions include:<ref name="urlPeople Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html |title=People Who Are at Higher Risk for Severe Illness &#124; Coronavirus &#124; COVID-19 &#124; CDC |format= |work= |accessdate=}}</ref>
 
**[[Chronic kidney disease]]
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
**[[Chronic obstructive pulmonary disease]]
 
**[[Immunocompromised]] state (weakened [[immune system]]) from solid organ transplant
OR
**[[Obesity]] ([[Body mass index]] ([[Body mass index|BMI]]) of 30 or higher)
 
**Serious heart conditions, such as [[heart failure]], [[coronary artery disease]], or [[cardiomyopathies]]
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
**[[Sickle cell disease]]
 
**[[Type 2 diabetes mellitus]]
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
*A high [[neutrophil]]-to-[[lymphocyte]] ratio has been linked to [[Intensive care unit|ICU]] admission. A routine [[complete blood count]] ([[Complete blood count|CBC]]) test should be done in [[COVID-19]] patients for early detection.
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common [[hematologic]] complications of [[coronavirus]] include [[COVID-19-associated lymphopenia|lymphopenia]], [[neutrophilia]] and [[COVID-19-associated thrombocytopenia|thrombocytosis]].
 
*The [[pathogenesis]] of the [[cytokine storm]] associated with [[neutrophilia]] in [[COVID-19]] patients is unclear.
OR
*It has, however, been associated with poor outcomes in patients. The neutrophil-to-[[lymphocyte]] ratio has been identified as an independent risk factor for severe disease in [[COVID-19]] patients.<ref name="EgebladZuo2020">{{cite journal|last1=Egeblad|first1=Mikala|last2=Zuo|first2=Yu|last3=Weber|first3=Andrew|last4=Yost|first4=Christian C.|last5=Spicer|first5=Jonathan D.|last6=Schwartz|first6=Robert E.|last7=Salvatore|first7=Steven|last8=Rousseau|first8=Simon|last9=Renaud|first9=Stephane|last10=Rayes|first10=Roni|last11=McAllister|first11=Florencia|last12=Looney|first12=Mark R.|last13=Loda|first13=Massimo|last14=Knight|first14=Jason S.|last15=Huynh|first15=Caroline|last16=Guerci|first16=Philippe|last17=Daßler-Plenker|first17=Juliane|last18=Crawford|first18=James M.|last19=Cools-Lartigue|first19=Jonathan|last20=Borczuk|first20=Alain|last21=Baxter-Stoltzfus|first21=Amelia|last22=Adrover|first22=Jose M.|last23=Barnes|first23=Betsy J.|title=Targeting potential drivers of COVID-19: Neutrophil extracellular traps|journal=Journal of Experimental Medicine|volume=217|issue=6|year=2020|issn=0022-1007|doi=10.1084/jem.20200652}}</ref>
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic study of Choice ===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*Peripheral [[white blood cell count]] on a [[Complete blood count|CBC]] with differential test
 
*[[Neutrophil]]-[[lymphocyte]] ratio
OR
*[[C-reactive protein]]
 
*[[Erythrocyte sedimentation rate]]
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.


OR
* [[Neutrophilia]] as a result of [[COVID-19]] can present with different symptoms. People with [[COVID-19]] have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. [[Symptoms]] may appear 2-14 days after exposure to the [[Coronavirus|virus]]. People with these symptoms may have [[COVID-19]]:<ref name="urlSymptoms of Coronavirus | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html |title=Symptoms of Coronavirus &#124; CDC |format= |work= |accessdate=}}</ref>
 
**[[Fever]] or [[chills]]
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
**[[Cough]]
**[[Shortness of breath]] (SOB) or [[difficulty breathing]]
**[[Fatigue]]
**[[Muscle]] or [[body aches]]
**[[Headache]]
**New loss of taste or [[smell]]
**Sore throat
**[[Congestion]] or [[runny nose]]
**[[Nausea]] or [[vomiting]]
**[[Diarrhea]]


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
* There are no physical findings associated with [[COVID-19]] associated [[neutrophilia]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
 
OR


Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
* For COVID-19 Physical examination click [[COVID-19 physical examination|here]].


OR
===Laboratory findings===
 
* Increased [[Neutrophil|neutrophils]] on [[Complete blood count|CBC]]
[Test] is usually normal among patients with [disease name].
* Increased [[inflammatory]] markers such as [[Interleukin 6|IL-6,]] [[C-reactive protein|CRP]]
 
* For more information about [[COVID-19]] related laboratory findings please click [[COVID-19 laboratory findings|here]].
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
* There are no [[The electrocardiogram|ECG]] findings associated with [[COVID-19]] associated [[neutrophilia]].
 
* To view the [[electrocardiogram]] findings on [[COVID-19]], [[COVID-19 electrocardiogram|click here]].
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
* There are no [[X-rays|X-ray]] findings associated with [[COVID-19]] associated [[neutrophilia]].
 
* To view [[X-rays|X-ray]] findings of COVID-19 ,click [[COVID-19 x ray|here]].
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
* There are no [[echocardiography]] or [[ultrasound]] findings associated with [[COVID-19]] associated [[neutrophilia]].
* To view the [[Echocardiography|echocardiographic]] findings on [[COVID-19]], [[COVID-19 echocardiography and ultrasound|click here]].


OR
===CT Scan===
 
* There are no [[Computed tomography|CT]] scan findings associated with [[COVID-19]] associated [[neutrophilia]].
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
* To view the [[Computed tomography|CT]] scan findings on [[COVID-19]], [[COVID-19 CT scan|click here]].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===CT scan===
There are no CT scan findings associated with [disease name].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
* There are no [[Magnetic resonance imaging|MRI]] findings associated with [[COVID-19]] associated [[neutrophilia]].
* To view the [[Magnetic resonance imaging|MRI]] findings on [[COVID-19]], [[COVID-19 MRI|click here]].


OR
===Other imaging findings===
* There are no other imaging findings associated with [[COVID-19]] associated [[neutrophilia]].


[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
* To view other imaging findings on [[COVID-19]], [[COVID-19 other imaging findings|click here]].


OR
===Other Diagnostic studies===
 
*[[Bone marrow examination|Bone marrow biopsy]], although not recommended may be helpful if there is suspicion of other disorders that can cause [[neutrophilia]] , but there is not enough evidence to support [[bone marrow biopsy]] in [[COVID-19]] patients.
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*To view other diagnostic studies for [[COVID-19]], [[COVID-19 other diagnostic studies|click here]].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
 
OR
 
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
Immune-Based Therapy:
 
*There is insufficient data to recommend either for or against the use of [[COVID-19]] [[convalescent]] [[plasma]] or [[SARS-CoV-2]] [[Immune globulin|immune globulins]] for the treatment of [[COVID-19]].
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].


OR
* The [[COVID-19]] Treatment Guidelines Panel (the Panel) recommends against the use of non-[[SARS-CoV-2]]-specific [[intravenous]] [[immune globulin]] ([[Intravenous immunoglobulin|IVIG]]) for the treatment of [[COVID-19]], except in the context of a [[clinical trial]]. This should not preclude the use of [[Intravenous immunoglobulin|IVIG]] when it is otherwise indicated for the treatment of complications that arise during the course of [[COVID-19]].


Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*There are insufficient data to recommend either for or against the use of the following agents for the treatment of [[COVID-19]]:<ref name="ZhongTang2020">{{cite journal|last1=Zhong|first1=Jixin|last2=Tang|first2=Jungen|last3=Ye|first3=Cong|last4=Dong|first4=Lingli|title=The immunology of COVID-19: is immune modulation an option for treatment?|journal=The Lancet Rheumatology|volume=2|issue=7|year=2020|pages=e428–e436|issn=26659913|doi=10.1016/S2665-9913(20)30120-X}}</ref>
**[[Interleukin 1|Interleukin-1]] inhibitors (e.g., [[Anakinra]])
**[[Interleukin-6]] inhibitors (e.g., [[Sarilumab]], [[siltuximab]], [[tocilizumab]])


OR
Except in the context of a [[clinical trial]], the panel recommends against the use of other [[Immunomodulator|immunomodulators]], such as :


Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
* [[Interferons]], because of the lack of efficacy in the treatment of [[severe acute respiratory syndrome]] ([[Severe acute respiratory syndrome|SARS]]) and [[Middle East respiratory syndrome]] ([[Middle East respiratory syndrome coronavirus infection|MERS]]) and toxicity.
*[[Janus kinase]] inhibitors (e.g., [[baricitinib]]), because of their broad [[immunosuppressive]] effect.


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
* Surgical intervention is not recommended for the management of [[COVID-19]] associated [[neutrophilia]].
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
* There are no established measures for the [[primary prevention]] of [[COVID-19]] associated [[neutrophilia]].
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
* There are no established measures for the secondary prevention of [[COVID-19]] associated [[neutrophilia]].
 
==References==  
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
 
==References==
{{reflist|2}}
{{reflist|2}}
 
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Latest revision as of 15:25, 4 August 2020

Main article: COVID-19

For COVID-19 frequently asked inpatient questions, click here
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Oluwabusola Fausat Adogba, MD[2]

Synonyms and keywords:WBC changes in COVID-19, SARS-COV2 related neutrophilia

Overview

Coronavirus disease 2019 (COVID-19) first emerged in Wuhan,China in late 2019. On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. There is no established system for the classification regarding COVID-19 associated neutrophilia. Research suggests COVID-19 associated neutrophilia could be the cause of the severe symptoms of COVID-19, including acute respiratory distress syndrome (ARDS) and can be linked to the Neutrophil Extracellular Traps (NETs). Acute respiratory distress syndrome (ARDS), pulmonary inflammation, thick mucus secretions in the airways, extensive lung damage, and blood clots are suggested to be a result of the action of neutrophils. When neutrophils detect pathogens, they can expel their DNA in a web laced with toxic enzymes (called a Neutrophil Extracellular Trap) to attack them. These NETs capture and digest the unwanted pathogen. However, in cases of ARDS, (COVID-19 manifestation) they cause damage to the lungs and other organs. People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19. Recent studies have shown the association of a high neutrophil-to-lymphocyte ratio (NLR) to severe forms of COVID-19 disease.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating COVID-19 related Neutrophilia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic study of Choice

History and Symptoms

Physical Examination

  • For COVID-19 Physical examination click here.

Laboratory findings

Electrocardiogram

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Echocardiography or Ultrasound

CT Scan

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Other imaging findings

Other Diagnostic studies

Treatment

Medical therapy

Immune-Based Therapy:

Except in the context of a clinical trial, the panel recommends against the use of other immunomodulators, such as :

Surgery

Primary Prevention

Secondary Prevention

References

  1. ↑ "WHO Western Pacific | World Health Organization".
  2. ↑ Ciccullo, Arturo; Borghetti, Alberto; Zileri Dal Verme, Lorenzo; Tosoni, Alberto; Lombardi, Francesca; Garcovich, Matteo; Biscetti, Federico; Montalto, Massimo; Cauda, Roberto; Di Giambenedetto, Simona (2020). "Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line". International Journal of Antimicrobial Agents: 106017. doi:10.1016/j.ijantimicag.2020.106017. ISSN 0924-8579.
  3. ↑ Walker, Ulrich A; Warnatz, Klaus (2006). "Idiopathic CD4 lymphocytopenia". Current Opinion in Rheumatology. 18 (4): 389–395. doi:10.1097/01.bor.0000231908.57913.2f. ISSN 1040-8711.
  4. ↑ "WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard".
  5. ↑ "People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC".
  6. ↑ Egeblad, Mikala; Zuo, Yu; Weber, Andrew; Yost, Christian C.; Spicer, Jonathan D.; Schwartz, Robert E.; Salvatore, Steven; Rousseau, Simon; Renaud, Stephane; Rayes, Roni; McAllister, Florencia; Looney, Mark R.; Loda, Massimo; Knight, Jason S.; Huynh, Caroline; Guerci, Philippe; Daßler-Plenker, Juliane; Crawford, James M.; Cools-Lartigue, Jonathan; Borczuk, Alain; Baxter-Stoltzfus, Amelia; Adrover, Jose M.; Barnes, Betsy J. (2020). "Targeting potential drivers of COVID-19: Neutrophil extracellular traps". Journal of Experimental Medicine. 217 (6). doi:10.1084/jem.20200652. ISSN 0022-1007.
  7. ↑ "Symptoms of Coronavirus | CDC".
  8. ↑ Zhong, Jixin; Tang, Jungen; Ye, Cong; Dong, Lingli (2020). "The immunology of COVID-19: is immune modulation an option for treatment?". The Lancet Rheumatology. 2 (7): e428–e436. doi:10.1016/S2665-9913(20)30120-X. ISSN 2665-9913.

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