We enrolled patients with SARS-CoV-2 infection who consecutively attended the Infectious Diseases Unit of the A.O.U. Federico II of Naples, from March 2020 through April 2020. The SARS-CoV-2 RNA infection was defined by the positivity of the rhino-oropharyngeal swab for SARS-CoV-2 RNA by reverse polymerase chain reaction (rRT-PCR). Diagnosis of COVID-19 was defined by the positivity of the rhino-oropharyngeal swab for SARS-CoV-2 RNA by reverse polymerase chain reaction (rRT-PCR) and from clinical-laboratory-instrumental manifestations characteristic of this infection. In particular, as regards the clinical manifestations, they were fever, dry cough, asthenia, nasal obstruction, rhinorrhea, pharyngodynia, myalgia, diarrhea, dyspnea, hypoxemia, ARDS (Acute Respiratory Distress Syndrome), septic shock, acidosis metabolic, coagulation deficiency and MOF (Multiple Organ Failure). As for blood chemistry tests, lymphopenia, elevated transaminases, lactate dehydrogenase (LDH), creatine kinase (CPK), myoglobin, troponin T elevation (TnT), increased D-dimer, an increase in reactive protein C (PCR) and erythro-sedimentation rate (ESR). Regarding instrumental diagnostics, in the initial phase of the disease a nodular and / or interstitial pattern occurs, especially in the periphery of the parenchyma. Subsequently, frosted glass patterns develop bilaterally, infiltrative patterns. (9) In turn, patients with SARS-CoV-2 infection were distinguished by the stage of the disease, in particular they distinguished: patients with an asymptomatic form, patients with a mild-moderate form (symptoms, no pneumonia), patients with non-severe pneumonia (patient with pneumonia and no signs of severe pneumonia and no need for oxygen therapy), patients with severe pneumonia (fever or suspected respiratory infection, and at least one of the following: respiratory rate > 30 acts / min, severe breathing difficulty or SpO2 < 93% in ambient air), patients with Acute Respiratory Distress Syndrome (ARDS). (10) For each patient, a urethral swab and a rectal swab were collected at the time of SARS-CoV-2 infection. Detection of SARS-CoV-2 was conducted on each sample by reverse polymerase chain reaction (rRT-PCR). For patients who presented with a urethral swab and / or a rectal swab positive at the time of diagnosis, the swab was performed again at the time of the patient's virological recovery. The patient was defined as virologically cured, when she/he presented two rino-oropharyngeal swabs for SARS-CoV-2 RNA, performed at least 24 hours apart, negative. (11) Subjects with the following inclusion and exclusion criteria were enrolled:
-
Inclusion criteria: patient with positivity of the rhino-oropharyngeal swab for SARS-CoV-2 RNA; age > 18 years; intention to participate in the study and to sign the informed consent.
-
Exclusion criteria: age < 18 years; inability to understand or sign informed consent; any other condition that in the opinion of the experienced person could make the patient unsuitable for enrollment or that could interfere with the patient's participation in the study and its completion.
Shapiro-Wilk test was used to check for Gaussian distribution. In case of non-Gaussian Distribution, Non-parametric tests (Wilcoxon-Mann-Whitney test, Kruskal-Wallis non-parametric ANOVA) were used in case of Gaussian distribution we used t-Student testù or ANOVA. Multivariate statistical analysis (Principal Components Analysis, hierarchical clustering, Principal Coordinates Analysis) were used to identify the groupings of the samples and the definition of the variables that allowed these groupings. All significance values are adjusted to take into account the effect of multiple comparisons, using the Benjamini-Hochberg correction and a False Discovery Rate value < 0.05 was considered statistically significant. A p-value < 0.05 was considered statistically significant for all tests conducted in the study.