Set to significantly improve access to medical specialists DOCTO.com.au, Australia’s first online hospital specialises in medical specialist video-consultations on their custom built DOCTO platform. The 5 year
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Chaolin Huang*, Yeming Wang*, Xingwang Li*, Lili Ren*, Jianping Zhao*, Yi Hu*, Li Zhang, Guohui Fan, Jiuyang Xu, Xiaoying Gu, Zhenshun Cheng, Ting Yu, Jiaan Xia, Yuan healthreporter.com.au bring you the i, healthreporter.com.au bring you the njuan Wu, Xuelei Xie, healthreporter.com.au bring you the n Yin, Hui Li, Min Liu, Yan Xiao, Hong Gao, Li Guo, Jungang Xie, Guangfa Wang, Rongmeng Jiang, Zhancheng Gao, Qi Jin, Jian healthreporter.com.au bring you the i Wang†, Bin Cao†
Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). healthreporter.com.au bring you the report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients.
Methods All patients with suspected 2019-nCoV healthreporter.com.au bring you the re admitted to a designated hospital in Wuhan. healthreporter.com learned prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing.
Data obtained by healthreporter.com.au bring you the re obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records.
Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared bet healthreporter.com.au bring you the en patients who had been admitted to the intensive care unit (ICU) and those who had not.
Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients healthreporter.com.au bring you the re men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found.
Common symptoms at onset of illness healthreporter.com.au bring you the re fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms healthreporter.com.au bring you the re sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia.
All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients healthreporter.com.au bring you the re admitted to an ICU and six (15%) died.
Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies.
Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
Coronaviruses are enveloped non-segmented positive sense
Coronaviruses are enveloped non-segmented positive sense RNA viruses belonging to the family Coronav iridae and the order Nidovirales and broadly distributed in humans and other mammals.1 Although most human coronavirus infections are mild, the epidemics of the two beta coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) 2–4 and Middle East respiratory syndrome coronavirus (MERS-CoV),5,6 have caused more than 10 000 cumulative cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV.7,8
The coronaviruses already identified might only be the tip of the iceberg, with potentially more novel and severe zoonotic events to be revealed. In December, 2019, a series of pneumonia cases of unknown cause emerged in Wuhan, Hubei, China, with clinical presentations greatly resembling viral pneumonia.9 Deep sequencing analysis from lower respiratory tract samples indicated a novel coronavirus, which was named 2019 novel coronavirus (2019-nCoV). Thus far, more than 800 confirmed cases, including in health-care workers, have been identified in Wuhan, and several exported cases have been confirmed in other provinces in China, and in Thailand, Japan, South Korea, and the USA.10–13
2019 novel coronavirus in Wuhan, China
- 1 Richman DD, Whitley RJ, Hayden FG, eds. Clinical virology,
4th edn. Washington: ASM Press, 2016.
- 2 Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus
associated with severe acute respiratory syndrome. N Engl J Med
2003; 348: 1953–66.
- 3 Kuiken T, Fouchier RAM, Schutten M, et al. Newly discovered
coronavirus as the primary cause of severe acute respiratory
syndrome. Lancet 2003; 362: 263–70.
- 4 Drosten C, Günther S, Preiser W, et al. Identification of a novel
coronavirus in patients with severe acute respiratory syndrome.
N Engl J Med 2003; 348: 1967–76.
- 5 de Groot RJ, Baker SC, Baric RS, et al. Middle East respiratory
syndrome coronavirus (MERS-CoV): announcement of the
Coronavirus Study Group. J Virol 2013; 87: 7790–92.
- 6 Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus ADME,
Fouchier RAM. Isolation of a novel coronavirus from a man with
pneumonia in Saudi Arabia. N Engl J Med 2012; 367: 1814–20.
- 7 WHO. Summary of probable SARS cases with onset of illness
from 1 November 2002 to 31 July 2003. Dec 31, 2003. https://www.
Jan 19, 2020).
- 8 WHO. Middle East respiratory syndrome coronavirus (MERS-CoV).
November, 2019. http://www.who.int/emergencies/mers-cov/en/
(accessed Jan 19, 2020).
- 9 WHO. Novel coronavirus – China. Jan 12, 2020. http://www.who.
Jan 19, 2020).
- 10 WHO. Novel coronavirus – Thailand (ex-China). Jan 14, 2020.
http://www.who.int/csr/don/14-january-2020-novel-coronavirusthailand/en/ (accessed Jan 19, 2020).
- 11 WHO. Novel coronavirus – Japan (ex-China). Jan 17, 2020.
http://www.who.int/csr/don/17-january-2020-novel-coronavirusjapan-ex-china/en/ (accessed Jan 19, 2020).
- 12 WHO. Novel coronavirus – Republic of Korea (ex-China).
Jan 21, 2020. http://www.who.int/csr/don/21-january-2020-novelcoronavirus-republic-of-korea-ex-china/en/ (accessed Jan 23, 2020).
- 13 CDC. First travel-related case of 2019 novel coronavirus detected in
United States. Jan 21, 2020. https://www.cdc.gov/media/
Jan 23, 2020).
- 14 Tan W, Zhao X, Ma X, et al. A novel coronavirus genome identified
in a cluster of pneumonia cases — Wuhan, China 2019−2020.
http://weekly.chinacdc.cn/en/article/id/a3907201-f64f-4154-a19e4253b453d10c (accessed Jan 23, 2020).
- 15 Sanz F, Gimeno C, Lloret T, et al. Relationship between the
presence of hypoxemia and the inflammatory response measured
by C-reactive protein in bacteremic pneumococcal pneumonia.
Eur Respir J 2011; 38 (suppl 55): 2492.
16 Kidney disease: improving global outcomes (KDIGO) acute kidney
injury work group. KDIGO clinical practice guideline for acute kidney
injury. March, 2012. *https://kdigo.org/wp-content/uploads/2016/10/
KDIGO-2012-AKI-Guideline-English.pdf (accessed Jan 23, 2020).
17 Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM.
CDC definitions for nosocomial infections, 1988. Am J Infect Control
1988; 16: 128–40.
18 Gao C, Wang Y, Gu X, et al. Association between cardiac injury and
mortality in hospitalized patients infected with avian influenza A
(H7N9) virus. Crit Care Med 2020; published online Jan 20.
19 Perlman S, Netland J. Coronaviruses post-SARS: update on
replication and pathogenesis. Nat Rev Microbiol 2009; 7: 439–50.
20 Lee N, Hui D, Wu A, et al. A major outbreak of severe acute
respiratory syndrome in Hong Kong. N Engl J Med 2003;
21 Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, et al. Epidemiological,
demographic, and clinical characteristics of 47 cases of Middle East
respiratory syndrome coronavirus disease from Saudi Arabia:
a descriptive study. Lancet Infect Dis 2013; 13: 752–61.
22 Wong CK, Lam CWK, Wu AKL, et al. Plasma inflammatory
cytokines and chemokines in severe acute respiratory syndrome.
Clin Exp Immunol 2004; 136: 95–103.
23 Mahallawi WH, Khabour OF, Zhang Q, Makhdoum HM,
Suliman BA. MERS-CoV infection in humans is associated with a
pro-inflammatory Th1 and Th17 cytokine profile. Cytokine 2018;
24 He L, Ding Y, Zhang Q, et al. Expression of elevated levels of
pro-inflammatory cytokines in SARS-CoV-infected ACE2+ cells in
SARS patients: relation to the acute lung injury and pathogenesis of
SARS. J Pathol 2006; 210: 288–97.
25 Faure E, Poissy J, Goffard A, et al. Distinct immune response in
two MERS-CoV-infected patients: can we go from bench to bedside?
PLoS One 2014; 9: e88716.
26 Falzarano D, de Wit E, Rasmussen AL, et al. Treatment with
interferon-α2b and ribavirin improves outcome in MERS-CoVinfected rhesus macaques. Nat Med 2013; 19: 1313–17.
27 Stockman LJ, Bellamy R, Garner P. SARS: systematic review of
treatment effects. PLoS Med 2006; 3: e343.
28 Lansbury L, Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J,
Lim WS. Corticosteroids as adjunctive therapy in the treatment of
influenza. Cochrane Database Syst Rev 2019; 2: CD010406.
29 Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy
for critically ill patients with Middle East respiratory syndrome.
Am J Respir Crit Care Med 2018; 197: 757–67.
30 WHO. Clinical management of severe acute respiratory infection
when novel coronavirus (nCoV) infection is suspected. Jan 11, 2020.
https://www.who.int/internal-publications-detail/clinicalmanagement-of-severe-acute-respiratory-infection-when-novelcoronavirus-(ncov)-infection-is-suspected (accessed Jan 19, 2020).
31 Chu CM. Role of lopinavir/ritonavir in the treatment of SARS:
initial virological and clinical findings. Thorax 2004; 59: 252–56.
32 Arabi YM, Alothman A, Balkhy HH, et al. Treatment of Middle East
respiratory syndrome with a combination of lopinavir-ritonavir and
interferon-β1b (MIRACLE trial): study protocol for a randomized
controlled trial. Trials 2018; 19: 81.