A Case of Critically Ill Infant of Coronavirus Disease 2019 With Persistent Reduction of T Lymphocytes.
冠状病毒病 2019 危重婴儿 1 例，T淋巴细胞持续减少。
- 作者列表："Qiu L","Jiao R","Zhang A","Chen X","Ning Q","Fang F","Zeng F","Tian N","Zhang Y","Huang Y","Sun Z","Dhuromsingh M","Li H","Li Y","Xu R","Chen Y","Luo X
BACKGROUND:The outbreak of coronavirus disease 2019 (COVID-19) is becoming a global threat. However, our understanding of the clinical characteristics and treatment of critically ill pediatric patients and their ability of transmitting the coronavirus that causes COVID-19 still remains inadequate because only a handful pediatric cases of COVID-19 have been reported. METHODS:Epidemiology, clinical characteristics, treatment, laboratory data and follow-up information and the treatment of critically ill infant were recorded. RESULTS:The infant had life-threatening clinical features including high fever, septic shock, recurrent apnea, petechiae and acute kidney injury and persistent declined CD3+, CD4+ and CD8+ T cells. The duration of nasopharyngeal virus shedding lasted for 49 days even with the administration of lopinavir/ritonavir for 8 days. The CD3+, CD4+ and CD8+ T cells was partially recovered 68 days post onset of the disease. Accumulating of effector memory CD4+ T cells (CD4+TEM) was observed among T-cell compartment. The nucleic acid tests and serum antibody for the severe acute respiratory syndrome coronavirus 2 of the infant's mother who kept intimate contact with the infant were negative despite no strict personal protection. CONCLUSIONS:The persistent reduction of CD4+ and CD8+ T cells was the typical feature of critically ill infant with COVID-19. CD4+ and CD8+ T cells might play a key role in aggravating COVID-19 and predicts a more critical course in children. The prolonged nasopharyngeal virus shedding was related with the severity of respiratory injury. The transmission of SARS-CoV-2 from infant (even very critical cases) to adult might be unlikely.
背景: 冠状病毒疾病 2019 (新型冠状病毒肺炎) 的爆发正在成为全球性威胁。然而，我们对危重儿科患者的临床特征和治疗以及他们传播导致新型冠状病毒肺炎的冠状病毒的能力的了解仍然不足，因为只有少数儿科病例报告了新型冠状病毒肺炎。 方法: 流行病学、临床特点、治疗方法、实验室资料及随访资料和治疗危重症婴儿记录. 结果: 患儿临床表现发热感染休克、反复呼吸暂停、瘀点及急性肾损伤，CD3 + 、CD4 + 、CD8 + T细胞持续下降。即使给予洛匹那韦/利托那韦 8 天，鼻咽病毒脱落的持续时间仍持续 49 天。发病后 68 天CD3 + 、CD4 + 和CD8 + T细胞部分恢复。观察到效应记忆CD4 + T细胞 (CD4 + TEM) 在T细胞间的积累。尽管没有严格的个人保护，但与婴儿密切接触的婴儿母亲的新型冠状病毒核酸检测和血清抗体均为阴性。 结论: CD4 + 和CD8 + T细胞持续减少是危重患儿新型冠状病毒肺炎的典型特征。CD4 + 和CD8 + T细胞可能在加重儿童新型冠状病毒肺炎中起关键作用，并预示着更为关键的病程。鼻咽病毒长时间脱落与呼吸损伤的严重程度有关。SARS-CoV-2 从婴儿 (甚至是非常危急的病例) 传染给成人的可能性不大。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.