Diagnostic performance of chest CT to differentiate COVID-19 pneumonia in non-high-epidemic area in Japan.
- 作者列表："Himoto Y","Sakata A","Kirita M","Hiroi T","Kobayashi KI","Kubo K","Kim H","Nishimoto A","Maeda C","Kawamura A","Komiya N","Umeoka S
PURPOSE:To evaluate the diagnostic performance of chest CT to differentiate coronavirus disease 2019 (COVID-19) pneumonia in non-high-epidemic area in Japan. MATERIALS AND METHODS:This retrospective study included 21 patients clinically suspected COVID-19 pneumonia and underwent chest CT more than 3 days after the symptom onset: six patients confirmed COVID-19 pneumonia by real-time reverse-transcription polymerase chain reaction (RT-PCR) and 15 patients proved uninfected. Using a Likert scale and its receiver operating characteristic curve analysis, two radiologists (R1/R2) evaluated the diagnostic performance of the five CT criteria: (1) ground glass opacity (GGO)-predominant lesions, (2) GGO- and peripheral-predominant lesions, (3) bilateral GGO-predominant lesions; (4) bilateral GGO- and peripheral-predominant lesions, and (5) bilateral GGO- and peripheral-predominant lesions without nodules, airway abnormalities, pleural effusion, and mediastinal lymphadenopathy. RESULTS:All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77-0.88 for R1 and 0.78-0.92 for R2. The criterion (e) showed the highest AUC. CONCLUSION:Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.
目的: 评价胸部CT对日本非高流行区冠状病毒病 2019 (新型冠状病毒肺炎) 肺炎的鉴别诊断价值。 材料与方法: 本回顾性研究纳入 21 例临床怀疑新型冠状病毒肺炎肺炎，并在症状发作后 3 天以上接受胸部CT检查的患者: 6 例患者经实时逆转录聚合酶链反应 (RT-PCR) 证实为新型冠状病毒肺炎肺炎，15 例未感染。使用Likert量表及其受试者工作特征曲线分析，两位放射科医生 (R1/R2) 评估了五个CT标准的诊断性能 :( 1) 磨玻璃不透明度 (GGO)-优势病变，(2) GGO-和外周-优势病变，(3) 双侧GGO-优势病变; (4)双侧GGO和周边为主的病变，(5) 双侧GGO和周边为主的病变，无结节、气道异常、胸腔积液和纵隔淋巴结肿大。 结果: 所有确诊为新型冠状病毒肺炎肺炎的患者均有双侧以GGO为主的病灶，无气道异常、纵隔淋巴结肿大及胸腔积液。5 项CT标准显示中度至极好的诊断性能，曲线下面积 (AUCs) 范围R1 为 0.77-0.88，r2 为 0.78-0.92。标准 (e) 显示AUC最高。 结论: 胸部CT对鉴别新型冠状病毒肺炎肺炎与临床表现相似的其他呼吸系统疾病有一定的辅助作用。
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.