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Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.

2020 年 1-3 月浙江省SARS-CoV-2 患者病毒载量动态和疾病严重程度: 回顾性队列研究。

  • 影响因子:0
  • DOI:10.1136/bmj.m1443
  • 作者列表:"Zheng S","Fan J","Yu F","Feng B","Lou B","Zou Q","Xie G","Lin S","Wang R","Yang X","Chen W","Wang Q","Zhang D","Liu Y","Gong R","Ma Z","Lu S","Xiao Y","Gu Y","Zhang J","Yao H","Xu K","Lu X","Wei G","Zhou J","Fang Q","Cai H","Qiu Y","Sheng J","Chen Y","Liang T
  • 发表时间:2020-04-21

OBJECTIVE:To evaluate viral loads at different stages of disease progression in patients infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first four months of the epidemic in Zhejiang province, China. DESIGN:Retrospective cohort study. SETTING:A designated hospital for patients with covid-19 in Zhejiang province, China. PARTICIPANTS:96 consecutively admitted patients with laboratory confirmed SARS-CoV-2 infection: 22 with mild disease and 74 with severe disease. Data were collected from 19 January 2020 to 20 March 2020. MAIN OUTCOME MEASURES:Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed. RESULTS:3497 respiratory, stool, serum, and urine samples were collected from patients after admission and evaluated for SARS-CoV-2 RNA viral load. Infection was confirmed in all patients by testing sputum and saliva samples. RNA was detected in the stool of 55 (59%) patients and in the serum of 39 (41%) patients. The urine sample from one patient was positive for SARS-CoV-2. The median duration of virus in stool (22 days, interquartile range 17-31 days) was significantly longer than in respiratory (18 days, 13-29 days; P=0.02) and serum samples (16 days, 11-21 days; P<0.001). The median duration of virus in the respiratory samples of patients with severe disease (21 days, 14-30 days) was significantly longer than in patients with mild disease (14 days, 10-21 days; P=0.04). In the mild group, the viral loads peaked in respiratory samples in the second week from disease onset, whereas viral load continued to be high during the third week in the severe group. Virus duration was longer in patients older than 60 years and in male patients. CONCLUSION:The duration of SARS-CoV-2 is significantly longer in stool samples than in respiratory and serum samples, highlighting the need to strengthen the management of stool samples in the prevention and control of the epidemic, and the virus persists longer with higher load and peaks later in the respiratory tissue of patients with severe disease.


前言: 目的: 探讨病毒载量不同阶段的疾病进展的患者感染了 2019 新型冠状病毒 (SARS-CoV-2) 前四个月的流行浙江省 [j]. 设计: 回顾性队列研究。 单位: 浙江省新型冠状病毒肺炎患者定点医院。 研究对象: 96 例连续入院的实验室确诊SARS-CoV-2 感染患者: 轻症 22 例,重症 74 例。数据收集时间为 2020 年 1 月 19 日至 20 20 年 3 月 20 日。 主要观察指标: 在呼吸、粪便、血清和尿液样本中测定核糖核酸 (RNA) 病毒载量。循环阈值,核酸浓度的测量值,绘制在基于标准品构建的标准曲线上。通过电子病历中的数据收集表格获得流行病学、临床和实验室特征以及治疗和结局数据,并分析临床数据与疾病严重程度之间的关系。 结果: 患者入院后采集了 3497 份呼吸道、粪便、血清和尿液样本,评估SARS-CoV-2 RNA病毒载量。所有患者均通过检测痰液和唾液样本确诊感染。在 55 例 (59%) 患者的粪便和 39 例 (41%) 患者的血清中检测到RNA。1 例患者的尿液样本为SARS-CoV-2 阳性。粪便中病毒的中位持续时间 (22 天,四分位数间距 17-31 天) 显著长于呼吸系统 (18 天,13-29 天; P = 0.02) 和血清样本 (16 天,11-21 天; P<0.001)。重症患者呼吸道样本中病毒的中位持续时间 (21 天,14-30 天) 明显长于轻症患者 (14 天,10-21 天; P = 0.04)。在轻度组中,病毒载量在发病后第二周的呼吸样本中达到高峰,而在重度组中病毒载量在第三周持续较高。60 岁以上患者和男性患者病毒持续时间较长。 结论: 粪便标本SARS-CoV-2 时间明显长于呼吸道和血清标本,突出了在疫情防控中加强粪便标本管理的必要性,病毒在重症患者呼吸道组织中持续时间较长,负荷较高,高峰较晚。



作者列表:["Lim J","Jeon S","Shin HY","Kim MJ","Seong YM","Lee WJ","Choe KW","Kang YM","Lee B","Park SJ"]

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.

作者列表:["Zhang W","Du RH","Li B","Zheng XS","Yang XL","Hu B","Wang YY","Xiao GF","Yan B","Shi ZL","Zhou P"]

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.

翻译标题与摘要 下载文献
作者列表:["Cheng ZJ","Shan J"]

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.