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Clinical and pathological investigation of patients with severe COVID-19.

重症新型冠状病毒肺炎患者的临床及病理研究

  • 影响因子:6.01400
  • DOI:10.1172/jci.insight.138070
  • 作者列表:"Li S","Jiang L","Li X","Lin F","Wang Y","Li B","Jiang T","An W","Liu S","Liu H","Xu P","Zhao L","Zhang L","Mu J","Wang H","Kang J","Li Y","Huang L","Zhu C","Zhao S","Lu J","Ji J","Zhao J
  • 发表时间:2020-06-18
Abstract

BACKGROUND:Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has become a pandemic. This study addresses the clinical and immunopathological characteristics of severe COVID-19. METHODS:Sixty-nine patients with COVID-19 were classified into severe and nonsevere groups to analyze their clinical and laboratory characteristics. A panel of blood cytokines was quantified over time. Biopsy specimens from 2 deceased cases were obtained for immunopathological, ultrastructural, and in situ hybridization examinations. RESULTS:Circulating cytokines, including IL-8, IL-6, TNF-α, IP10, MCP1, and RANTES, were significantly elevated in patients with severe COVID-19. Dynamic IL-6 and IL-8 were associated with disease progression. SARS-CoV-2 was demonstrated to infect type II and type I pneumocytes and endothelial cells, leading to severe lung damage through cell pyroptosis and apoptosis. In severe cases, lymphopenia, neutrophilia, depletion of CD4+ and CD8+ T lymphocytes, and massive macrophage and neutrophil infiltrates were observed in both blood and lung tissues. CONCLUSIONS:A panel of circulating cytokines could be used to predict disease deterioration and inform clinical interventions. Severe pulmonary damage was predominantly attributed to both cytopathy caused by SARS-CoV-2 and immunopathologic damage. Strategies that prohibit pulmonary recruitment and overactivation of inflammatory cells by suppressing cytokine storm might improve the outcomes of patients with severe COVID-19.

摘要

研究背景: 由严重急性呼吸道冠状病毒 2 型 (新型冠状病毒肺炎) 引起的冠状病毒病 2019 (SARS-CoV-2) 已经成为一种流行病。本研究探讨重症新型冠状病毒肺炎的临床和免疫病理特点。 方法: 将 69 例新型冠状病毒肺炎患者分为重症组和非重症组,分析其临床及实验室检查特点。一组血液细胞因子随着时间的推移进行定量。获得 2 例死亡病例的活检标本进行免疫病理、超微结构和原位杂交检查。 结果: 循环细胞因子,包括IL-8 、IL-6 、TNF-α 、IP10 、MCP1 和RANTES在严重新型冠状病毒肺炎患者中显著升高。动态IL-6 和IL-8 与疾病进展相关。SARS-CoV-2 感染II型和I型肺细胞和内皮细胞,通过细胞焦亡和凋亡导致严重的肺损伤。在严重病例中,血液和肺组织均观察到淋巴细胞减少、中性粒细胞增多、CD4 + 和CD8 + T淋巴细胞耗竭以及巨噬细胞和中性粒细胞浸润。 结论: 一组循环细胞因子可用于预测疾病恶化和告知临床干预措施。严重的肺损伤主要是由于SARS-CoV-2 引起的细胞病变和免疫病理损害。通过抑制细胞因子风暴抑制肺复张和炎症细胞过度激活的策略可能改善严重新型冠状病毒肺炎患者的预后。

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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.

影响因子:4.36
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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
影响因子:2.48
发表时间:2020-04-01
来源期刊:Infection
DOI:10.1007/s15010-020-01401-y
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.

呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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