ABSTRACT
Background A pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been spreading over the world. However, the viral dynamics, host serologic responses, and their associations with clinical manifestations, have not been well described in prospective cohort. Methods We conducted a prospective cohort and enrolled 67 COVID-19 patients admitting between Jan 26 and Feb 5, 2020. Clinical specimens including nasopharyngeal swab, sputum, blood, urine and stool were tested periodically according to standardized case report form with final follow-up on February 27. The routes and duration of viral shedding, antibody response, and their associations with disease severity and clinical manifestations were systematically evaluated. Coronaviral particles in clinical specimens were observed by transmission electron microscopy (TEM). Results The median duration of SARS-CoV-2 RNA shedding were 12 (3-38), 19 (5-37), and 18 (7-26) days in nasopharyngeal swabs, sputum and stools, respectively. Only 13 urines (5.6%) and 12 plasmas (5.7%) were viral positive. Prolonged viral shedding was observed in severe patients than that of non-severe patients. Cough but not fever, aligned with viral shedding in clinical respiratory specimens, meanwhile the positive stool-RNA appeared to align with the proportion who concurrently had cough and sputum production, but not diarrhea. Typical coronaviral particles could be found directly in sputum by TEM. The anti-nucleocapsid-protein IgM started on day 7 and positive rate peaked on day 28, while that of IgG was on day 10 and day 49 after illness onset. IgM and IgG appear earlier, and their titers are significantly higher in severe patients than non-severe patients (p<0.05). The weak responders for IgG had a significantly higher viral clearance rate than that of strong responders (p= 0.011). Conclusions Nasopharyngeal, sputum and stools rather than blood and urine, were the major shedding routes for SARS-CoV-2, and meanwhile sputum had a prolonged viral shedding. Symptom cough seems to be aligned with viral shedding in clinical respiratory and fecal specimens. Stronger antibody response was associated with delayed viral clearance and disease severity.
Subject(s)
COVID-19ABSTRACT
Background Chest computed tomography (CT) provides insight into the progression and prognosis of COVID-19 pneumonia. Purpose To quantify the chest CT scans of patients with CODIV-19 pneumonia using the pulmonary inflammation index (PII)and associate it with the severity of pneumonia. Methods A total of thirty inpatients admitted between January 30 and February 29, 2020 with confirmed COVID-19 infection were enrolled in this retrospective review. Patients were classified as “severe”(those who met the severe pneumonia criteria) or “mild”. Chest CT scans and clinical statistics data were obtained at four milestones (the date of admission, 3 days after treatment, 1 week after treatment and the time the last CT scan was obtained before discharge orthe completionof our research). Results Thirty patients (18 males and 12 females, age 20–74 years) with confirmed COVID-19pneumonia were evaluated. Increased neutrophilswere noted in 11 (36.7%) patients and decreased in 3 (10%) patients. Elevation of C-reactive protein (CRP) in 22 (73.3%) patients and erythrocyte sedimentation rate in 27 (90%) patient were observed, but elevation of procalcitonin was not obvious. Seven (53.8%) patients had elevation of lactate dehydrogenase (LDH).The presentation of CT opacities was mainly in the form of distribution in both the severe andmild groups. The mean PII score in the severe group was 58% and 13.7% in the mild group. The score in the severe group was more than 50%and less than 20%in the mild group at every milestone. The score in the severe group was always higher than the mild group, therefore, the severity of the disease may be positively correlated with PII score. Conclusion The pulmonary inflammation index (PII) score of chest CT scans correlated with coronavirus disease (COVID-19) progression and could be used to indicate severity in patients.