Coronavirus disease 19 with gastrointestinal symptoms as initial manifestations: a case report.

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019, an epidemic has spread rapidly worldwide. COVID-19 is caused by the highly infectious severe acute respiratory syndrome coronavirus-2. A 42-year-old woman presented to hospital who was suffering from epigastric discomfort and dyspepsia for the past 5 days. Before the onset of symptoms, she was healthy, and had no travel history to Wuhan or contact with laboratory-confirmed COVID-19 cases. An examination showed chronic superficial gastritis with erosion and esophagitis. Enhanced magnetic resonance imaging of the abdomen showed a lesion in the right lower lobe of the lungs. Chest computed tomography showed multiple ground-glass opacity in the lungs. Reverse transcription-polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus-2. There was no improvement after antibiotic treatment. Polymerase chain reaction performed 2 days later was positive and she was diagnosed with COVID-19. After several days of antiviral and symptomatic treatments, her symptoms improved and she was discharged. None of the medical staff were infected. Clinical manifestations of COVID-19 are nonspecific, making differentiating it from other diseases difficult. This case shows the sequence in which symptoms developed in a patient with COVID-19 with gastrointestinal symptoms as initial manifestations.

In-flight transmission cluster of COVID-19: a retrospective case series.

BACKGROUND: No data is available about in-flight transmission of SARS-CoV-2. Here, we report an in-flight transmission cluster of COVID-19 and describe the clinical characteristics of these patients. METHODS: After a flight, laboratory-confirmed COVID-19 was reported in 12 patients. Ten patients were admitted to the designated hospital. Data was collected from 25th January to 28th February 2020. Clinical information was retrospectively collected. RESULTS: All patients were passengers, and none were flight attendants. The median age was 33 years, and 70% were females. None was admitted to intensive care unit, and no patients died up to 28th February. The median incubation period was 3.0 days and time from onset of illness to hospital admission was 2 days. The most common symptom was fever. Two patients were asymptomatic and had normal chest CT scan during hospital stay. On admission, initial RT-PCR was positive in 9 patients, and initial chest CT was positive in half of the patients. The median lung 'total severity score' of chest CT was 6. 'Crazy-paving' pattern, pleural effusion, and ground-glass nodules were seen. CONCLUSION: There is potential for COVID-19 transmission in aeroplanes, but the symptoms were mild in our patients. Passengers and attendants must be protected during flights.