PMC:7033263 / 6505-9976 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7033263","sourcedb":"PMC","sourceid":"7033263","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7033263","text":"Clinical features\nBased on the current epidemiological survey, most individuals had a history of close contact to a patient who had 2019-nCoV infection or a history of travel from Wuhan City or Hubei province, China. The incubation period is generally 3–7 days (within 14 days) [20].\n\nSymptoms\nThe symptoms of 2019-nCoV infection were nonspecific. The most common symptoms were onset of fever, generalized weakness and dry cough. Some patients had headache and/or myalgia, but upper respiratory symptoms such as runny nose were rare [20]. Diarrhea was often identified, which had been reported 10.6% in SARS and up to 30% in MERS [21]. More than half of patients developed shortness of breath, the median duration from disease onset to dyspnea was 8 days [2]. Patients infected with 2019-nCoV might develop acute respiratory distress syndrome (ARDS), followed by septic shock, refractory metabolic acidosis and coagulation dysfunction, if the disease could not be controlled [20].\nNotably, some patients were afebrile or confirmed biologically to have an asymptomatic infection [21]. These cryptic cases of walking pneumonia might serve as a possible source to propagate the outbreak. Further studies on the epidemiological significance of these asymptomatic cases are warranted.\n\nLaboratory findings\nThe blood cell counts of patients showed total white blood cells, lymphocyte, and platelet were lower than the average with extended activated thromboplastin time, increased C-reactive protein and muscle enzyme level. D-dimer level were higher and lymphocyte decrease progressively, if the disease had aggravation. The cytokine storm such as IL1B, IL1RA, IL7, IL8 could be associated with disease severity [2, 21].\nThe multifocal ground glass changes on chest CT scan were typical of viral pneumonia [Fig. 3]. If the disease continued to develop, the bilateral multiple lobular and subsegmental areas of consolidation would be found on chest CT scan [2, 21]. The lungs of aged patients showed more diffuse and extensive imaging than those of the younger patients [20].\nFig. 3 The multifocal ground glass changes on chest CT scan were typical of viral pneumonia in one infected 2019-nCoV patients. a shadow in right upper lobe; b shadow in bilateral lobe; c shadow in left lower lobe\n\nMicrobiological testing\nNasopharyngeal swab or sputum samples of patients were available for testing by specific RT-PCR assays for 2019-nCoV to detect the highly conserved RdRp and variable S gene. The cycle threshold values of the sputum samples were 8–13 cycles earlier than those of throat swabs, indicating higher viral loads detected in the lower respiratory tract. It is consistent with the observations in patients with MERS who had higher viral loads in lower respiratory tract samples than in upper respiratory tract samples [22].\nSerum samples for 2019-nCoV which might indicate some virus spillover from the more severely infected lung into the systemic circulation, as previously reported in patients with SARS [23]. However, the first case of 2019-nCoV in the United States report the stool and respiratory specimens from the patients tested positive by RT-PCR for 2019-nCoV, whereas the serum remained negative [24].\nImportantly, the ground glass changes on chest CT scan appeared earlier than the positive for RT-PCR test in some cases. Repeat testing of nasopharyngeal swab or sputum samples are recommended in clinical suspected cases with an initially negative 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