Results
At presentation, all 55 patients had a history of epidemiological exposure to COVID-19, and 5 (9%) patients who discharged from hospital presented SARS-CoV-2 reactivation. The age range of the SARS-CoV-2 reactivated patients was 27–42 years. None of the reactivated patients had underlying diseases such as diabetes, chronic hypertension, or cardiovascular disease. One patient, however, had history of tuberculosis in the mediastinal lymph node in 2009. Additionally, all the reactivated patients excluded influenza virus and H7 avian influenza virus infection upon admission to hospital.
Four of the 5 patients presented with a fever without chills, one had a high fever (39.3 °C). Patients’ body temperatures fluctuated within a range from 36.2 to 39.3 °C. One patient showed normal body temperature. Other symptoms of an upper respiratory tract infection were also observed: one patient had cough, one had sore throat, all patients reported fatigue (Table 1 ). Additionally, one patient showed constipation. However, none of the 5 patients developed severe pneumonia, requiring mechanical ventilation, or died of COVID-19 pneumonia, as of Feb. 24, 2020.
Table 1 Clinical and laboratory characteristics.
Clinical characteristics Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Date of admission Jan. 3 Jan. 13 Jan. 27 Jan. 22 Jan. 20
Sex Male Male Female Female Female
Age (years) 30 42 32 27 31
Epidemiological history Yes Yes Yes Yes Yes
SARS-CoV-2 negative to positive (days) 4 8 17 15 9
Complications None None None None None
Signs and symptoms
Fever on admission Yes Yes Yes No Yes
Cough No Yes No No No
Dyspnoea No No No No No
Sore throat No No Yes No No
Fatigue Yes Yes Yes Yes Yes
Laboratory characteristics
White blood cell count (× 109 cells per L) 5.9 7.1 4.4 6.5 4.5
Neutrophil count (× 109 cells per L) 3.5 4.5 1.8 4.1 2.6
Lymphocyte count (× 109 cells per L) 1.7 1.3 1.7 1.7 1.4
Monocyte count (× 109 cells per L) 0.63 1.24 0.75 0.58 0.4
Eosinophil count (× 109 cells per L) 0.13 0.05 0.02 0.09 0
Basophile count (× 109 cells per L) 0.02 0.04 0.03 0.02 0.02
C-reactive protein (mg/L) 18.7 23.7 NA <0.50 NA
Elevated ALT (>45 U/L) or AST (>35 U/L) No No No No No
ALT (U/L) 40 16 11 9 10
AST(U/L) 32 19 20 13 22
Confirmatory test (SARS-CoV-2 PCR) Yes Yes Yes Yes Yes
CT evidence of pneumonia
Typical signs of viral infection Yes Yes Yes Yes Yes
Treatment
Antiviral therapy Yes Yes Yes Yes Yes
Antibiotic therapy Yes Yes Yes Yes Yes
Use of corticosteroid Yes Yes No No Yes
NA=not applicable. ALT=alanine transaminase. AST=aspartate transaminase.
All the 5 reactivated patients were given empirical antibiotic treatment and were administered antiviral therapy (Table 1). Data from laboratory tests showed that one patient had progressive lymphopenia (from 1.3 to 0.56 × 109 cells per L) and progressive elevated neutrophilia (from 4.5 to 18.28 × 109 cells per L). Two patients had elevated concentrations of C-reactive protein (> 18 mg/L). All the 5 patients had normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST). All 5 patients had chest CT scan. All patients showed typical findings of chest CT images-multiple patchy ground-glass shadows in lungs (Fig. 1 ).
Fig. 1 Chest CT scans of the 5 patients.