Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea
Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea
复制标题
DOI：
10.1001/jamainternmed.2020.3862
复制
发表时间：
2020-11-01
影响因子：
39
通讯作者：
Kim, Tae Hyong
中科院分区：
文献类型：
--
作者：
Lee, Seungjae;Kim, Tark;Kim, Tae Hyong
重要性关于严重急性呼吸综合征冠状病毒2型感染的无症状患者的临床病程和病毒载量的信息有限（SARS-CoV-2）。目的定量描述SARS-CoV-2在无症状和有症状患者中的分子病毒脱落。和参与者对303例有症状和无症状的SARS-CoV患者进行了回顾性评价，2020年3月6日至3月26日期间感染2例。参与者被隔离在一个社区治疗中心在天安，韩国Republic.Main结果和措施流行病学，人口统计学和实验室数据进行了收集和分析。在隔离期间，主治医护人员仔细辨认患者症状。解除隔离的决定是基于上呼吸道标本（鼻咽和口咽拭子）和下呼吸道标本（痰液）的SARS-CoV-2逆转录-聚合酶链反应（RT-PCR）检测结果。在分离的第8、9、15和16天进行该检测。在第10、17、18和19天，根据医生判断进行上呼吸道或下呼吸道的RT-PCR测定。结果303例SARS冠状病毒2型感染者中位年龄（四分位距）为25（22-36）岁，女性201例（66.3%）。仅12例（3.9%）患者存在合并症（10例高血压、1例癌症和1例哮喘）。在303名SARS-CoV-2感染者中，193名（63.7%）在隔离时有症状。在110名（36.3%）无症状患者中，21名（19.1%）在隔离期间出现症状。症状前患者从检测到SARS-CoV-2到出现症状的中位（四分位距）时间间隔为15（13-20）天。在无症状患者中，在诊断后第14天和第21天阴转的受试者比例分别为33.7%和75.2%，在有症状患者（包括症状前患者）中分别为29.6%和69.9%。无症状患者从诊断到首次阴转的中位（SE）时间为17（1.07）天，有症状（包括症状前）患者为19.5（0.63）天（P = 0.07）。下呼吸道标本的包膜（env）基因Ct值显示，从诊断到出院，无症状患者的病毒载量在时间相互作用趋势上比有症状患者下降得更慢。（包括前驱症状）患者（β = -0.065 [SE，0.023]; P =.005）。结论和相关性在这项对有症状和无症状的SARS-CoV患者的队列研究中，在韩国天安市社区治疗中心隔离的2例感染者中，无症状患者的Ct值与有症状患者相似。隔离无症状患者可能是控制SARS-CoV-2传播所必需的。
IMPORTANCE There is limited information about the clinical course and viral load in asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).OBJECTIVE To quantitatively describe SARS-CoV-2 molecular viral shedding in asymptomatic and symptomatic patients.DESIGN, SETTING, AND PARTICIPANTS A retrospective evaluationwas conducted for a cohort of 303 symptomatic and asymptomatic patients with SARS-CoV-2 infection between March 6 and March 26, 2020. Participants were isolated in a community treatment center in Cheonan, Republic of Korea.MAIN OUTCOMES AND MEASURES Epidemiologic, demographic, and laboratory datawere collected and analyzed. Attending health care personnel carefully identified patients' symptoms during isolation. The decision to release an individual from isolation was based on the results of reverse transcription-polymerase chain reaction (RT-PCR) assay from upper respiratory tract specimens (nasopharynx and oropharynx swab) and lower respiratory tract specimens (sputum) for SARS-CoV-2. This testing was performed on days 8, 9, 15, and 16 of isolation. On days 10, 17, 18, and 19, RT-PCR assays from the upper or lower respiratory tract were performed at physician discretion. Cycle threshold (Ct) values in RT-PCR for SARS-CoV-2 detection were determined in both asymptomatic and symptomatic patients.RESULTS Of the 303 patients with SARS-CoV-2 infection, the median (interquartile range) age was 25 (22-36) years, and 201 (66.3%) were women. Only 12 (3.9%) patients had comorbidities (10 had hypertension, 1 had cancer, and 1 had asthma). Among the 303 patients with SARS-CoV-2 infection, 193 (63.7%) were symptomatic at the time of isolation. Of the 110 (36.3%) asymptomatic patients, 21 (19.1%) developed symptoms during isolation. The median (interquartile range) interval of time from detection of SARS-CoV-2 to symptom onset in presymptomatic patients was 15 (13-20) days. The proportions of participants with a negative conversion at day 14 and day 21 from diagnosis were 33.7% and 75.2%, respectively, in asymptomatic patients and 29.6% and 69.9%, respectively, in symptomatic patients (including presymptomatic patients). The median (SE) time from diagnosis to the first negative conversion was 17 (1.07) days for asymptomatic patients and 19.5 (0.63) days for symptomatic (including presymptomatic) patients (P =.07). The Ct values for the envelope (env) gene from lower respiratory tract specimens showed that viral loads in asymptomatic patients from diagnosis to discharge tended to decrease more slowly in the time interaction trend than those in symptomatic (including presymptomatic) patients (beta = -0.065 [SE, 0.023]; P =.005).CONCLUSIONS AND RELEVANCE In this cohort study of symptomatic and asymptomatic patients with SARS-CoV-2 infection who were isolated in a community treatment center in Cheonan, Republic of Korea, the Ct values in asymptomatic patients were similar to those in symptomatic patients. Isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2.