Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore
Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore
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DOI：
10.1001/jama.2020.3204
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发表时间：
2020-04-21
影响因子：
120.7
通讯作者：
Lye, David Chien
中科院分区：
文献类型：
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作者：
Young, Barnaby Edward;Ong, Sean Wei Xiang;Lye, David Chien
本病例系列描述了新加坡首批18例确诊的2019冠状病毒病（COVID-19）患者的流行病学特征、临床表现、治疗和结局。重要性严重急性呼吸系统综合征冠状病毒2（SARS-CoV-2）于2019年12月在中国武汉出现，并已在全球范围内传播，在中国以外地区持续人际传播。目的报告新加坡暴发疫情的流行病学调查、临床特征和管理的初步经验。设计、设置和参与者描述性病例系列，研究对象为2020年1月23日至2月3日在新加坡4家医院确诊为聚合酶链反应（PCR）确诊的SARS-CoV-2感染的前18例患者;最终随访日期为2020年2月25日。暴露证实SARS-CoV-2感染。收集临床、实验室和放射学数据，包括鼻咽拭子PCR循环阈值和血液、尿液和粪便中的病毒脱落。总结了临床过程，包括需要补充氧气和重症监护以及使用洛匹那韦-利托那韦经验性治疗。结果在18例PCR证实的SARS-CoV-2感染住院患者中（中位年龄47岁; 9例[50%]女性），12例（67%）临床表现为上呼吸道感染，15例（83%）鼻咽病毒脱落延长7天或更长时间。6人（33%）需要补充氧气;其中2人需要重症监护。无死亡病例。通过PCR在粪便（4/8 [50%]）和血液（1/12 [8%]）中可检出病毒，但在尿液中不可检出。5名需要补充氧气的患者接受了洛匹那韦-利托那韦治疗。5例患者中有3例在3天内发热消退，补充氧气需求减少，而2例恶化伴进行性呼吸衰竭。接受洛匹那韦-利托那韦治疗的5例患者中有4例发生恶心、呕吐和/或腹泻，3例发生肝功能检查结果异常。结论和相关性在新加坡确诊为SARS-CoV-2感染的首批18名患者中，临床表现通常为轻度呼吸道感染。问题新加坡在严重急性呼吸系统综合征冠状病毒2型（SARS-CoV-2）爆发的最初经验是什么？在2020年1月23日至2月3日期间在新加坡诊断为SARS-CoV-2感染的前18名患者的描述性病例系列中，临床表现为呼吸道感染，其中15名患者（83%）的鼻咽病毒脱落时间延长至7天或更长。6例患者（33%）需要补充氧气，其中5例接受洛匹那韦-利托那韦治疗，治疗后临床结局不同。这些发现提供了新加坡诊断为SARS-CoV-2感染的患者的临床特征和病程。
This case series describes the epidemiologic features, clinical presentation, treatment, and outcomes of the first 18 patients with confirmed coronavirus disease 2019 (COVID-19) in SingaporeImportance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China. Objective To report the initial experience in Singapore with the epidemiologic investigation of this outbreak, clinical features, and management. Design, Setting, and Participants Descriptive case series of the first 18 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection at 4 hospitals in Singapore from January 23 to February 3, 2020; final follow-up date was February 25, 2020. Exposures Confirmed SARS-CoV-2 infection. Main Outcomes and Measures Clinical, laboratory, and radiologic data were collected, including PCR cycle threshold values from nasopharyngeal swabs and viral shedding in blood, urine, and stool. Clinical course was summarized, including requirement for supplemental oxygen and intensive care and use of empirical treatment with lopinavir-ritonavir. Results Among the 18 hospitalized patients with PCR-confirmed SARS-CoV-2 infection (median age, 47 years; 9 [50%] women), clinical presentation was an upper respiratory tract infection in 12 (67%), and viral shedding from the nasopharynx was prolonged for 7 days or longer among 15 (83%). Six individuals (33%) required supplemental oxygen; of these, 2 required intensive care. There were no deaths. Virus was detectable in the stool (4/8 [50%]) and blood (1/12 [8%]) by PCR but not in urine. Five individuals requiring supplemental oxygen were treated with lopinavir-ritonavir. For 3 of the 5 patients, fever resolved and supplemental oxygen requirement was reduced within 3 days, whereas 2 deteriorated with progressive respiratory failure. Four of the 5 patients treated with lopinavir-ritonavir developed nausea, vomiting, and/or diarrhea, and 3 developed abnormal liver function test results. Conclusions and Relevance Among the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore, clinical presentation was frequently a mild respiratory tract infection. Some patients required supplemental oxygen and had variable clinical outcomes following treatment with an antiretroviral agent.Question What was the initial experience in Singapore with the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)? Findings In this descriptive case series of the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore between January 23 and February 3, 2020, clinical presentation was a respiratory tract infection with prolonged viral shedding from the nasopharynx of 7 days or longer in 15 patients (83%). Supplemental oxygen was required in 6 patients (33%), 5 of whom were treated with lopinavir-ritonavir, with variable clinical outcomes following treatment. Meaning These findings provide clinical features and course among patients diagnosed with SARS-CoV-2 infection in Singapore.