Clinical and virological data of the first cases of COVID-19 in Europe: a case series
Clinical and virological data of the first cases of COVID-19 in Europe: a case series
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DOI：
10.1016/s1473-3099(20)30200-0
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发表时间：
2020-06-01
影响因子：
56.3
通讯作者：
Yazdanpanah, Yazdan
中科院分区：
文献类型：
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作者：
Lescure, Francois-Xavier;Bouadma, Lila;Yazdanpanah, Yazdan
2019年12月31日，中国报告了湖北省武汉市发生的一起聚集性肺炎病例。致病病原体是一种新型冠状病毒，被命名为严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）。我们报告欧洲首例确诊感染病例的相关特征，命名为2019冠状病毒病（COVID-19），第一位患者于2020年1月24日被诊断出患有该疾病。方法在本病例系列中，我们对5例在法国巴黎比夏-克劳德伯纳德大学医院和法国波尔多佩勒格林大学医院接受鼻咽拭子半定量RT-PCR诊断为COVID-19的患者进行随访。我们评估了不同样本（鼻咽和血液、尿液和粪便样本）的临床疾病模式和病毒载量，这些样本从住院开始每天采集一次，持续3天，每2或3天采集一次，直到患者出院。所有样本被冷藏并运送到国家呼吸道病毒参考中心（巴黎巴斯德研究所和里昂平民医院，法国里昂）的实验室，在那里进行RNA提取、实时RT-PCR和病毒分离和滴定程序。患者为3名男性（年龄31岁、48岁和80岁）和2名女性（年龄30岁和46岁），均为中国血统，于2020年1月中旬左右从中国前往法国。描述了三种不同的临床演变：(1)两名无症状的妇女在出现症状的一天内被诊断出来，在发病的前24小时内鼻咽部SARS-CoV- 2的高滴度（分别为每1000个细胞5.2和7.4 log 10拷贝）和粪便中检测到病毒RNA；(2)两名年轻男性的两步疾病进展，在发病后10天左右出现二次恶化，尽管鼻咽样本中的病毒载量有所下降；(3) 80岁男性，向多器官功能衰竭快速演变，下、上呼吸道持续高病毒载量，伴全身性病毒传播和血浆病毒检测。患者80岁，发病第14天死亡（2020年2月14日）；截至2020年2月19日，其余患者全部康复出院。我们通过详细和全面的病毒采样策略说明了5例SARS-CoV-2感染患者的三种不同临床和生物学类型的进化。我们相信，这些发现将有助于更好地了解疾病的自然历史，并将有助于实施更有效的感染控制策略。
Background On Dec 31, 2019, China reported a cluster of cases of pneumonia in people at Wuhan, Hubei Province. The responsible pathogen is a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report the relevant features of the first cases in Europe of confirmed infection, named coronavirus disease 2019 (COVID-19), with the first patient diagnosed with the disease on Jan 24, 2020.Methods In this case series, we followed five patients admitted to Bichat-Claude Bernard University Hospital (Paris, France) and Pellegrin University Hospital (Bordeaux, France) and diagnosed with COVID-19 by semi-quantitative RT-PCR on nasopharyngeal swabs. We assessed patterns of clinical disease and viral load from different samples (nasopharyngeal and blood, urine, and stool samples), which were obtained once daily for 3 days from hospital admission, and once every 2 or 3 days until patient discharge. All samples were refrigerated and shipped to laboratories in the National Reference Center for Respiratory Viruses (The Institut Pasteur, Paris, and Hospices Civils de Lyon, Lyon, France), where RNA extraction, real-time RT-PCR, and virus isolation and titration procedures were done.Findings The patients were three men (aged 31 years, 48 years, and 80 years) and two women (aged 30 years and 46 years), all of Chinese origin, who had travelled to France from China around mid-January, 2020. Three different clinical evolutions are described: (1) two paucisymptomatic women diagnosed within a day of exhibiting symptoms, with high nasopharyngeal titres of SARS-CoV- 2 within the first 24 h of the illness onset (5.2 and 7.4 log 10 copies per 1000 cells, respectively) and viral RNA detection in stools; (2) a two-step disease progression in two young men, with a secondary worsening around 10 days after disease onset despite a decreasing viral load in nasopharyngeal samples; and (3) an 80- year-old man with a rapid evolution towards multiple organ failure and a persistent high viral load in lower and upper respiratory tract with systemic virus dissemination and virus detection in plasma. The 80- year-old patient died on day 14 of illness (Feb 14, 2020); all other patients had recovered and been discharged by Feb 19, 2020.Interpretation We illustrated three different clinical and biological types of evolution in five patients infected with SARS-CoV-2 with detailed and comprehensive viral sampling strategy. We believe that these findings will contribute to a better understanding of the natural history of the disease and will contribute to advances in the implementation of more efficient infection control strategies.