National Centre for Infectious Diseases, Singapore.
Tan Tock Seng Hospital, Singapore.
JAMA. 2020 Apr 21;323(15):1488-1494. doi: 10.1001/jama.2020.3204.
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.
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.
Confirmed SARS-CoV-2 infection.
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.
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.
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.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）于 2019 年 12 月在中国武汉出现，并在中国境外持续发生人与人之间的传播而在全球范围内传播。
报告新加坡在此次暴发的流行病学调查、临床特征和管理方面的初步经验。
设计、地点和参与者：对 2020 年 1 月 23 日至 2 月 3 日在新加坡 4 家医院诊断出的 18 例聚合酶链反应（PCR）确诊的 SARS-CoV-2 感染患者进行描述性病例系列研究；最终随访日期为 2020 年 2 月 25 日。
确诊 SARS-CoV-2 感染。
收集了临床、实验室和影像学数据，包括鼻咽拭子的 PCR 循环阈值和血液、尿液和粪便中的病毒脱落。总结了临床病程，包括对补充氧气和重症监护的需求，以及经验性使用洛匹那韦-利托那韦治疗。
在 18 例经 PCR 确诊的 SARS-CoV-2 感染住院患者中（中位年龄 47 岁；9 [50%] 例为女性），12 例（67%）的临床表现为上呼吸道感染，15 例（83%）的鼻咽病毒脱落持续 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。病毒可通过 PCR 在粪便（8/8 [50%]）和血液（1/12 [8%]）中检测到，但在尿液中未检测到。5 名需要补充氧气的患者接受了洛匹那韦-利托那韦治疗。在 5 名需要补充氧气的患者中，有 3 名患者的发热在 3 天内消退，对补充氧气的需求减少，而另外 2 名患者的呼吸衰竭逐渐恶化。5 名接受洛匹那韦-利托那韦治疗的患者中有 4 名出现恶心、呕吐和/或腹泻，3 名患者出现肝功能异常。
在新加坡诊断出的首例 18 例 SARS-CoV-2 感染患者中，临床表现常为轻度呼吸道感染。一些患者需要补充氧气，并在使用抗逆转录病毒药物后出现不同的临床结局。
