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在新冠疫情早期,一家筛查诊所的冠状病毒病(COVID-19)病例的流行病学和临床特征:一项单中心研究。

Epidemiological and clinical characteristics of coronavirus disease (COVID-19) cases at a screening clinic during the early outbreak period: a single-centre study.

机构信息

Department of Pathology, Rehman Medical Institute Peshawar, Pakistan.

Department of Diabetes and Endocrinology, Manchester University Hospitals NHS Foundation Trust, UK.

出版信息

J Med Microbiol. 2020 Aug;69(8):1114-1123. doi: 10.1099/jmm.0.001231.

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Corona Virus-2 (SARS-CoV-2). The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019-2020 corona virus pandemic. SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have a zoonotic origin. The virus is primarily spread between people during close contact, often via small droplets produced by coughing, sneezing or talking. People may also become infected by touching a contaminated surface and then touching their face. COVID-19 patients currently remain the primary source of infection. An epidemiological survey indicated that the general population is susceptible to SARS-CoV-2. The spectrum of this disease ranges from mild to life-threatening. Fever is the most common symptom, although older people and those with comorbidities may experience fever later in the disease. Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains. Symptoms such as nausea, vomiting and diarrhea have been observed in varying percentages. Some cases might progress promptly to acute respiratory distress syndrome (ARDS) and/or multiple organ function failure. Asymptomatic carriers and those in the incubation period may also be infectious. To determine the epidemiological and clinical characteristics of patients presenting with COVID-19 at the screening clinic of a tertiary care hospital in Peshawar, Pakistan. In this descriptive study, we analysed data of patients presenting to a newly established Covid-19 screening clinic in Rehman Medical Institute. Anyone who reported with new onset fever and/or cough was tested for SARS-CoV-2 in the screening clinic. We documented and analysed demographic, epidemiological and clinical characteristics, which included age, sex, travel history, clinical features, comorbidities and laboratory data of patients confirmed by real-time reverse-transcription (RT)-PCR at Rehman Medical Institute, Peshawar, Pakistan from 15 March till 21 April 2020. Paired specimens of throat swabs and nasal swabs were obtained from 845 patients, ribonucleic acid (RNA) was extracted and tested for SARS-CoV-2 by the RT-PCR assay. A total of 845 specimens were taken as described above. The positive rate for SARS-CoV-2 was about 14.3%. Male and older population had a significantly higher positive rate. Of the 121 patients infected with SARS-CoV-2, the mean age was 43.19 years (sd, 17.57) and the infections were more frequent among male gender accounting for 85 (70.25 %) patients. Common symptoms included fever (88 patients, 72 %), cough (72 patients, 59.5 %) and shortness of breath (69 patients, 57 %). Twenty-two (18 %) patients had recent travel history outside Pakistan in the previous 14 days, the majority of whom had returned back from Saudi Arabia. In this single-centre, prospective, descriptive study, fever, cough and shortness of breath were the most common symptoms. Old age (>50 years), chronic underlying comorbidities and travel history may be risk factors. Therefore, we concluded that viral nucleic acid amplification tests (NAAT) played an important role in identifying SARS-CoV-2 infection in a screening clinic, which helped with isolation and cohorting of these patients.

摘要

2019 年冠状病毒病(COVID-19)是由严重急性呼吸系统综合征冠状病毒 2 型(SARS-CoV-2)引起的传染病。该疾病于 2019 年 12 月在中国湖北省省会武汉首次被发现,此后已在全球范围内传播,导致了正在进行的 2019-2020 年冠状病毒大流行。SARS-CoV-2 与原始 SARS-CoV 密切相关。据认为它具有动物源性起源。该病毒主要通过咳嗽、打喷嚏或说话产生的小飞沫在人与人之间近距离接触时传播。人们也可能通过触摸受污染的表面然后触摸自己的脸而感染。COVID-19 患者仍然是主要的感染源。一项流行病学调查表明,普通人群易感染 SARS-CoV-2。该疾病的范围从轻度到危及生命。发烧是最常见的症状,尽管老年人和患有合并症的人可能在疾病后期出现发烧。其他常见症状包括咳嗽、食欲不振、疲劳、呼吸急促、咳痰和肌肉关节疼痛。恶心、呕吐和腹泻等症状也有不同比例的出现。一些病例可能迅速进展为急性呼吸窘迫综合征(ARDS)和/或多器官功能衰竭。无症状携带者和潜伏期患者也可能具有传染性。为了确定在巴基斯坦白沙瓦的一家三级保健医院的筛查诊所就诊的 COVID-19 患者的流行病学和临床特征。在这项描述性研究中,我们分析了 Rehman 医学研究所新成立的 COVID-19 筛查诊所就诊患者的数据。任何出现新发发热和/或咳嗽的人都在筛查诊所接受了 SARS-CoV-2 检测。我们记录并分析了患者的人口统计学、流行病学和临床特征,包括年龄、性别、旅行史、临床特征、合并症和巴基斯坦白沙瓦 Rehman 医学研究所实时逆转录(RT)-PCR 确诊的患者的实验室数据,时间为 2020 年 3 月 15 日至 4 月 21 日。从 845 名患者中获得了咽拭子和鼻拭子的配对标本,提取了核糖核酸(RNA),并通过 RT-PCR 检测了 SARS-CoV-2。如上所述共采集了 845 个标本。SARS-CoV-2 的阳性率约为 14.3%。男性和老年人口的阳性率明显更高。在 121 名感染 SARS-CoV-2 的患者中,平均年龄为 43.19 岁(标准差,17.57),感染更多见于男性,占 85 名(70.25%)患者。常见症状包括发热(88 例,72%)、咳嗽(72 例,59.5%)和呼吸急促(69 例,57%)。22 例(18%)患者在过去 14 天内有巴基斯坦境外旅行史,其中大多数人是从沙特阿拉伯返回的。在这项单中心、前瞻性、描述性研究中,发热、咳嗽和呼吸急促是最常见的症状。年龄较大(>50 岁)、慢性基础合并症和旅行史可能是危险因素。因此,我们得出结论,病毒核酸扩增检测(NAAT)在筛查诊所中对识别 SARS-CoV-2 感染具有重要作用,有助于对这些患者进行隔离和分组。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/865d/7642977/6bc2bfeced55/jmm-69-1114-g001.jpg

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