Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
J Korean Med Sci. 2020 Sep 21;35(37):e333. doi: 10.3346/jkms.2020.35.e333.
There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms.
We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at Ulsan University Hospital, Ulsan, Korea. The final follow-up date was May 19, 2020. All COVID-19 cases in Ulsan were included. Demographic and epidemiological information, comorbidities, clinical signs and symptoms, laboratory and radiologic findings, medications, treatments, outcomes, and main durations of patients with COVID-19 were compared according to supplemental oxygen requirement.
Forty patients were included (median age, 30 years; interquartile range [IQR], 25-57 years; 58% female). Six (15%) patients required supplemental oxygen. The prevalence of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was 5% and that of presymptomatic infection was 13%. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea were the screening criteria for diagnosing symptomatic and presymptomatic SARS-CoV-2 infections. Sputum production, chest discomfort, a large number of symptoms, abnormal procalcitonin and C-reactive protein levels, and abnormal chest X-ray or chest computed tomography findings were more common in patients requiring supplemental oxygen than in those not requiring supplemental oxygen. Overall mortality rate was 3% (1/40). Four patients (10%) were readmitted after testing positive by reverse-transcription polymerase chain reaction again. Incubation period was 5 days (IQR, 4-6 days), and the duration of viral shedding was 21 days (IQR, 14-28 days; maximum, 51 days).
The prevalence of asymptomatic SARS-CoV-2 infection was 5%, which is much lower than that previously reported. This finding suggests that careful interviews and follow-ups should be performed to identify SARS-CoV-2 infections. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea are adequate screening criteria for covering all symptoms of SARS-CoV-2 infection. Further evaluation is required to create representative screening criteria for COVID-19.
目前关于无症状或轻症的 2019 冠状病毒病(COVID-19)患者的临床特征信息有限。
我们对 2020 年 2 月 22 日至 3 月 26 日期间筛查并连续住院于韩国蔚山大学医院的 COVID-19 患者进行了回顾性病例系列研究。40 例 COVID-19 病例通过实时逆转录聚合酶链反应确诊。蔚山的所有 COVID-19 病例均纳入研究。根据是否需要补充氧气,比较了 COVID-19 患者的人口统计学和流行病学信息、合并症、临床症状和体征、实验室和影像学发现、药物、治疗、结局以及主要持续时间。
共纳入 40 例患者(中位年龄 30 岁,四分位距 [IQR] 25-57 岁;58%为女性)。6 例(15%)患者需要补充氧气。无症状严重急性呼吸综合征冠状病毒-2(SARS-CoV-2)感染的发生率为 5%,亚临床感染的发生率为 13%。咳嗽、发热、肌痛、流涕或鼻塞、腹泻是诊断有症状和亚临床 SARS-CoV-2 感染的筛查标准。与不需要补充氧气的患者相比,需要补充氧气的患者更常出现咳痰、胸部不适、大量症状、降钙素原和 C 反应蛋白水平异常、以及异常的胸部 X 线或胸部计算机断层扫描结果。总体死亡率为 3%(1/40)。4 例患者(10%)再次经逆转录聚合酶链反应检测阳性后再次入院。潜伏期为 5 天(IQR 4-6 天),病毒脱落持续时间为 21 天(IQR 14-28 天;最长 51 天)。
无症状 SARS-CoV-2 感染的发生率为 5%,远低于既往报告的发生率。这一发现提示应仔细询问病史和进行随访,以识别 SARS-CoV-2 感染。咳嗽、发热、肌痛、流涕或鼻塞、腹泻是涵盖 SARS-CoV-2 感染所有症状的充分筛查标准。需要进一步评估以制定 COVID-19 的代表性筛查标准。