新加坡SARS-CoV-2感染者的流行病學特徵及臨床病程

新加坡SARS-CoV-2感染者的流行病學特徵及臨床病程

作者：

小柯機器人

發布時間：2020/3/9 22:41:47

新加坡國家傳染病中心Barnaby Edward Young聯合Yee-Sin Leo研究組近日取得新進展。他們分析了新加坡SARS-CoV-2感染患者的流行病學特徵和臨床病程。這一研究成果發表在《美國醫學會雜誌》上。

為了報告新加坡在這次疫情中流行病學調查、臨床特徵和管理方面的的初步經驗，2020年1月23日至2月3日，研究組對新加坡4所醫院中首批確診為SARS-CoV-2感染的18例患者進行了描述性分析。

這18例SARS-CoV-2感染住院患者的中位年齡為47歲，50％為女性，臨床表現為上呼吸道感染的有12例（67％），15例（83％）患者的鼻咽拭子中檢出病毒的時間持續7天甚至更久。6例（33％）患者需要補充氧氣，其中2例需要重症監護，沒有患者死亡。

通過PCR在50%的糞便樣本和8%的血液樣本中檢測到了病毒，但在尿液中未檢測到。5名需要補充氧氣的患者接受了洛匹那韋-利託那韋治療。5例患者中有3例在3天內退燒，吸氧需求減少，2例因進行性呼吸衰竭而惡化。使用洛匹那韋-利託那韋治療的5例患者中有4例出現噁心、嘔吐和/或腹瀉，而3例出現肝功能異常。

總之，在新加坡首批被診斷為SARS-CoV-2感染的18例患者中，臨床表現通常是輕度呼吸道感染。一些患者需要補充氧氣，並在接受抗逆轉錄病毒藥物治療後有不同的臨床結局。

附：英文原文

Title: Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore

Author: Barnaby Edward Young, Sean Wei Xiang Ong, Shirin Kalimuddin, Jenny G. Low, Seow Yen Tan, Jiashen Loh, Oon-Tek Ng, Kalisvar Marimuthu, Li Wei Ang, Tze Minn Mak, Sok Kiang Lau, Danielle E. Anderson, Kian Sing Chan, Thean Yen Tan, Tong Yong Ng, Lin Cui, Zubaidah Said, Lalitha Kurupatham, Mark I-Cheng Chen, Monica Chan, Shawn Vasoo, Lin-Fa Wang, Boon Huan Tan, Raymond Tzer Pin Lin, Vernon Jian Ming Lee, Yee-Sin Leo, David Chien Lye

Issue&Volume: 2020-03-03

Abstract: AbstractImportance  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.

DOI: 10.1001/jama.2020.3204

Source: https://jamanetwork.com/journals/jama/fullarticle/2762688