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      The First Confirmed Case of Coronavirus Disease 2019 (COVID-19) in an Adolescent with Abdominal Pain in Iran

      case-report

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          Abstract

          Background:

          The outbreak of coronavirus disease 2019 (COVID-19) is evolving rapidly. However, there is limited information about this disease in children and adolescents. Only a few pediatric cases of COVID-19 have been reported so far. Since the immune responses of children are different from adults, their clinical findings and therapeutic responses may differ. To the best of our knowledge, this is the first confirmed case of COVID-19 in a 12-year-old girl with abdominal pain in Iran.

          Case Presentation:

          A 12-year-old girl with a history of cold, dry cough, sore throat, fever, and left-sided abdominal pain was referred to the Children’s Medical Center, Tehran, Iran, on March 7, 2020. The chest X-ray indicated air space opacification in the right lower lobe and faint ground-glass opacity in the left lower lung. A subsequent chest computed tomography (CT) scan indicated blialteral patchy lower lobe consolidations. The patient’s oropharyngeal swab was positive for COVID-19, based on the result of real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. The patient’s clinical status was improved, and she was discharged five days after admission (March 11, 2020).

          Conclusion:

          Since the number of infected cases with COVID-19 is growing rapidly in Iran, early detection and management of infected cases are highly recommended for preventing the disease transmission and reducing the rate of infection.

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          Most cited references8

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          The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak

          Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
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            The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status

            An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4%) had been reported by WHO. Meanwhile, several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human-to-human transmission, along with many exported cases across the globe. The clinical symptoms of COVID-19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
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              On the origin and continuing evolution of SARS-CoV-2

              ABSTRACT The SARS-CoV-2 epidemic started in late December 2019 in Wuhan, China, and has since impacted a large portion of China and raised major global concern. Herein, we investigated the extent of molecular divergence between SARS-CoV-2 and other related coronaviruses. Although we found only 4% variability in genomic nucleotides between SARS-CoV-2 and a bat SARS-related coronavirus (SARSr-CoV; RaTG13), the difference at neutral sites was 17%, suggesting the divergence between the two viruses is much larger than previously estimated. Our results suggest that the development of new variations in functional sites in the receptor-binding domain (RBD) of the spike seen in SARS-CoV-2 and viruses from pangolin SARSr-CoVs are likely caused by mutations and natural selection besides recombination. Population genetic analyses of 103 SARS-CoV-2 genomes indicated that these viruses evolved into two major types (designated L and S), that are well defined by two different SNPs that show nearly complete linkage across the viral strains sequenced to date. Although the L type (∼70%) is more prevalent than the S type (∼30%), the S type was found to be the ancestral version. Whereas the L type was more prevalent in the early stages of the outbreak in Wuhan, the frequency of the L type decreased after early January 2020. Human intervention may have placed more severe selective pressure on the L type, which might be more aggressive and spread more quickly. On the other hand, the S type, which is evolutionarily older and less aggressive, might have increased in relative frequency due to relatively weaker selective pressure. These findings strongly support an urgent need for further immediate, comprehensive studies that combine genomic data, epidemiological data, and chart records of the clinical symptoms of patients with coronavirus disease 2019 (COVID-19).
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                Author and article information

                Journal
                Tanaffos
                Tanaffos
                Tanaffos
                Tanaffos
                Tanaffos
                National Research Institute of Tuberculosis and Lung Disease
                1735-0344
                2345-3729
                November 2020
                : 19
                : 2
                : 156-159
                Affiliations
                [1 ] Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran,
                [2 ] Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran,
                [3 ]Radiology Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Mamishi S, Address: Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran, Email address: smamishi@ 123456sina.tums.ac.ir
                Article
                Tanaffos-19-156
                7680510
                33262804
                d0ab0c8a-a5c3-48b6-b6ce-c485b5ee8158
                Copyright© 2020 National Research Institute of Tuberculosis and Lung Disease

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 April 2020
                : 04 May 2020
                Categories
                Case Report

                covid-19,children,iran
                covid-19, children, iran

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