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      High-resolution CT features of 17 cases of Corona Virus Disease 2019 in Sichuan province, China

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          Abstract

          The city of Wuhan, Hubei province in China is the focus of global attention due to the Corona Virus Disease 2019 (COVID-19) outbreak [1]. Sichuan, as a province near Hubei, also has been involved. As of February 12, 2020, 59 741 confirmed cases of COVID-19 have been reported in China, of which 451 cases have been identified in Sichuan province. This disease is caused by infection of a new coronavirus named COVID-19 by the World Health Organization (WHO). According to the latest research, the novel coronavirus is 96% identical at the whole-genome level to a bat coronavirus, leading to speculation that this new coronavirus may originate from bats [2, 3]. Current epidemiologic data indicate that person-to-person transmission of COVID-19 is occurring [4]. This disease has become a major health crisis in China, and has the potential to become a worldwide epidemic. According to the guidelines stated by the WHO, epidemiologic characteristics, clinical manifestations, chest images and laboratory findings represent the major screening tools for identifying COVID-19 infection. Diagnostic confirmation is ultimately dependent on respiratory samples tested by real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) [5]. However, the false-negative rate of RT-PCR is reported to be up to 70% at the early stage in the clinical course, which may lead to missed diagnosis and thus increased spread of illness. Further, the time required to do the PCR test, given patient flow in the current health crisis and the many other flu variants that can lead to similar symptoms, can delay treatment and appropriate patient isolation. Therefore, for patients with clinical manifestations and suspect exposure history to the novel coronavirus, clinical imaging findings can play an important role in making preliminary diagnoses and guide patient management decisions.

          Abstract

          Bilateral ground-glass opacities and a combination of consolidation and ground-glass opacities mainly in the subpleural lung regions is a noteworthy high-resolution CT feature of Corona Virus Disease 2019 which may help in the early diagnosis of the disease.

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          Most cited references9

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

              Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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                Author and article information

                Journal
                Eur Respir J
                Eur. Respir. J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                05 March 2020
                : 2000334
                Affiliations
                [1 ]Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
                [2 ]Department of Radiology, West China - Guang'an Hospital of Sichuan University, Guang'an, China
                [3 ]Department of Infectious Diseases, West China - Guang'an Hospital of Sichuan University, Guang'an, China
                [4 ]These authors contributed to this study equally
                Author notes
                Prof. Sun, Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China. E-mail: sunhuaiqiang@ 123456scu.edu.cn
                Author information
                https://orcid.org/0000-0003-0687-6065
                Article
                ERJ-00334-2020
                10.1183/13993003.00334-2020
                7098481
                32139463
                e1738f66-5d8c-46e9-a98f-cf66be75895e
                Copyright ©ERS 2020

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 10 February 2020
                : 22 February 2020
                Funding
                Funded by: Young Elite Scientists Sponsorship Program by CAST
                Award ID: YESS20160060
                Categories
                Research Letter

                Respiratory medicine
                Respiratory medicine

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