What are the symptoms of pneumonitis infected by a new coronavirus? How is it diagnosed? How is it treated? On the 22nd, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology (hereinafter referred to as “Tongji Hospital”) released the “Quick Guide for the Diagnosis and Treatment of New Coronavirus Pneumonia” formulated by the expert group of the hospital.
According to the guidelines, after analysis of the virus sequence, it is speculated that the natural host of the new coronavirus disease may be bats. Unknown intermediate host vectors are likely to exist during the transmission from bat to human.
This is a new type of coronavirus pneumonia. The population generally lacks immunity to the virus and is susceptible to it. If you are exposed to a large number of patients, or patients with poor immune function, infection is very likely.
For people with poor immune function, such as the elderly or those with liver and kidney dysfunction, the disease progresses relatively quickly and the severity is higher. However, people with normal immune function may have severe inflammatory reactions after infection, leading to ARDS or sepsis.
Similar to the epidemiological characteristics of SARS, children and infants have less incidence. At present, a child patient diagnosed nationwide has relatively mild symptoms, but has a clear history of exposure and typical changes in lung CT. The virus turns negative faster and the prognosis is better. There are also many children suspected of being patients.
How to effectively inactivate viruses
Coronavirus is sensitive to heat. Keeping at 56 ° C for 30 minutes, ether, 75% ethanol (medical alcohol), chlorine-containing disinfectant, peracetic acid and chloroform can effectively inactivate the virus.
What are the symptoms
Onset of fever is the main manifestation, and may be combined with mild dry cough, fatigue, poor breathing, diarrhea and other symptoms, runny nose, sputum and other catarrhal symptoms are rare. Half of the patients developed dyspnea after one week, and severe cases progressed rapidly to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis, and coagulopathy. Some patients have mild onset symptoms and may have no clinical symptoms such as fever. They usually recover after 1 week.
What medical methods are used to judge
Imaging: Multiple small patchy shadows and interstitial changes appeared early, and the extrapulmonary bands were obvious. Furthermore, it develops multiple ground glass infiltration and infiltrates in both lungs. In severe cases, pulmonary consolidation and pleural effusion are rare.
Blood test: In the early stage of the disease, the total number of white blood cells in the peripheral blood was normal or decreased, the lymphocyte count decreased, and some patients had increased liver enzymes, muscle enzymes, and myoglobin. Most patients had elevated C-reactive protein and erythrocyte sedimentation rate and normal procalcitonin. In severe cases, D-D dimers increase and lymphocytes progressively decrease.
How to judge a suspected case
According to the previous diagnosis and treatment experience, there was a history of travel or residence in Wuhan within 2 weeks before the onset; or patients with fever with respiratory symptoms from Wuhan within 14 days before the onset of the disease, or clustered onset; Imaging features; normal or decreased white blood cells in the early stage of disease, or decreased lymphocyte count, can be judged as suspected cases.
How to diagnose
On the basis of meeting the criteria for suspected cases, sputum, throat swabs, lower respiratory tract secretions and other specimens can be diagnosed by real-time fluorescent RT-PCR detection of 2019-nCoV nucleic acid positive.
What to do
For all suspected cases, in-situ medical isolation is required; for mild patients, observation can be made in the clinic or at home; all patients who go home for observation should require that they return to the designated hospital as soon as any deterioration of the disease occurs Treatment; severe cases and critical cases need to be hospitalized.
How to distinguish between new coronavirus pneumonia and other pneumonia
- First, it needs to be distinguished from other types of pneumonia, such as bacterial pneumonia, or non-viral pneumonia such as mycoplasma and chlamydia pneumonia. However, patients with bacterial pneumonia often have a high blood rate and are mainly single-lung. There may be pus and sputum when coughing. ;
- Secondly, it is distinguished from other viral pneumonia. Many viruses can cause pneumonia, such as influenza virus, respiratory syncytial virus, rhinovirus, adenovirus, etc. can cause pneumonia, but these virus infections have a relatively low probability and relatively small number of pneumonia, and patients with new coronavirus infection have pneumonia. The probability is higher and the infectivity is stronger than other viral pneumonia;
- It needs to be distinguished from interstitial lung disease, especially acute interstitial pneumonia, mainly from epidemiological and imaging manifestations.
How to treat
- At present, there is no specific antiviral drug for new coronavirus, and the treatment is mainly symptomatic and supportive.
- Avoid blind or inappropriate antibacterial treatment, especially the combined application of broad-spectrum antibacterial drugs. For mild patients, it is recommended to administer intravenous or oral antibacterial drugs, such as moxifloxacin or azithromycin, based on the patient’s condition. For severe or critically ill patients, empirical antimicrobials are given to treat all possible pathogens. For patients with sepsis, antimicrobials should be given within one hour after the initial patient assessment.
- Unless for special reasons, routine corticosteroid use should be avoided. Glucocorticoids are a “double-edged sword” for viruses. On the one hand, they can inhibit the body’s immune function and may cause the virus to spread; on the other hand, they can reduce the inflammation of the lungs and help improve the symptoms of hypoxia and respiratory distress. Glucocorticoids can be used for a short period of time (3-5 days) according to the patient’s dyspnea and chest imaging progress. There are currently no specific antiviral drugs. Try alpha-interferon nebulizer, lopinavir / ritonavir and other drugs.
- If there is a local epidemiological history or other infection-related risk factors (including travel history or exposure to animal influenza virus), empiric therapy should include neuraminidase inhibitors (oseltamivir) or membrane fusion inhibitors (Abidol).
Most patients have a good prognosis, and a few patients are critically ill and even die. Discharged patients should be followed up on time, pay attention to prevent recurrence of infection, and be isolated at home for a period of time.
At present, some patients have been treated and discharged, especially for mild patients. Before discharge, the nucleic acid test should be routinely performed. The nucleic acid test is negative for 2 consecutive days, and the clinical symptoms are significantly relieved, or the imaging performance is significantly improved. Follow up. During the follow-up, attention should be paid to preventing recurrence of infection and quarantine at home for a period of time to ensure complete recovery.