Since the end of December 2019, there have been cases of pneumonia infected by the 2019 novel coronavirus in Wuhan, Hubei Province, China and other countries around the world. What are the symptoms of new coronavirus pneumonia, how to detect, how to confirm, how to treat, how to do personal protection, and what to pay attention to after discharge from hospital? The expert team of Tongji Hospital Affiliated to Huazhong University of Science and Technology in China responded quickly. Based on the first-hand data of the first batch of patients diagnosed and treated by major medical institutions in Wuhan, including Tongji Hospital Affiliated to Huazhong University of Science and Technology in China, the “New Coronavirus” Quick Guide to Diagnosis and Treatment of Pneumonia.
The pathogenic characteristics of the new coronavirus
After comparison and analysis of virus sequences, it is speculated that the natural host of the new coronavirus disease may be bats. In the process of infection from bats to humans, there is likely to be an unknown intermediate host vector. According to the research on SARS-CoV and MERS-CoV, coronaviruses are sensitive to heat. Keeping at 56℃ for 30 minutes, ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid and chloroform and other lipid solvents can effectively inactivate the virus. Chlorhexidine cannot effectively inactivate the virus.
Onset with fever as the main manifestation
From the perspective of clinical manifestations, the onset of new coronavirus pneumonia is mainly manifested by fever, which can be combined with mild dry cough, fatigue, shortness of breath, diarrhea and other symptoms. Cathartic symptoms such as runny nose and sputum are rare. Half of the patients developed dyspnea after a week. In severe cases, they rapidly progressed to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis, and coagulopathy. Some patients have mild onset symptoms, but no clinical symptoms such as fever, and usually recover after 1 week. Most patients have a good prognosis, and a few patients are critically ill and even die.
Early imaging manifestations showed multiple small patchy shadows and interstitial changes, which were obvious in the outer lung. It then develops into multiple ground-glass shadows and infiltration shadows in both lungs. In severe cases, lung consolidation may occur, and pleural effusion is rare.
In addition to imaging findings, patients may also have normal or decreased peripheral white blood cell counts and decreased lymphocyte counts in the early stages of onset. Some patients have increased liver enzymes, muscle enzymes and myoglobin. C-reactive protein and erythrocyte sedimentation rate are elevated in most patients, and procalcitonin is normal. In severe cases, D-D dimer increases, and lymphocytes progressively decrease.
Which symptoms of fever patients should be suspected of being infected
The new type of coronavirus pneumonia is a new type of coronavirus pneumonia. The population generally lacks immunity to this virus and is susceptible to the population. If you are exposed to a large number of viruses or patients with poor immune functions, they are very likely to be infected. .
According to previous diagnosis and treatment experience, there is a history of travel or residence in Wuhan within 2 weeks before the onset; or contact with patients with fever and respiratory symptoms from Wuhan within 14 days before the onset, or clustered onset; the patient has fever and pneumonia Imaging features; the total number of white blood cells is normal or decreased in the early stage of the disease, or the lymphocyte count is decreased, which can be judged as a suspected case.
On the basis of meeting the criteria for suspected cases, sputum, throat swabs, lower respiratory tract secretions and other specimens can be confirmed by real-time fluorescent RT-PCR detection of 2019-nCoV nucleic acid positive.
For all suspected cases, local medical isolation is required. For mild patients, they can be isolated and observed in the outpatient clinic or at home. All patients returning home for observation should be required to return to the designated hospital for intensive treatment once they show signs of deterioration of any disease. Severe cases and critically ill patients need to be hospitalized.
Diseases that need to be identified for new coronavirus pneumonia
Since patients with this type of pneumonia often have fever, diffuse and infiltrating lung lesions, it is first necessary to distinguish from other types of pneumonia, such as bacterial pneumonia, or non-viral pneumonia such as mycoplasma and chlamydia pneumonia, but patients with bacterial pneumonia often have blood pictures Higher, and mainly single lung, purulent sputum may be present 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 the probability of these viruses causing pneumonia is relatively low, and the number is relatively small, and patients with new coronavirus infection have pneumonia It has a higher probability and is more infectious than other viral pneumonias. In addition, it needs to be differentiated from interstitial lung diseases, especially acute interstitial pneumonia, mainly from epidemiology and imaging findings.
Antiviral drugs, antibacterial drugs and hormone applications need attention
At present, there are no specific antiviral drugs for the 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 give antibiotics for community-acquired pneumonia, such as moxifloxacin or azithromycin, intravenously or orally according to the patient’s condition. For severe or critically ill patients, empirical antimicrobial drugs are given to treat all possible pathogens. For patients with sepsis, antimicrobial drugs should be administered within one hour after the initial patient evaluation.
Glucocorticoids are a “double-edged sword” for viruses. On the one hand, they inhibit the immune function of the body and may cause the spread of the virus. On the other hand, it can reduce the inflammatory response in the lungs and help improve the symptoms of hypoxia and respiratory distress, unless there are special reasons. , The use of conventional corticosteroids should be avoided. Glucocorticoids can be used for short-term (3 to 5 days) according to the patient’s dyspnea and chest imaging progress. There is currently no specific antiviral drug. Alpha-interferon nebulized inhalation, lopinavir/ritonavir and other drugs can be tried.
If there is a history of endemic epidemiology or other infection-related risk factors (including travel history or contact with animal influenza viruses), empirical therapy should include neuraminidase inhibitors (oseltamivir) or membrane fusion inhibitors (a Bidor).
The elderly and pregnant women progress relatively faster
The new type of coronavirus pneumonia can occur in people with low immune function and normal immune function, and it has a certain relationship with the amount of virus exposure. If you are exposed to a large number of viruses at a time, you may get sick even if your immune function is normal. For people with poor immune function, such as the elderly or people with liver and kidney dysfunction, the disease progresses relatively faster and the severity is higher. However, people with normal immune function may have severe inflammatory reaction after infection, leading to ARDS or sepsis, which should not be taken lightly.
Similar to the epidemiological characteristics of SARS, children and infants have less disease. The currently confirmed case of a child patient has mild symptoms, but has a clear history of exposure and typical lung CT changes. The virus turns negative faster and the prognosis is better. There are also many suspected children.
Discharged patients should be followed up on time
At present, some patients have been cured and discharged from the hospital, especially those with mild illness. Before being discharged from the hospital, nucleic acid testing should be performed routinely. The nucleic acid test is negative for 2 consecutive days, and the clinical symptoms are significantly relieved, or the imaging performance is significantly improved. You can consider leaving the hospital on a regular basis. Follow up. In the follow-up, attention should be paid to prevent the recurrence of infection and stay at home for a period of time to ensure complete recovery from the disease.