Please wait a minute...
J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (2): 270-274    DOI: 10.3785/j.issn.1008-9292.2020.03.11
    
Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19
LI Youjiang1(),HU Yingying2,ZHANG Xiaodong1,YU Yuanyuan2,LI Bin3,WU Jianguo1,WU Yingping1,XIA Xiaoping1,XU Jian2,*()
1. Clinical Laboratory, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
2. Department of Gynecology and Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
3. Department of Infection Diseases, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Download: HTML( 25 )   PDF(1758KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To investigate the clinical outcome of patients with moderate type of coronavirus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid. Methods: Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantined in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the quarantined period, the symptoms and signs were documented, and sputum or nasal swab and feces samples were collected to test SARS-CoV-2 nucleic acid by RT-PCR method. Results: There was no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-CoV-2 nucleic acid at 5 to 7 days after they met the discharge criteria. Conclusion: There is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.



Key wordsCoronavirus disease 2019      Severe acute respiratory syndrome coronavirus 2      Novel coronavirus pneumonia      Discharge criteria      Nucleic acid test      Follow-up     
Received: 11 March 2020      Published: 27 March 2020
CLC:  R512.99  
Corresponding Authors: XU Jian     E-mail: liyoujiang26@zju.edu.cn;xuj@zju.edu.cn
Cite this article:

LI Youjiang,HU Yingying,ZHANG Xiaodong,YU Yuanyuan,LI Bin,WU Jianguo,WU Yingping,XIA Xiaoping,XU Jian. Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19. J Zhejiang Univ (Med Sci), 2020, 49(2): 270-274.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.03.11     OR     http://www.zjujournals.com/med/Y2020/V49/I2/270


七例2019冠状病毒病(COVID-19)普通型患者出院后病毒核酸随访结果

目的: 随访研究2019冠状病毒病(COVID-19)患者在达到出院标准后病毒核酸检测结果,为医疗机构对出院患者随访管理提供决策依据。方法: 对浙江大学医学院附属第四医院经治疗后已符合出院标准的COVID-19患者采取院内继续隔离观察7 d,再居家隔离4周,期间记录患者每日临床体征,定期送检痰液行病毒核酸检测,评估患者病情变化。结果: 已符合现有出院标准的7例患者中有3例在5~7 d后再次出现痰液病毒核酸检测阳性,持续阳性2~6 d后再次转阴;复查患者血常规、C反应蛋白、血生化以及胸部CT结果均无明显异常,也无明显临床症状。其余4例患者随访4周,痰液病毒核酸检测均为阴性,未出现COVID-19相关临床症状,实验室和影像学检查结果无异常。结论: COVID-19患者按现有标准出院后复阳的比例较高,建议有条件的医疗机构对满足现行出院标准的患者继续院内隔离观察7 d并进行连续的病毒核酸监测。


关键词: 2019冠状病毒病,  严重急性呼吸综合征冠状病毒2,  新型冠状病毒肺炎,  出院标准,  核酸检测,  随访 
项目 病例1 病例2 病例3 病例4 病例5 病例6 病例7
  COVID-19:2019冠状病毒病;ALT:丙氨酸转氨酶;AST:天冬氨酸转氨酶.
性别 女性 女性 女性 女性 女性 男性 男性
年龄(岁) 24 72 71 56 37 37 73
暴露情况 与武汉回义乌人员接触 与武汉回义乌人员接触 否认有暴露史 与武汉回义乌人员接触 武汉回义乌人员 武汉回义乌人员 与武汉回义乌人员接触
首发症状日期 1月23日 1月23日 1月20日 1月22日 1月23日 1月23日 1月15日
确诊日期 2月2日 1月30日 2月6日 1月23日 1月26日 1月26日 1月28日
符合出院标准日期 2月17日 2月19日 2月17日 2月11日 2月11日 2月17日 2月11日
发热
咳嗽
肌肉酸痛
乏力
咽痛
呼吸困难
腹泻
白细胞计数正常或减少(9.5× 109/L以下)
淋巴细胞计数减少
ALT超过45 U/L
AST超过35 U/L
C反应蛋白超过6 mg/L
CT表现典型病毒感染特征
出院时肺部影像 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收
鼻导管氧气支持
抗病毒药物
抗菌药物
糖皮质激素
Tab 1 Demographics and baseline characteristics of 7 patients with COIVD-19
Fig 1 Recurrence of SARS-CoV-2 nucleic acid in 3 patients after discharge
[1]   广东省政府新闻办疫情防控第三十一场新闻发布会[EB/OL].(2020-02-25)[2020-02-25].http://gdio.southcn.com/g/2020-02/25/content_190429333.htm.
The 31st press conference on epidemic prevention and control from Guangdong Provincial Government Information Office[EB/OL].(2020-02-25)[2020-02-25]. http://gdio.southcn.com/g/2020-02/25/content_190429333.htm. (in Chinese)
[2]   中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医涵〔2020〕145号.(2020-02-18)[2020-02-28].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No. 145〔2020〕of the General Office of the National Health Commission. (2020-02-18)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
[3]   LAN L, XU D, YE G, et al. Positive RT-PCR test results in patients recovered from COVID-19[J/OL]. JAMA, 2020: e202783. DOI: 10.1001/jama.2020.2783.
[4]   CHAN J F W , YUAN S F , KOK K H et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster[J]. Lancet, 2020, 395 (10223): 514- 523
doi: 10.1016/S0140-6736(20)30154-9
[5]   ZHANG W , DU RH , LI B et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes[J]. Emerg Microbes Infect, 2020, 9 (1): 386- 389
doi: 10.1080/22221751.2020.1729071
[6]   YANG Y, YANG M, SHEN C, et al. Laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections[J/OL]. medRxiv, 2020. DOI: 10.1101/2020.02.11.20021493.
[1] CHEN Zhimin,FU Junfen,SHU Qiang,WANG Wei,CHEN Yinghu,HUA Chunzhen,LI Fubang,LIN Ru,TANG Lanfang,WANG Tianlin,WANG Yingshuo,XU Weize,YANG Zihao,YE Sheng,YUAN Tianming,ZHANG Chenmei,ZHANG Yuanyuan. Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition)[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 139-146.
[2] XU Kaijin,CAI Hongliu,SHEN Yihong,NI Qin,CHEN Yu,HU Shaohua,LI Jianping,WANG Huafen,YU Liang,HUANG He,QIU Yunqing,WEI Guoqing,FANG Qiang,ZHOU Jianying,SHENG Jifang,LIANG Tingbo,LI Lanjuan. Management of COVID-19: the Zhejiang experience[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 147-157.
[3] JIANG Saiping,LI Lu,RU Renping,ZHANG Chunhong,RAO Yuefeng,LIN Bin,WANG Rongrong,CHEN Na,WANG Xiaojuan,CAI Hongliu,SHENG Jifang,ZHOU Jianying,LU Xiaoyang,QIU Yunqing. Pharmaceutical care for severe and critically ill patients with COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 158-169.
[4] LI Xin,DAI Tian,WANG Hong,SHI Junnian,YUAN Wei,LI Jing,CHEN Lijun,ZHANG Tianming,ZHANG Shanshan,KONG Yan,YUE Ning,SHI Hui,HE Yuping,HU Huifang,LIU Furong,YANG Caixia. Clinical analysis of suspected COVID-19 patients with anxiety and depression[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 203-208.
[5] LUO Song,YANG Lijuan,WANG Chun,LIU Chuanmiao,LI Dianming. Clinical observation of 6 severe COVID-19 patients treated with plasma exchange or tocilizumab[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 227-231.
[6] HONG Dongsheng,NI Jian,SHAN Wenya,LI Lu,HU Xi,YANG Hongyu,ZHAO Qingwei,ZHANG Xingguo. Establishment of a rapid identification of adverse drug reaction program in R language implementation based on monitoring data[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 253-259.
[7] ZHONG Qi,LI Zhi,SHEN Xiaoyong,XU Kaijin,SHEN Yihong,FANG Qiang,CHEN Feng,LIANG Tingbo. CT imaging features of patients with different clinical types of COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 198-202.
[8] KANG Xianhui,ZHANG Rong,HE Huiliang,YAO Yongxing,ZHENG Yueying,WEN Xiaohong,ZHU Shengmei. Anesthesia management in cesarean section for patient with COVID-19: a case report[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 249-252.
[9] CHEN Xu,LI Yang,WANG Jinxi,CAI Hongliu,CAO Hongcui,SHENG Jifang. Pregnant women complicated with COVID-19: a clinical analysis of 3 cases[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 240-244.
[10] SHEN Lihua,HUANG Fei,CHEN Xiang,XIONG Zuan,YANG Xiaoyu,LI Hui,CHENG Feng,GUO Jian,GONG Guofu. Diagnostic efficacy of three test kits for SARS-CoV-2 nucleic acid detection[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 185-190.
[11] ZHAGN Sheng,LI Danping,CHEN Huazhong,ZHENG Dan,ZHOU Yiping,CHEN Baoguo,SHI Weiwu,LIN Ronghai. Dynamic inflammatory response in a critically ill COVID-19 patient treated with corticosteroids[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 220-226.
[12] YE Ziqi,HONG Yun,WU Xiuhua,HONG Dongsheng,ZHANG Yanfang,DONG Xihao,RAO Yuefeng,LU Xiaoyang. Management of a colon cancer patient complicated with COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 245-248.
[13] DING Shubo,YU Shi'an,CHEN Haijun,ZHANG Dehe,XU Yejin,ZHU Dan,CHENG Kun. Roles of multidisciplinary team in diagnosis and treatment of suspected cases of COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 209-214.
[14] HE Guojun,HAN Yijiao,FANG Qiang,ZHOU Jianying,SHEN Jifang,LI Tong,PU Qibin,CHEN Aijun,QI Zhiyang,SUN Lijun,CAI Hongliu. Clinical experience of high-flow nasal cannula oxygen therapy in severe COVID-19 patients[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 232-239.
[15] FAN Tiantian,CHEN Yongcan,BAI Yu,MA Fengqi,WANG Hengcang,YANG Yiping,CHEN Jinxu,LIN Yuqi. Analysis of medication characteristics of traditional Chinese medicine in treating COVID-19 based on data mining[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 260-269.