Diagnosis and treatment investigation of one confirmed COVID-19 case

Abstract

Objective We investigated the CT changes, clinical manifestations, and epidemiological characteristics of patients′ lung, which is contribute to perform the "five early" principle as soon as possible for similar cases in the future, and to avoid misdiagnosis, missed diagnosis, and reduce the contact with unprotected infectious sources, reducing the risk of COVID-19 transmission. Additionally, we explore the new approach of traceable epidemiological investigations by carry out the epidemiological investigations in different ways. Methods Diagnosis and treatment of a 53-year-old male patient who was diagnosed as COVID -19 by the Tianlin County People’s Hospital on January 30, 2020 and epidemiological history were retrospectively analyzed. Results Clinical symptoms including fever, fatigue and cough with a little sputum. The patient was admitted to the hospital for treatment of "respiratory tract infection", and the CT showed ground-glass opacity and the lesions increased progressively. The radiologist highly suspected the case as COVID-19 by comparing the CT imagine before and after different dates, and then the patient was isolated for treatment and collected sputum for nucleic acid detection. The patient was a positive case of COVID-19. The patient has been living in Ding′an Town, Tianlin County for a long time. Neither himself nor his family members had a history of traveling or staying in epidemic areas such as Wuhan. The patient has been running a breakfast shop with his wife before onset of the disease, and he denied contact with the suspected people. Departments of Public Security investigated the suspected individuals who have meals in the restaurant during the incubation period of the patient through big data. It was found that on the morning of January 20, 2020, a citizen, named Lu, from Huangshi City, Hubei Province (Ministry of Public Security detected Lu was confirmed case for Huangshi City) in the restaurant with breakfast which cooked by the patient. Generally, customers through the small window of food delivery have a short-term face-to-face conversation with the patient. Conclusion The clinical symptoms of this patient were not obvious, and the severity of chest CT lesions was inconsistent with the clinical manifestations, which was consistent with the common features of COVID-19. The route of infection of the patient was transmitted by a close distance airborne droplet transmission from the COVID-19 patient (source of infection), who returned from the epidemic area to the local temporary residence before onset of illness (late incubation period). 摘要：目的 分析广西田林县人民医院首例新型冠状病毒肺炎 (COVID-19) 患者肺部 CT 变化、临床表现特征和流 行病学特点, 为 COVID-19 防控提供经验依据。 方法 采用描述性流行病学方法对 2020 年 1 月 30 日在田林县人民医 院收治的 1 例 COVID-19 确诊病例的诊疗经过和流行病史进行分析。 结果 患者临床表现为发热、乏力、咳嗽伴少许 咳痰, 入院以“呼吸道感染”收治, CT 显示磨玻璃影, 病灶进行性增大, 通过对不同日期肺部 CT 对比高度怀疑新冠疑似 病例, 进而对患者隔离治疗并取样送检, 该患者新冠肺炎病毒核酸检测阳性。患者长期居住田林县定安镇, 其本人及 家属均无武汉等旅居史; 患者发病前同其妻一直经营一家早餐店。经大数据手段对患者潜伏期内到其经营粉店用餐 的可疑人员逐一排查发现, 2020 年 1 月 20 日上午来自湖北省黄石市卢某某 (卢某某为黄石市确诊病例) 在患者经营的 粉店用早餐, 用餐人员一般情况下均通过递粉小窗口与患者面对面有近距离短暂交流对话。 结论 患者临床症状不 明显, 肺部 CT 病灶严重程度与临床表现不一致, 符合新冠病毒感染肺炎普通型特征。该患者感染途径是通过自疫区的 当地短暂旅居者 (感染源) 发病前 (潜伏期后期) 近距离空气飞沫途径传播。