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Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report

Iran Red Crescent Med J. 2020 March; 22(3):e102828.
Published online 2020 March 28.
doi: 10.5812/ircmj.102828.
Case Report
Frequent Convulsive Seizures in an Adult Patient with COVID-19: A
Case Report
Narges Karimi 1, * , Athena Sharifi Razavi2and Nima Rouhani 2
1Immunogenetics Research Center, School of Medicine, Clinical Research Development Unit of Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
2School of Medicine, Clinical Research Development Unit of Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
*Corresponding author: Bou Ali Sina Hospital, Pasdararn Blvd, Postal code: 4815838477, Sari, Iran. Tel: +98-1133343018 , Fax: +98-1133344506, Email:
Received 2020 March 18; Revised 2020 March 23; Accepted 2020 March 24.
Introduction: Coronavirus disease 2019 (COVID-19) is a novel coronavirus that was extracted from patients with respiratory tract
infections. The most common symptoms of patients are fever and respiratory tract involvement. In this report, we describe one
patient with frequent seizures probably due to COVID-19 infection for the first time.
Case Presentation: A 30-year-old previously healthy female was admitted with generalized tonic-clonic seizure in the neurology
emergency room. The patient complained of dr y cough five days before the admission. She had seizures (five times) approximately
every 8 hours. Brain MRI was normal and chest CT revealed focal ground-glass opacities. The respiratory specimen was positive for
COVID-19 using real-time PCR assay. The symptoms of the patient improved with anticonvulsive and antiviral medications.
Conclusions: Tothe best of our knowledge, this is the first case study to report an association between frequent seizures and COVID-
19. In our opinion, there is a hypothesis about this subject that the etiology of seizure may be due to encephalitis and invasion virus
to the brain or toxic effect of inflammatory cytokines.
Keywords: Seizure, COVID-19, Novel Coronavirus, Case Report, Convulsion
1. Introduction
Coronavirus disease 2019 (COVID-19) is a novel coron-
avirus that was extracted from patients with respiratory
tract infection of unknown causes on December 31, 2019,
in Wuhan, Hubei, China (1-3). The infected patients’ symp-
toms ranged from asymptomatic to severe (4). The most
common complaints of patients are fever (98%), cough
(76%), dyspnea (55%), myalgia, and fatigue (44%) (5-7). Some
pieces of evidence reported gastrointestinal involvement,
acute cardiac injury, and acute kidney injury due to COVID-
19 (7,8). Mao et al. (9) reported neurological manifesta-
tions of patients with COVID-19. The most common symp-
toms were dizziness, headache, hypogeusia, and hypos-
mia (9). Severe patients had ischemic or hemorrhagic
stroke, and loss of consciousness (9). At this time, the like-
lihood of COVID-19 should be considered primarily in pa-
tients with fever and/or respiratory tract symptoms who
had close contact with a confirmed or suspected patient
of COVID-19 (1). Real-time polymerase chain reaction (real-
time PCR) and next-generation sequencing were used for
definitive diagnosis of this novel coronavirus (5). To the
best of our knowledge, up to now, no seizure was reported
due to COVID-19. In this report, we describe one patient
with frequent seizures probably owing to COVID19 for the
first time.
2. Case Presentation
A 30-year-old previously healthy female was admit-
ted with generalized tonic-clonic seizure in the neurol-
ogy emergency room in Bou Ali Sina Hospital, Mazandaran
Province, Iran. The patient had no history of drug and alco-
hol abuse. She complained of dry cough five days before
admission. Three days prior to admission, she had fever
(T = 38°C axillary) and fatigue. The first generalized tonic-
clonic seizure (GTC) of the patient occurred in the sleep,
two days before the admission. Then, recurrent seizures
(five times) happened approximately every 8 hours. Also,
one seizure attack arose in the hospital, at the admission
time. As the seizure ended, the patient was sleepy and con-
fused for thirty minutes to one hour. The patient was con-
scious between attacks. She neither had a history of epilep-
tic seizures nor a family history concerning seizure disor-
ders. At the time of hospitalization in the Emergency De-
partment, the body temperature was 38.8°C, blood pres-
sure 130/70 mmHg, heart rate 98 beats/minute, respiratory
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Karimi N et al.
rate 20/minute and oxygen saturation of 96% on room air.
The bedside serum glucose level was 108 mg/dL. In terms
of neurological examination, the patient was drowsy with
disorientation to time. The cranial nerves were intact.
Pupils were midsize and reactive to light and accommo-
dation. There was no optic disc swelling bilaterally. The
patient was able to move all four extremities and there
was no stiff neck and nuchal rigidity. Deep tendon reflexes
were normal. Considering general examination, no skin
rash was observed and other systems, including cardiac
and abdominal examination, were normal. Primary labo-
ratory tests discovered a normal blood sugar, electrolytes,
calcium, phosphor, magnesium, liver function test, urea,
and creatinine. The blood sample revealed the following
results: white blood cell count 5,500 cells per microliter
with 26% lymphocytes and 70% neutrophils, mildly ele-
vated erythrocyte sedimentation rate (ESR = 35 mm/hour),
and normal C-reactive protein (CRP). Lumbar puncture was
done and the cerebrospinal fluid (CSF) showed normal pro-
tein, glucose, with five cell counts (all of them were lym-
phocytes). There was no bacterial growth after 48 hours of
incubation. Brain MRI was normal. Given that the patient
had cough and fever, the chest computed tomography (CT)
was done and revealed focal ground-glass opacities (Fig-
ure 1). Respiratory specimens, including nasal and phar yn-
geal swabs, and CSF sample were tested for COVID-19 using
real-time PCR in the Health Center no. 5 (Shahid Ghasemi)
Laboratory. This center is under the supervision of Mazan-
daran University of Medical Sciences. Nasal and pharyn-
geal samples were positive for COVID-19. The CSF sample
was unremarkable for COVID-19 infection. The patient was
treated with intravenous phenytoin and levetiracetam. In
addition, the patient received chloroquine 200 mg BD and
Lopinavir-ritonavir 400/100 mg bd. The patient was mon-
itored for one week. Fever and seizure of the patient were
3. Discussion
Coronavirus disease 2019 (COVID-19) is beta coron-
aviruses, similar to severe acute respiratory syndrome
coronavirus (SARS-CoV) in 2003 but with a different mono-
phyletic group. Both viruses bind to receptor angiotensin-
converting enzyme 2 (ACE2) to enter the cell (10,11). The
most well-known clinical symptoms of this virus are respi-
ratory symptoms. Moreover, Mao et al. (9) described neu-
rological presentations of infected patients with COVID-19.
The most common reported symptoms were headache and
dizziness. In this report, we reported a case with COVID-19
and frequent seizures, with no past medical history. There
are many different viruses that play a role in the develop-
ment of seizures and convulsions (12). The causes of seizure
Figure 1. Chest computer tomography in the patient with COVID-19 is shown
may be due to a primary infection or due to reactivation of
the latent virus. There are several mechanisms for the eti-
ology of seizure in the patients who suffer from viral infec-
tions, including direct infiltration of brain tissue and pro-
duction of toxins by the virus or production of inflamma-
tory mediators by the brain (13). Huang et al. (2) reported
that COVID-19 provokes the inflammatory cascade and as
a result, releases inflammatory cytokines, including inter-
leukins 2, 6, 7, and 10, tumor necrotizing αand the granu-
locyte colony-stimulating factor. Previous studies reported
that TNF-αand IL-6 cytokines and C3 of the complement
system are the main factors of stimulating the immune sys-
tem. Consecutively, these cytokines can drive neuronal hy-
perexcitability via activation of glutamate receptors and
play a role in the development of acute seizures(14-16).
3.1. Conclusions
To the best of our knowledge, this is the first case study
that reports an association between frequent seizures and
COVID-19. In our opinion, there is a hypothesis about this
subject that the etiology of seizure may be encephalitis
and the invasion of the virus to the brain or toxic effect of
inflammatory cytokines.
We thank the patient for her consent to publish the
case report.
2Iran Red Crescent Med J. 2020; 22(3):e102828.
Karimi N et al.
Authors’ Contribution: Study concept and design:
Narges Karimi and Nima Rouhani. Interpretation of
data: Narges Karimi and Athena Sharifi Razavi. Drafting
of the manuscript: Narges Karimi. Critical revision of
the manuscript for important intellectual content: Nima
Rouhani and Athena Sharifi Razavi.
Conflict of Interests: No conflict of interest was reported
regarding this case report.
Ethical Approval: Mazandaran University of Medical Sci-
ences approved the publication of this case report.
Funding/Support: Not applicable.
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Iran Red Crescent Med J. 2020; 22(3):e102828. 3
... However, there are also reports of adult patients without any history of epilepsy risk factors, normal brain MRI and CSF studies, who present with COVID-19 infection and generalized tonic-clonic seizures [44,53,54]. New onset focal motor seizures and focal status epilepticus were described in two patients with severe COVID-19 infection and encephalopathy, who otherwise had no history of seizures, no seizure risk factors, and no previous history of any neurological diseases [36,39]. ...
Seizures have been increasingly identified as a neurologic manifestation of coronavirus disease 2019 (COVID-19) infection. They may be symptomatic due to systemic infections, as a result of direct central nervous system (CNS) invasion, or occur in response to inflammatory reactions to the virus. It is possible that proinflammatory molecules released in response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to hyperexcitability and epileptogenesis, similar to infections caused by other neurotrophic viruses. Cerebral spinal fluid (CSF) in patients with COVID-19 and seizures is negative for SARS-CoV-2 (PCR) in the majority of patients, but has been found to be positive for proinflammatory molecules like IL-6, IL-8, and anti-neuronal autoantibodies. Electroencephalogram (EEG) in COVID-19 patients are nonspecific. However, in the encephalopathic and critically ill subpopulation, EEG is essential in detecting nonconvulsive seizures and status epilepticus which is associated with increased overall mortality in COVID-19 patients. Thus, as encephalopathy is often the only CNS symptom evidenced in patients with nonconvulsive seizures, more judicious use of continuous EEG in encephalopathic COVID-19 patients should be considered. This would facilitate earlier detection and treatment of seizures in this population, which would ultimately improve outcomes. Further research into the onset and potential for development of seizures and epilepsy in patients with COVID-19 is needed.
... Patients with COVID-19 are at risk of seizures due to electrolyte derangements, hypoxia, organ damage, and cerebral injury. Seizures have been reported in patients without any medical history of mesial temporal sclerosis or seizures and normal MRI and CSF studies (Karimi et al., 2020;Lu et al., 2020;Moriguchi et al., 2020). ...
Cytokine storms and extra-activated cytokine signaling pathways can lead to severe tissue damage and patient death. Activation of inflammatory signaling pathways during Cytokine storms are an important factor in the development of acute respiratory syndrome (SARS-CoV-2), which is the major health problem today, causing systemic and local inflammation. Cytokine storms attract many inflammatory cells that attack the lungs and other organs and cause tissue damage. Angiotensin-converting enzyme 2 (ACE2) are expressed in a different type of tissues. inhibition of ACE2 activity impairs renin-angiotensin (RAS) function, which is related to the severity of symptoms and mortality rate in COVID-19 patients. Different signaling cascades are activated, affecting various organs during SARS-CoV-2 infection. Nowadays, there is no specific treatment for COVID-19, but scientists have recognized and proposed several treatment alternatives, including applying cytokine inhibitors, immunomodulators, and plasma therapy. Herein, we have provided the detailed mechanism of SARS-CoV-2 induced cytokine signaling and its connection with pathophysiological features in different organs. Possible treatment options to cope with the severe clinical manifestations of COVID-19 are also discussed. Data Availability Statement Data will be available, when it is needed.
... The patient was given intravenous phenytoin and levetiracetam which helped control the seizures. 64 A retrospective multicenter study conducted by Lu L et al. on 304 patients reported seizures in 2 females of ages 32 and 65 years. The latter developed the symptom due to metabolic abnormalities which was resolved by correcting the metabolic disturbance. ...
Full-text available
The COVID-19 pandemic causing virus, SARS-CoV-2 emerged in the year 2019 from China. Since then, it has inflicted millions of people globally. Common presentations include cough, fever, body ache, fatigue, and shortness of breath, whereas few people might not develop any symptom. The main target of this virus is respiratory system; precisely it attacks the ACE-2 receptors of alveolar cells of lungs. ACE-2 receptors are also found in heart, gastrointestinal tract, kidneys, testis, and brain; hence involvement of these organs is also seen with this disease. An emerging discovery of invasion of nervous system by this virus has impelled researchers to investigate and understand the neurological mechanisms and features of COVID-19. The virus can affect Central as well as Peripheral Nervous System. Peripheral nervous system implications are not critical and include hypersomnia, ageusia, Guillain barre syndrome, paresthesia, skeletal muscle injury and cranial nerve involvement, whereas in central nervous system, dizziness, headache, acute cerebrovascular disease, altered level of consciousness, transverse myelitis, acute hemorrhagic necrotizing encephalopathy, encephalopathy, encephalitis, epilepsy and ataxia can develop. Neurological manifestations are particularly seen with severely ill COVID patients. In this article, we present a comprehensive review of prevalence of various CNS and PNS symptoms in COVID-19, risk factors, investigations, management, and prognosis related to these. This will aid the physicians and neurologists in better understanding the course of this illness and the current statistics of neurological presentations, crucial for handling the disease.
... Although there have been case reports of patients with COVID-19 having seizures with no history of epilepsy, it is not clear if this is directly due to SARS-CoV-2 infection or an unmasking of a seizure disorder due to other factors. [22] Yang et al. reported that COVID-19 provokes the inflammatory cascade and as a result, releases inflammatory cytokines, including interleukins 2, 6, 7, and 10, tumour necrotizing factors and the granulocyte colony-stimulating factor. It is reported that TNF-α and IL-6 cytokines and C3 of the complement system are the main factors of stimulating the immune system that can drive neuronal hyperexcitability via activation of glutamate receptors and play a role in the development of acute seizures. ...
Background and objective: SARS-CoV-2 infections present with predominant respiratory symptoms. Only a few anecdotal reports of neurological involvement have come out from India so far. Adverse neurological events following immunization (AEFI) were also reported. We present the neurological symptoms seen either in association with vaccination or COVID-19 infection during the second wave. Methods: This was a retrospective study that included consecutive COVID-19 patients' admissions during the second wave of COVID-19 pandemic in two tertiary health care centres in Kerala. Neurological symptoms two weeks prior or thirty days after a positive status of antigen or RTPCR was termed as COVID-19-Associated Neurological Disorders (CAND) and those with neurological symptoms within one month of COVID-19 vaccination was termed as Post-Vaccinal Neurological Disorders (PVND). Results: During the study period, 1270 COVID-19 admissions were reported. We identified neurological symptoms in 42 patients (3.3%), of which 35 were CAND and 7 were PVND. Stroke was the most common (50%), followed by seizures and peripheral nervous system disorders (14.2% each). Encephalitis/demyelination (11.9%) and COVID-19-associated infections (9.5%) were also seen. Conclusion: During the SARS-CoV-2 pandemic, CAND and PVND have been emerging. Association of some of these may be fortuitous; however it is worth mentioning as pathogenic mechanisms of COVID-19 affecting various organ systems still remain unclear. Moreover, this may be helpful in future studies designing management options.
Central nervous system (CNS) infection is one of the important risk factors for epilepsy. COVID-19 pandemic, which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has primarily been considered to involve respiratory system only, but it can also affect the CNS. A wide range of neurological manifestations have been reported in SARS-CoV-2 infected patients including seizures, status epilepticus, stroke, which are considered as important risk factors for the development of epilepsy. In post-mortem, brain tissue samples of COVID-19 patients have shown neuropathological changes and presence of SARS-CoV-2 RNA and viral proteins. In this review, mechanisms of SARS-CoV-2 neuroinvasion like neuronal retrograde trans-synaptic route and vascular route are described along with important neurological manifestations in COVID-19 patients such as seizures and cerebrovascular diseases, which have been found to be associated with the development of epilepsy. Hence, an increased risk of future burden of epilepsy in susceptible COVID-19 survivors has been proposed and preventive measures are suggested. The present review highlights about the possible association between neurological manifestations and future risk of epilepsy in COVID-19 patients.
Vital activity restoration in patients with fatigue syndrome after coronavirus disease-2019 and myalgic encephalomyelitis/chronic fatigue syndrome is a priority in the medical rehabilitation of this category of patients. This study aimed to review the literature using Russian and international sources and present data from contemporary studies on symptoms, possible pathophysiology and proposed treatment for neurological manifestations of consequences after an acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The recovery level of vital activity after acute infection with SARS-CoV-2 is low, and neurological symptoms persist in many patients. Chronic fatigue syndrome gradually develops in patients with a history of the disease, which subsequently leads to mental disorders, due to decreased physical activity.
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Introduction. Recently, humanity has faced a new public health threat – the spread of the new coronavirus in 2019 (SARS-CoV-2). To address the problems caused by the high REVIEW ARTICLE Epidemiological aspects in COVID-19 infection based on current evidences: article of narrative synthesis What is not known yet, about the topic COVID-19 infection is an emerging disease that has a number of unclear epidemiological features, such as the primary sources of human infection, the duration of the patient’s contagiousness, the possibility of transmitting the infection from mother to foetus, and the specific prophylaxis of infection. Research hypothesis Publications addressing the epidemiological features of COVID-19 infection could contribute to the development of non-pharmaceutical measures for the prevention and early localization of outbreaks of SARS-CoV-2 in conditions of community spread. Article’s added novelty on this scientific topic The article summarizes the recently published articles on the features of the spread of COVID-19 infection according to the sources of infection, infectivity rate, routes of transmission, risk factors related to patients age, gender, associated comorbidities, and last but not least, trends in the development of the effective vaccine in combating the spread of SARS-CoV-2 virus. morbidity and mortality caused by this virus, a series of researches, have been carried out. The aim of these researches is to implement measures based on scientific evidence that will help to reduce the medical, social and economic impact worldwide. Material and methods. The existing bibliographic source on the PubMed platform was analysed, 251 articles, that are related to the objectives of our research, were pre-selected, and after excluding articles focused on clinic, treatment and diagnosis, 72 articles relevant to the proposed research topic were selected. Results. The analysed bibliographic sources allowed the highlighting of the inter-human transmission of the virus; incubation period is 2-14 days; the reproduction index varies from 2 to 6 infected people, depending on the prevention measures applied; the sources of infection can be asymptomatic persons, the most vulnerable to infection are the elderly with co-morbidities; the virus is sensitive to the action of hydrogen peroxide, sodium hypochlorite and alcohol over 60%. At the same time, based on the large number of infected people, the strategy for the development of effective vaccines against SARS-CoV-2 is initiated. Conclusions. At the current stage, COVID-19 infection has caused a very high medical, social and economic impact, becoming a pressing public health problem that needs to be solved. Assessing the features of the epidemic process with highlighting the epidemiological aspects, risk factors and specific prevention measures, will contribute to reducing the cases of infection and stabilizing the situation in the world. Despite the fact that a number of scientific publications mention the epidemiological features of the infection spread, there are some moments in studies, based on outbreaks of infection recorded under the conditions of community transmission, that need to be elucidated. Key words: COVID-19 infection, SARS-CoV-2 virus, source of infection, reproduction rate, routes of transmission, risk factors, vaccine.
The epidemic of coronavirus disease 2019 (COVID-19) has broken the normal spread mode of respiratory viruses, namely, mainly spread in winter, resulting in over 230 million confirmed cases of COVID-19. Many studies have shown that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can affect the nervous system by varying degrees. In this review, we look at the acute neuropsychiatric impacts of COVID-19 patients, including acute ischemic stroke, encephalitis, acute necrotizing encephalopathy, dysosmia, and epilepsy, as well as the long-term neuropsychiatric sequelae of COVID-19 survivors: mental disorder and neurodegenerative diseases. In particular, this review discusses long-term changes in brain structure and function associated with COVID-19 infection. We believe that the traditional imaging sequences are important in the acute phase, while the nontraditional imaging sequences are more meaningful for the detection of long-term neuropsychiatric sequelae. These long-term follow-up changes in structure and function may also help us understand the causes of neuropsychiatric symptoms in COVID-19 survivors. Finally, we review previous studies and discuss some potential mechanisms of SARS-CoV-2 infection in the nervous system. Continuous focus on neuropsychiatric sequelae and a comprehensive understanding of the long-term impacts of the virus to the nervous system is significant for formulating effective sequelae prevention and management strategies, and may provide important clues for nervous system damage in future public health crises.
Novel coronavirus 19 (COVID-19) is the latest and most intense epidemic, which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to causing respiratory symptoms, SARS-CoV-2 can have severe effects on the nervous system. Clinically, COVID-19 patients have been reported ranging from mild hypogeusia and hyposmia to severe neurological disorders, such as encephalopathy, encephalitis, strokes, and seizures syndrome. However, the pathological mechanisms of this SARS-CoV-2 neuro aggressiveness remain unclear, so it is of great significance to explore the neurological effects of SARS-CoV-2 infection. To facilitate clinicians to timely recognize the manifestations of COVID-19 patients with neurological injury and timely treatment, the author hereby reviews the latest research progress in the possible pathways, clinical manifestations, and pathogenesis of COVID-19 patients with nerve injury.
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In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.
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Importance In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited. Objective To describe the epidemiological and clinical characteristics of NCIP. Design, Setting, and Participants Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020. Exposures Documented NCIP. Main Outcomes and Measures Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked. Results Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 10⁹/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0). Conclusions and Relevance In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
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Since the SARS outbreak 18 years ago, a large number of severe acute respiratory syndrome-related coronaviruses (SARSr-CoV) have been discovered in their natural reservoir host, bats1–4. Previous studies indicated that some of those bat SARSr-CoVs have the potential to infect humans5–7. Here we report the identification and characterization of a novel coronavirus (2019-nCoV) which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started from 12 December 2019, has caused 2,050 laboratory-confirmed infections with 56 fatal cases by 26 January 2020. Full-length genome sequences were obtained from five patients at the early stage of the outbreak. They are almost identical to each other and share 79.5% sequence identify to SARS-CoV. Furthermore, it was found that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. The pairwise protein sequence analysis of seven conserved non-structural proteins show that this virus belongs to the species of SARSr-CoV. The 2019-nCoV virus was then isolated from the bronchoalveolar lavage fluid of a critically ill patient, which can be neutralized by sera from several patients. Importantly, we have confirmed that this novel CoV uses the same cell entry receptor, ACE2, as SARS-CoV.
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A novel coronavirus (2019-nCov) was identified in Wuhan, Hubei Province, China in December of 2019. This new coronavirus has resulted in thousands of cases of lethal disease in China, with additional patients being identified in a rapidly growing number internationally. 2019-nCov was reported to share the same receptor, Angiotensin-converting enzyme 2 (ACE2), with SARS-Cov. Here based on the public database and the state-of-the-art single-cell RNA-Seq technique, we analyzed the ACE2 RNA expression profile in the normal human lungs. The result indicates that the ACE2 virus receptor expression is concentrated in a small population of type II alveolar cells (AT2). Surprisingly, we found that this population of ACE2-expressing AT2 also highly expressed many other genes that positively regulating viral reproduction and transmission. A comparison between eight individual samples demonstrated that the Asian male one has an extremely large number of ACE2-expressing cells in the lung. This study provides a biological background for the epidemic investigation of the 2019-nCov infection disease, and could be informative for future anti-ACE2 therapeutic strategy development.
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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 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.
Objective: To analyze the clinical characteristics of 2019 novel coronavirus (2019-nCoV) pneumonia and to investigate the correlation between serum inflammatory cytokines and severity of the disease. Methods: 29 patients with 2019-ncov admitted to the isolation ward of Tongji hospital affiliated to Tongji medical college of Huazhong University of Science and Technology in January 2020 were selected as the study subjects. Clinical data were collected and the general information, clinical symptoms, blood test and CT imaging characteristics were analyzed. According to the relevant diagnostic criteria, the patients were divided into three groups: mild (15 cases), severe (9 cases) and critical (5 cases). The expression levels of inflammatory cytokines and other markers in the serum of each group were detected, and the changes of these indicators of the three groups were compared and analyzed, as well as their relationship with the clinical classification of the disease. Results: (1) The main symptoms of 2019-nCoV pneumonia was fever (28/29) with or without respiratory and other systemic symptoms. Two patients died with underlying disease and co-bacterial infection, respectively. (2) The blood test of the patients showed normal or decreased white blood cell count (23/29), decreased lymphocyte count (20/29), increased hypersensitive C reactive protein (hs-CRP) (27/29), and normal procalcitonin. In most patients,serum lactate dehydrogenase (LDH) was significantly increased (20/29), while albumin was decreased(15/29). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), serum creatinine (Scr) and other items showed no significant changes. (3) CT findings of typical cases were single or multiple patchy ground glass shadows accompanied by septal thickening. When the disease progresses, the lesion increases and the scope expands, and the ground glass shadow coexists with the solid shadow or the stripe shadow. (4) There were statistically significant differences in the expression levels of interleukin-2 receptor (IL-2R) and IL-6 in the serum of the three groups (P<0.05), among which the critical group was higher than the severe group and the severe group was higher than the mildgroup. However, there were no statistically significant differences in serum levels of tumor necrosis factor-alpha (TNF-α), IL-1, IL-8, IL-10, hs-CRP, lymphocyte count and LDH among the three groups (P>0.05). Conclusion: The clinical characteristics of 2019-nCoV pneumonia are similar to those of common viral pneumonia. High resolution CT is of great value in the differential diagnosis of this disease. The increased expression of IL-2R and IL-6 in serum is expected to predict the severity of the 2019-nCoV pneumonia and the prognosis of patients.
Background The chest CT findings of patients with 2019 Novel Coronavirus (2019-nCoV) pneumonia have not previously been described in detail.PurposeTo investigate the clinical, laboratory, and imaging findings of emerging 2019-nCoV pneumonia in humans.Materials and Methods Fifty-one patients (25 men and 26 women; age range 16-76 years) with laboratory-confirmed 2019-nCoV infection by using real-time reverse transcription polymerase chain reaction underwent thin-section CT. The imaging findings, clinical data, and laboratory data were evaluated.ResultsFifty of 51 patients (98%) had a history of contact with individuals from the endemic center in Wuhan, China. Fever (49 of 51, 96%) and cough (24 of 51, 47%) were the most common symptoms. Most patients had a normal white blood cell count (37 of 51, 73%), neutrophil count (44 of 51, 86%), and either normal (17 of 51, 35%) or reduced (33 of 51, 65%) lymphocyte count. CT images showed pure ground-glass opacity (GGO) in 39 of 51 (77%) patients and GGO with reticular and/or interlobular septal thickening in 38 of 51 (75%) patients. GGO with consolidation was present in 30 of 51 (59%) patients, and pure consolidation was present in 28 of 51 (55%) patients. Forty-four of 51 (86%) patients had bilateral lung involvement, while 41 of 51 (80%) involved the posterior part of the lungs and 44 of 51 (86%) were peripheral. There were more consolidated lung lesions in patients 5 days or more from disease onset to CT scan versus 4 days or fewer (431 of 712 lesions vs 129 of 612 lesions; P < .001). Patients older than 50 years had more consolidated lung lesions than did those aged 50 years or younger (212 of 470 vs 198 of 854; P < .001). Follow-up CT in 13 patients showed improvement in seven (54%) patients and progression in four (31%) patients.Conclusion Patients with fever and/or cough and with conspicuous ground-glass opacity lesions in the peripheral and posterior lungs on CT images, combined with normal or decreased white blood cells and a history of epidemic exposure, are highly suspected of having 2019 Novel Coronavirus (2019-nCoV) pneumonia.© RSNA, 2020.
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.