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First confirmed case of COVID-19 infection in India: A case report

Authors:
MA Andrews
MA Andrews
MA Andrews
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Binu Areekal at Governmental Medical College, Ernakulam
Binu Areekal
  • Governmental Medical College, Ernakulam
KR Rajesh
KR Rajesh
KR Rajesh
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Jijith Krishnan
Jijith Krishnan
Jijith Krishnan
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© 2020 Indian Journal of Medical Research, published by Wolters Kluwer - Medknow for Director-General, Indian Council of Medical Research
Sir,
Coronaviruses (CoV) are a large family of viruses
that cause illness ranging from the common cold to
more severe diseases such as Middle East respiratory
syndrome (MERS)-CoV and severe acute respiratory
syndrome (SARS)-CoV1. On December 31, 2019, China
informed the World Health Organization (WHO) about
cases of pneumonia of unknown aetiology detected in
Wuhan city, Hubei province of China. From December
31, 2019 to January 3, 2020, a total of 44 patients with
pneumonia of unknown aetiology were reported to the
WHO by the national authorities in China2. During
this period, the causal agent was not identied. The
cases initially identied had a history of exposure to
the Huanan Seafood Wholesale Market3. The most
common clinical features of the early clinical cases from
Wuhan, China, were fever (98.6%), fatigue (69.6%)
and dry cough (59.4%)4. The second meeting of the
Emergency Committee convened by the WHO Director-
General under the International Health Regulations
(2005) regarding the outbreak of novel coronavirus
2019 in the People’s Republic of China on January 30,
2020, declared COVID-19 outbreak as Public Health
Emergency of International Concern (PHEIC)5. As on
February 17, 2020, except China, 25 other countries
have been aected by COVID-19 outbreak with 70,635
conrmed cases and 1,772 deaths in China. Outside
China, 794 cases were reported with three deaths6.
We present here the rst case of COVID-19
infection reported in Kerala, India. On January 27,
2020, a 20 yr old female presented to the Emergency
Department in General Hospital, Thrissur, Kerala,
with a one-day history of dry cough and sore throat.
There was no history of fever, rhinitis or shortness of
breath. She disclosed that she had returned to Kerala
from Wuhan city, China, on January 23, 2020 owing
to COVID-19 outbreak situation there. She was
asymptomatic between January 23 and 26. On the 27th
morning, she felt a mild sore throat and dry cough.
She did not give a history of contact with a person
suspected or conrmed with COVID-19 infection. She
did not visit the Huanan Seafood Wholesale Market,
however, she gave a history of travel from Wuhan
to Kunming by train where she noticed people with
respiratory symptoms in railway station and train.
She received the instructions from the Kerala State
authorities to visit a healthcare facility if she develops
any symptoms because of the travel history to China.
In the Emergency department in General Hospital,
she was afebrile with a pulse rate of 82/min, blood
pressure 130/80 mmHg, temperature 98.5°F and
oxygen saturation 96 per cent while the patient was
breathing ambient air. Lung auscultation revealed
normal breath sounds with no adventitious sounds.
In view of her travel history from Wuhan, the district
rapid response team decided to admit her in an isolation
room which was designated for the corona epidemic.
An oropharyngeal swab was obtained and was sent
to the ICMR-National Institute of Virology (NIV),
Pune, for the detection of viral respiratory pathogens
on January 27, 2020. Three millilitres each of EDTA
blood and plain blood samples were also collected and
sent to NIV, Pune, where COVID-19 was diagnosed
using real time reverse transcription PCR. Specimen
collection was done on day 0 (admission) and every
alternate day. Urine and stool samples were also sent for
detailed evaluation. She was started on azithromycin
(500 mg), cetirizine (10 mg) and saline gargle. Over
the next three days, her symptoms improved.
Her oropharyngeal swab result was reported by
the NIV, Pune, to District Control Cell on January
30, 2020 as positive for COVID-19 infection. The
details of basic laboratory investigations done on
days 3, 7 and 20 of illness are shown in the Table.
On day 1 of illness, the total white blood cell count
was towards the low normal side, but on days 5 and
Quick Response Code:
Correspondence
First conrmed case of COVID-19 infection in India: A case report
Indian J Med Res, Epub ahead of print
DOI: 10.4103/ijmr.IJMR_2131_20
[Downloaded free from http://www.ijmr.org.in on Tuesday, June 2, 2020, IP: 47.30.213.160]
2 INDIAN J MED RES, 2020
20, the count showed a rise which was consistent
with a viral infection. Erythrocyte sedimentation rate
was highest on day 7. The rest of the investigations
were normal. She was referred to the Government
Medical College, Thrissur, Kerala on January 31,
2020, and was admitted in isolation block designated
for corona infection. By this time, the outbreak
monitoring unit of the institution had brought out
a detailed policy regarding the standard operating
procedures including infection control measures to
be followed in the isolation block. On presentation,
she had only mild sore throat and rhinitis. She was
conscious, oriented, afebrile, with pulse rate 76/min,
blood pressure 100/70 mmHg, respiratory rate 12/min
and oxygen saturation 97 per cent in the ambient air.
General examination revealed no signicant ndings.
She was started on oseltamivir and symptomatic
measures. She gradually improved over the three days
and became asymptomatic on February 3, 2020 and
became negative for COVID-19 infection on day 19
of her illness. The oropharyngeal swabs for diagnosis
of COVID-19 infection were collected on days 1, 4,
5, 7 and every alternate day, i.e. days 9, 11, 13 and
so on after the onset of illness. The initial swabs
remained positive till day 17 after which the swabs on
days 19, 21 and 23 were negative and the patient was
discharged. She was discharged from the hospital on
February 20, 2020.
A detailed contact tracing was done by the
Community Medicine department of the Government
Medical College, Thrissur, with the District Health
Authorities. Those identied were followed up for 28
days for any symptoms. All healthcare workers in the
isolation block also were followed up for 14 days.
Financial support & sponsorship: None.
Conicts of Interest: None.
M. A. Andrews1,*, Binu Areekal2, K.R. Rajesh3,
Jijith Krishnan3, R. Suryakala4, Biju Krishnan6,
C. P. Muraly5 & P.V. Santhosh6
Departments of 1Medicine, 2Community
Medicine, 3Internal Medicine, 4Microbiology,
5Pulmonology & 6Surgery, Government Medical
College, Thrissur 680 596, Kerala, India
Table. Clinical laboratory report of the patient
Measure Days of illness
1 5 14 24
Haemoglobin (g/dl) 10.8 12.2 12.1 11.3
Total WBC count (cells/µl) 5300 7300 7400 8500
Dierential count Polymorphs-46
Lymphocytes-47
Monocytes-7
Polymorphs-47
Lymphocytes-42
Monocytes-11
Polymorphs-50
Lymphocytes-46
Monocytes-4
Polymorphs-56
Lymphocytes-36
Monocytes-8
Platelet count (×106 cells/µl) 2.88 3.6 3 3.9
ESR 13 44 33 80
Urine routine Normal Normal Normal Normal
Random blood sugar (mg/dl) 89 82 83 95
Blood urea (mg/dl) 22 14 14 14
Serum creatinine (mg/dl) 0.7 0.8 0.7 0.6
Serum sodium (mmol/l) 136 135 134 134
Serum potassium (mmol/l) 4.3 4.4 4.2 4.3
Total bilirubin (mg/dl) 0.7 0.4 0.5 0.4
Direct bilirubin (mg/dl) 0.2 0.2 0.2 0.2
Total protein (g/dl) 6.1 6.8 6.2 7.8
Serum albumin (g/dl) 3.9 4 3.4 4.8
Alanine aminotransferase (IU/l) 15 13 16 16
Aspartate aminotransferase (IU/l) 19 21 23 22
Alkaline phosphatase (IU/l) 113 110 116 150
WBC, white blood cell; ESR, erythrocyte sedimentation rate
[Downloaded free from http://www.ijmr.org.in on Tuesday, June 2, 2020, IP: 47.30.213.160]
ANDREWS et al: FIRST COVID-19 CASE IN INDIA 3
*For correspondence:
anjulioness@gmail.com
Received May 23, 2020
References
1. Coronavirus disease: What you need to know. Available from:
https://www.afro.who.int/news/coronavirus-disease-what-you-
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2. World Health Organization. Pneumonia of unknown cause
– China. Geneva: WHO; January 5, 2020. Available from:
https://www.who.int/csr/don/05-january-2020-pneumonia-
of-unkown-cause-china/en/, accessed on February 18, 2020.
3. World Health Organization. Novel coronavirus – China.
Available from: http://www.who.int/csr/don/12-january-2020-
novel-coronavirus-china/en/, accessed on February 18, 2020.
4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical
Characteristics of 138 hospitalized patients with 2019 novel
coronavirus-infected pneumonia in Wuhan, China. JAMA
2020; 323 : 1061-9.
5. World Health Organization. Novel coronavirus (2019-nCoV)
situation report – 11. Geneva: WHO; January 31, 2020.
6. World Health Organization. Coronavirus disease 2019
(COVID-19) Situation Report – 28. Geneva: WHO; February
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[Downloaded free from http://www.ijmr.org.in on Tuesday, June 2, 2020, IP: 47.30.213.160]
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Pneumonia of unknown cause -China
  • Jan 2020
World Health Organization. Pneumonia of unknown cause -China. Geneva: WHO; January 5, 2020. Available from: https://www.who.int/csr/don/05-january-2020-pneumoniaof-unkown-cause-china/en/, accessed on February 18, 2020.