SARS-CoV-2: Difference between revisions

Revision as of 23:16, 30 July 2020

Background

Microbiology

Coronavirus related to SARS-CoV
Virion consists of:
- Spike glycoprotein (S)
- Membrane protein (M)
- Nucleocapsid protein (N)
- Hemagglutinin esterase (He)
- Envelope protein (E)

Epidemiology

First cases detected Dec 2019 related to likely exposure in wet market in Wuhan, Hubei, China, and declared a pandemic in 2020
Secondary household attack rate of 12-17%

Risk Factors for Mortality

Greater age
Male sex
COPD
Dyslipidemia
Diabetes

Clinical Manifestations

Incubation period 4-5 days (range 2 to 11), possibly as long as 14 days in some cases
Main presenting symptoms were fever and cough, followed by myalgia, fatigue, headache, dyspnea
Other symptoms include dyspnea, rhinorrhea, vomiting, diarrhea, anosmia/hyposmia
Lymphopenia is common, as is hypoalbuminemia, elevated D-dimer, CRP, LDH, AST/ALT
Viral load detectable before symptom onset and peaks around the time of symptom onset

Complications

In critically ill patients:
- ARDS (75%)
- AKI (40%)
- Thrombosis (10%)

Diagnosis

PCR from NP swab
- May be positive long after no longer infectious

Management

Dexamethasone for patients requiring supplemental oxygen
Investigational therapeutics include tocilizumab, lopinavir/ritonavir, and chloroquine

References

^ Louise Lansbury, Benjamin Lim, Vadsala Baskaran, Wei Shen Lim. Co-infections in people with COVID-19: a systematic review and meta-analysis. Journal of Infection. 2020;81(2):266-275. doi:10.1016/j.jinf.2020.05.046.
^ Scott Simpson, Fernando U. Kay, Suhny Abbara, Sanjeev Bhalla, Jonathan H. Chung, Michael Chung, Travis S. Henry, Jeffrey P. Kanne, Seth Kligerman, Jane P. Ko, Harold Litt. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging. 2020;2(2):e200152. doi:10.1148/ryct.2020200152.
^ Robert L. Gottlieb, Carlos E. Vaca, Roger Paredes, Jorge Mera, Brandon J. Webb, Gilberto Perez, Godson Oguchi, Pablo Ryan, Bibi U. Nielsen, Michael Brown, Ausberto Hidalgo, Yessica Sachdeva, Shilpi Mittal, Olayemi Osiyemi, Jacek Skarbinski, Kavita Juneja, Robert H. Hyland, Anu Osinusi, Shuguang Chen, Gregory Camus, Mazin Abdelghany, Santosh Davies, Nicole Behenna-Renton, Frank Duff, Francisco M. Marty, Morgan J. Katz, Adit A. Ginde, Samuel M. Brown, Joshua T. Schiffer, Joshua A. Hill. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. New England Journal of Medicine. 2021. doi:10.1056/nejmoa2116846.

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
-* Coronavirus related to [[SARS-CoV]]
+*Coronavirus related to [[SARS-CoV]]
-=== Epidemiology ===
+*Virion consists of:
-* First cases detected Dec 2019 related to likely exposure in wet market in Wuhan, Hubei, China
+**Spike glycoprotein (S)
-* Declared pandemic by WHO in 2020
+**Membrane protein (M)
+**Nucleocapsid protein (N)
+**Hemagglutinin esterase (He)
+**Envelope protein (E)
+===Epidemiology===
-== Clinical Manifestations ==
-* Incubation period 4-5 days on average, possibly as long as 14 days in some cases
-* Main presenting symptoms were fever and cough
-* Other symptoms include dyspnea, rhinorrhea, vomiting, diarrhea
+*First cases detected Dec 2019 related to likely exposure in wet market in Wuhan, Hubei, China, and declared a pandemic in 2020
-== Management ==
+*Secondary household attack rate of 12-17%
-* Primarily supportive
-* Investigational therapeutics include [[tocilizumab]], [[lopinavir/ritonavir]], and [[chloroquine]]
+=== Risk Factors for Mortality ===
+* Greater age
+* Male sex
+* [[COPD]]
+* [[Dyslipidemia]]
+* [[Diabetes]]
+==Clinical Manifestations==
+*Incubation period 4-5 days (range 2 to 11), possibly as long as 14 days in some cases
+*Main presenting symptoms were fever and cough, followed by myalgia, fatigue, headache, dyspnea
+*Other symptoms include dyspnea, rhinorrhea, vomiting, diarrhea, anosmia/hyposmia
+*Lymphopenia is common, as is hypoalbuminemia, elevated D-dimer, CRP, LDH, AST/ALT
+*Viral load detectable before symptom onset and peaks around the time of symptom onset
+=== Complications ===
+* In critically ill patients:
+** [[ARDS]] (75%)
+** [[AKI]] (40%)
+** [[Thrombosis]] (10%)
+== Diagnosis ==
+* PCR from NP swab
+** May be positive long after no longer infectious
+==Management==
+*Dexamethasone for patients requiring supplemental oxygen
+*Investigational therapeutics include [[tocilizumab]], [[lopinavir/ritonavir]], and [[chloroquine]]
+== Further Reading ==
+* 10.1001/jama.2020.12839
 [[Category:Viruses]]