一个家庭聚集性新型冠状病毒肺炎(新冠肺炎)案例引发的思考

Reflection on A Familial Gathering COVID-19 Case

目的研究新型冠状病毒肺炎(新冠肺炎)家庭聚集性病例在流行病学、临床表现及CT特征方面是否不同。方法收集云南省楚雄彝族自治州大姚县人民医院2020年1月31日~2月1日接诊的3位患者的流行病学及临床资料、实验室检查结果、CT检查结果,详细分析这3例患者相关特征的差异。结果3例患者为父母与女儿关系,有共同武汉居住史和共同离开武汉史。父亲41岁,最先发病,为离开武汉6d后,症状最明显(发热,咳嗽、咽痛);母亲40岁,在父亲发病5天后出现症状,症状轻微(少许咳嗽);女儿12岁,始终无症状。父亲1次病毒核酸检测阳性,母亲第2次病毒核酸检测阳性,女儿作为密切接触者筛查,经第3次病毒核酸检测阳性。父母CT均有肺炎表现,比较CT,母亲较父亲病灶范围大且更多实变,女儿CT阴性。根据当时国家卫健委发布的《新型冠状病毒感染的肺炎诊疗方案(试行第四版)》诊疗规范,父亲分类为成人普通型,母亲为成人重型,女儿为隐性感染者。3名患者均无其他基础疾病。结论新型冠状病毒肺炎在家庭聚集性感染病例中可以有不同表现,包括隐性感染。同时感染病毒可能在不同时间发病,存在明显个体差异。CT病灶严重程度和临床症状不完全平行。发病早期CT即可出现实变,而不只是磨玻璃影(GGO)。

Objective To study difference of epidemiology,clinical manifestations and CT characteristics of family gathering COVID-19 cases.Methods The paper collected epidemiological and clinical data,laboratory examination and CT examination results of 3 patients in Dayao County People’s Hospital of Chuxiong Yi Autonomous Prefecture from January 31 to February 1,2020,and analyzed differences of relevant characteristics of 3 cases in details.Results 3 patients were parents and daughter relationship with history of living in Wuhan together and leaving Wuhan together.The father,41,was the first onset after leaving Wuhan for 6 days,with most obvious symptoms(fever,cough and sore throat);the mother,40,showed symptoms 5 days after onset of the father,with mild symptoms(a little cough),the daughter,12,was asymptomatic all the time.The father was positive at first viral nucleic acid test and the mother positive at the second viral nucleic acid test.The daughter was screened as close contact and positive at the third viral nucleic acid test.Parents showed pneumonia on CT.The mother had larger range of lesions and more changes than the father,the daughter was negative on CT.According to diagnosis and treatment norms of diagnosis and treatment scheme for New Coronavirus infection(the fourth trial version)issued by the National Health Commission,the father was classified as adult normal type,the mother adult heavy tyep,and the daughter was recessive infected.There were no other underlying diseases for 3 cases.Conclusion COVID-19 can have different manifestations in family gathering infection cases,including latent infection.At the same time,Severity of CT lesions was not completely parallel to clinical symptoms.Virus infection may occur at different times,with obvious individual differences.CT may show consolidation at early stage of onset,not just ground glass opacity(GGO).