ウイルス血症は重症度の指標となる

CoVID-19は肺炎を引き起こします。

臨床検査室でリアルタイムPCRによって検出された咽頭スワブ、血液、および肛門スワブのウイルスの存在を後方視的に分析しました。

予期せぬことに、2109-nCoV RNAは血液（患者57人中6人）および肛門スワブ（患者28人中11人）で容易に検出されました。

重要なことに、血液コホートでウイルスRNAが検出された6人の患者全員が重篤な症状段階に進行し、血清ウイルスRNAと疾患の重症度（p値= 0.0001）の強い相関を示しています。

一方、肛門スワブウイルス陽性の11人の患者のうち8人は、重度の臨床段階にありました。

ただし、肛門スワブのウイルスRNAの濃度（Ct値= 24 + 39）は患者2の血液（Ct値= 34 + 39）よりも高かったため、ウイルスが消化管で複製される可能性があることが示唆されました。

全体として、我々の結果は、肺外の部位におけるウイルスRNAの存在を確認した。

Detectable 2019-nCoV Viral RNA in Blood Is a Strong Indicator for the Further Clinical Severity

Weilie Chen , Yun Lan , Xiaozhen Yuan , Xilong Deng , Yueping Li , Xiaoli Cai , Liya Li , Ruiying He , Yizhou Tan , Xizi Deng , Ming Gao , Guofang Tang , Lingzhai Zhao , Jinlin Wang , Qinghong Fan , Chunyan Wen , Yuwei Tong , Yangbo Tang , Fengyu Hu , Feng Li , Xiaoping Tang

erg Microbes Infect. 2020 Feb 26;9(1):469-473.

doi: 10.1080/22221751.2020.1732837. eCollection 2020.

PMID: 32102625 PMCID: PMC7054964 DOI: 10.1080/22221751.2020.1732837

https://pubmed.ncbi.nlm.nih.gov/32102625/?fbclid=IwAR2djVo9RsrLc5XI6WQkpSws8bF66rvj2JLNoESdjMEdRLxvyRhjqpKobPI

Abstract

The novel coronavirus (2019-nCoV) infection caused pneumonia. we retrospectively analyzed the virus presence in the pharyngeal swab, blood, and the anal swab detected by real-time PCR in the clinical lab. Unexpectedly, the 2109-nCoV RNA was readily detected in the blood (6 of 57 patients) and the anal swabs (11 of 28 patients). Importantly, all of the 6 patients with detectable viral RNA in the blood cohort progressed to severe symptom stage, indicating a strong correlation of serum viral RNA with the disease severity (p-value = 0.0001). Meanwhile, 8 of the 11 patients with annal swab virus-positive was in severe clinical stage. However, the concentration of viral RNA in the anal swab (Ct value = 24 + 39) was higher than in the blood (Ct value = 34 + 39) from patient 2, suggesting that the virus might replicate in the digestive tract. Altogether, our results confirmed the presence of virus RNA in extra-pulmonary sites.

Keywords: 2019-ncov; anal swab; blood viral RNA; laboratory test; pharyngeal swab.

References

1. 1. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020. 10.1038/s41586-020-2008-3 [Epub ahead of print]. - DOI - PMC - PubMed

   2. Zhou P, Yang XL, Wang XG, et al. . A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020. 10.1038/s41586-020-2012-7 [Epub ahead of print]. - DOI - PMC - PubMed

   3. Chen L, Liu W, Zhang Q, et al. RNA based mNGS approach identifies a novel human coronavirus from two individual pneumonia cases in 2019 Wuhan outbreak. Emerg Microbes Infect. 2020;9(1):313–319. doi: 10.1080/22221751.2020.1725399 - DOI - PMC - PubMed

   4. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513. doi: 10.1016/S0140-6736(20)30211-7 - DOI - PMC - PubMed

   5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5 - DOI - PMC - PubMed

   6. Chen L, Liu HG, Liu W, et al. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):E005. - PubMed

   7. Wan Y, Shang J, Graham R, et al. Receptor recognition by novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS. J Virol. 2020. 10.1128/JVI.00127-20 [Epub ahead of print]. - DOI - PMC - PubMed

   8. Hamming I, Timens W, Bulthuis MLC, et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–637. doi: 10.1002/path.1570 - DOI - PMC - PubMed

   9. Zhou P, Fan H, Lan T, et al. Fatal swine acute diarrhoea syndrome caused by an HKU2-related coronavirus of bat origin. Nature. 2018;556(7700):255–258. doi: 10.1038/s41586-018-0010-9 - DOI - PMC - PubMed

   10. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020. 10.1056/NEJMoa2001191 [Epub ahead of print]. - DOI - PMC - PubMed

ウイルス量、ウイルス排出パターン、およびコロナウイルス疾患2019（COVID-19）の無症候性患者（AP）のデータは、潜在的な感染力は限定的であることを示しています。

この研究には、ウイルス学的にCOVID-19であることが確認されているが入院時に無症候性であった31人の成人患者が含まれていました。

これらの31人の患者のうち、22人が入院後に症状を示し、潜伏期間中の無症候性患者（API）として定義されました。他の9人の患者は入院中に無症候性のままであり、無症候性患者（AP）として定義されました。

AP（39.0、四分位範囲（IQR）37.5〜39.5）のサイクル中央値（Ct）の中央値は、API（34.5、IQR 32.2〜37.0）の値よりも大幅に高く、APのウイルス負荷が低いことを示しています。

ただし、ウイルス排出の期間は2つのグループで同じままでした（7日、IQR 5〜14日vs 8日、IQR 5〜16日）

調査結果では、COVID-19のAPのウイルス量は少ないものの、一定期間のウイルスの排出が認められ、無症候期の感染の可能性が示唆されました。

ウイルス核酸検査によるこれらの無症候性症例のさらなる長期的サーベイランスが保証されています。

International Journal of Infectious Diseases 96 (2020) 288–290

Rui Zhoua,1, Furong Lia,1, Fengjuan Chenb,1, Huamin Liua, Jiazhen Zhenga, Chunliang Leib,**, Xianbo Wua,*

Accepted 7 May 2020

https://www.ijidonline.com/article/S1201-9712(20)30337-4/fulltext

Data are limited on the viral load, viral shedding patterns, and potential infectivity of asymptomatic patients (APs) with coronavirus disease 2019 (COVID-19). This study included 31 adult patients who were virologically confirmed to have COVID-19 but were asymptomatic on admission. Among these 31 patients, 22 presented symptoms after admission and were defined as asymptomatic patients in the incubation period (APIs); the other nine patients remained asymptomatic during hospitalization and were defined as asymptomatic patients (APs). The median cycle threshold (Ct) value of APs (39.0, interquartile range (IQR) 37.5–39.5) was significantly higher than that of APIs (34.5, IQR 32.2–37.0), indicating a lower viral load in APs. However, the duration of viral shedding remained similar in the two groups (7 days, IQR 5–14 days vs. 8 days, IQR 5–16 days). The study findings demonstrated that although APs with COVID-19 have a lower viral load, they still have certain period of viral shedding, which suggests the possibility of transmission during their asymptomatic period. Further longitudinal surveillance of these asymptomatic cases via virus nucleic acid testing are warranted.

************************************************

Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure

Lauren M. Kucirka, MD, PhD, Stephen A. Lauer, PhD, Oliver Laeyendecker, PhD, MBA, Denali Boon, PhD, Justin Lessler, PhD

https://doi.org/10.7326/M20-1495

https://www.acpjournals.org/doi/10.7326/M20-1495?fbclid=IwAR1EKeMvbScXjEXKO9Fz-8XfMaFQzoqQBtet_m20AokEdzsZIxZKfJ4ly08&#.XsXfodSqDx8.facebook