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. 2020 Mar 15;16(10):1698-1707.
doi: 10.7150/ijbs.45357. eCollection 2020.

Evaluation of SARS-CoV-2 RNA shedding in clinical specimens and clinical characteristics of 10 patients with COVID-19 in Macau

Iek Long Lo  1 , Chon Fu Lio  2 , Hou Hon Cheong  2 , Chin Ion Lei  3 , Tak Hong Cheong  4 , Xu Zhong  1 , Yakun Tian  5 , Nin Ngan Sin  2
Affiliations

Evaluation of SARS-CoV-2 RNA shedding in clinical specimens and clinical characteristics of 10 patients with COVID-19 in Macau

Iek Long Lo et al. Int J Biol Sci. .

Abstract

As a city famous for tourism, the public healthcare system of Macau SAR has been under great pressure during the outbreak of the Coronavirus Disease 2019 (COVID-19). In this study, we report clinical and microbiological features of ten COVID-19 patients enrolled in the Centro Hospitalar Conde de São Januário (CHCSJ) between January 21 to February 16, 2020. Clinical samples from all patients including nasopharyngeal swab (NPS)/sputum, urine, and feces were collected for serial virus RNA testing by standard qRT-PCR assay. In total, seven were imported cases and three were local cases. The median duration from Macau arrival to admission in imported cases was 3 days. Four patients required oxygen therapy but none of them needed machinal ventilation. No fatal cases were noted. The most common symptoms were fever (80%) and diarrhea (80%). In the "Severe" group, there was significantly more elderly patients (p=0.045), higher lactate dehydrogenase levels (p=0.002), and elevated C-Reactive protein levels compared to the "Mild to Moderate" group (p<0.001). There were positive SARS-CoV-2 RNA signals in all patients' NPS and stool specimens but negative in all urine specimens. Based on our data on SARS-CoV-2 RNA shedding in stool and the possibility of a lag in viral detection in NPS specimens, the assessment of both fecal and respiratory specimen is recommended to enhance diagnostic sensitivity, and also to aid discharge decision before the role of viral RNA shedding in stool is clarified.

Keywords: COVID-19; Macau; SARS-CoV-2; nasopharyngeal swab; novel coronavirus; qRT-PCR; sputum; stool; urine.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
A. Chronology of 7 imported cases of COVID-19 in Macau. B. Chronology of 3 local cases of COVID-19 in Macau.
Figure 1
Figure 1
A. Chronology of 7 imported cases of COVID-19 in Macau. B. Chronology of 3 local cases of COVID-19 in Macau.
Figure 2
Figure 2
The dynamic change and evolution in laboratory data of ten COVID-19 patients from the first week to the third week and beyond since symptoms of onset. A. The lower bound of mean white blood cell counts was back to normal two weeks after symptoms onset. B. Neutrophil counts were gradually increased from the first to the third week. C. Lymphocyte counts reached its lowest levels in the second week with the elevation of D. C-Reactive Protein, E. lactate dehydrogenase and F. creatine kinase suggesting clinical exacerbation. Elevating G. Gamma-glutamyl transferase and H. Alanine aminotransferase levels were noted which might be related to viral infection per se or medication side effects. I. The creatinine level was remained steady during the study period.
Figure 3
Figure 3
ChestComputed Tomographic Images of a 57-year-old patient (Patient 5) with SARS-CoV-2 pneumonia during hospitalization. A. and B. were two different levels of Chest CT images in patient 5 on day 9 of symptoms onset, it showed bilateral distribution of patchy shadows and ground glass opacity. C. and D. showed significant lesions absorption on day 21 of symptoms onset comparing to the same level images of A. and B.
See this image and copyright information in PMC

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