Thread
1/ @nejm case report on #2019nCoV #coronavirus 1st US case
-35 yo M, healthy returned traveler, 4 day hx of cough/N/V, subjective fever
-No contact w/ seafood market. No sick contacts he remembered
-afebrile, tachycardic, normal O2 sat
-Rhoncherous
-Normal initial CXR
1/ @nejm case report on #2019nCoV #coronavirus 1st US case
-35 yo M, healthy returned traveler, 4 day hx of cough/N/V, subjective fever
-No contact w/ seafood market. No sick contacts he remembered
-afebrile, tachycardic, normal O2 sat
-Rhoncherous
-Normal initial CXR
@NEJM 2/
-intermittent measured fevers started hospital day (HD) 2/ illness day 6 (4 day hx prior to presentation)
-loose stools on HD2
-labs w/ leukopenia/ thrombocytopenia/elevated CK & lactate/mild LFT abnormalities
-supportive care: IV fluids/tylenol/ibuprofen
-intermittent measured fevers started hospital day (HD) 2/ illness day 6 (4 day hx prior to presentation)
-loose stools on HD2
-labs w/ leukopenia/ thrombocytopenia/elevated CK & lactate/mild LFT abnormalities
-supportive care: IV fluids/tylenol/ibuprofen
@NEJM 3/
-HD5, febrile, new LL opacity on CXR, desats to 90%, c/f bacterial PNA--> empiric vanc/cefepime
-HD6, rales at bases, CXR w/ bilateral streaky opacities more c/w atypical PNA
-HD7, compassionate use of IV remdesivir; abx stopped
-HD8 clinical improvement, ongoing dry cough
-HD5, febrile, new LL opacity on CXR, desats to 90%, c/f bacterial PNA--> empiric vanc/cefepime
-HD6, rales at bases, CXR w/ bilateral streaky opacities more c/w atypical PNA
-HD7, compassionate use of IV remdesivir; abx stopped
-HD8 clinical improvement, ongoing dry cough
@NEJM 4/
-stool & both respiratory specimens tested positive by rRT-PCR; serum remained negative
-In summary: In this young, healthy patient, the early presentation is similar to most seasonal viral PNA that we see (cough, subj fever, mild GI sx).
Travel hx is key but...
-stool & both respiratory specimens tested positive by rRT-PCR; serum remained negative
-In summary: In this young, healthy patient, the early presentation is similar to most seasonal viral PNA that we see (cough, subj fever, mild GI sx).
Travel hx is key but...
@NEJM 5/
As cases become more widespread around the world, will be harder to rule out based on travel history alone.
Expect to have some missed cases based on a travel hx that doesn't include China & may be falsely reassuring.
Will likely depend on evolving epidemiology.
As cases become more widespread around the world, will be harder to rule out based on travel history alone.
Expect to have some missed cases based on a travel hx that doesn't include China & may be falsely reassuring.
Will likely depend on evolving epidemiology.
