Material Educativo

[Artigo] Coronavirus: novel coronavirus (COVID-19) infection

TERMINOLOGY
CLINICAL CLARIFICATION

  • COVID-19 (coronavirus disease 2019) is a respiratory tract infection with a newly recognized coronavirus thought to have originated as a zoonotic virus that has mutated or otherwise adapted in ways that allow human pathogenicity
    ○ Disease was provisionally called 2019-nCoV infection at start of outbreak (2019 novel coronavirus infection)
  • Outbreak began in China, where its effects to date are most widespread; it has since spread to many other countries, and it was officially declared by WHO to be a pandemic on March 11, 2020
  • Illness ranges in severity from asymptomatic or mild to severe; a significant proportion of patients with clinically evident infection develop severe disease
    ○ Mortality rate among diagnosed cases (case fatality rate) is about 2% to 3%; true overall mortality rate is uncertain, as the total number of cases (including undiagnosed persons with milder illness) is unknown
  • Knowledge of this disease is incomplete and evolving; moreover, coronaviruses are known to mutate and recombine often, presenting an ongoing challenge to our understanding and to clinical management

CLASSIFICATION

  • Pathogen is a betacoronavirus, similar to the agents of SARS (severe acute respiratory syndrome) and MERS (Middle East
    respiratory syndrome)
    ○ Classified as a member of the species Severe acute respiratory syndrome–related coronavirus 
    ○ Designated as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) 

DIAGNOSIS

CLINICAL PRESENTATION

  • History
    ○ In symptomatic patients, illness may evolve over the course of a week or longer, beginning with mild symptoms that progress (in some cases) to the point of dyspnea and shock 
    ○ Most common complaints are fever (almost universal) and cough, which may or may not be productive
    ○ Myalgia and fatigue are common
    ○ Patients with moderate to severe disease complain of dyspnea
    ○ Hemoptysis has been reported in a small percentage of patients
    ○ Pleuritic chest pain has been reported
    ○ Upper respiratory tract symptoms (eg, rhinorrhea, sneezing, sore throat) are unusual
    ○ Headache and gastrointestinal symptoms (eg, nausea, vomiting, diarrhea) are uncommon but may occur
    ○ Patients may report close contact with an infected person; outside of an identified outbreak area, a history of recent travel (within 14 days) to an area with widespread infection7 is relevant, although cases with no identifiable risk factor 8 are being reported
  • Physical examination
    ○ Reported case series have not detailed physical findings, but clinicians should be particularly attuned to pulmonary and
    hemodynamic indicators of severe disease
    ○ Patients with severe disease may appear quite ill, with tachypnea and labored respirations
    ○ Fever is usual, often exceeding 39 °C. Patients in the extremes of age or with immunodeficiency may not develop
    fever 4
    ○ Hypotension, tachycardia, and cool/clammy extremities suggest shock – In children, hypotension plus 2 or 3 of the following criteria: 
    □ Altered mental status
    □ Tachycardia (heart rate more than 160 beats per minute in infants or 150 in older children) or bradycardia (heart rate less than 90 in infants or 70 in older children)
    □ Prolonged capillary refill (more than 2 seconds) or warm vasodilation and bounding pulses
    □ Tachypnea
    □ Mottled skin, petechiae, or purpura
    □ Oliguria
    □ Hyperthermia or hypothermia

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