Covid19 Corona Virus - Comment
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Etiology, Clinical features and Management of COVID-19 Corona Virus. Information covered in this presentation slides: 1. Etiology, Clinical features & Management of COVID-19 Dr.S.Sesha Sai Assistant Professor Dept. of Pulmonary Medicine East Point College of Medical Sciences 2. WHO Situation Report as of 4/3/2020 3. Definitions • Coronavirus disease 2019 (COVID-19) is a severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/previously called as 2019-nCoV) • The virus was identified as the cause of an outbreak of pneumonia of unknown cause in Wuhan City, Hubei Province, China, in December 2019 4. Etiology SARS-CoV-2 is a previously unknown betacoronavirus Discovered in BAL samples taken from clusters of patients who presented with pneumonia of unknown cause in Wuhan City, Hubei Province, China, in December 2019 SARS-CoV-2 - Sarbecovirus subgenus of the Coronaviridae family, 7th coronavirus known to infect humans. A majority of patients in the initial stages of this outbreak reported a link to the Huanan South China Seafood Market, a live animal or "wet" market, suggesting a zoonotic origin of the virus 5. Etiology • Animal reservoir and intermediary host(s) - unknown • Recombinant virus between the bat coronavirus and an origin-unknown coronavirus • Person-to-person spread has been confirmed in community and healthcare settings in China and other countries. • Perinatal transmission or transmission via breastfeeding – Possible but unlikely (based on data from SARS,MERS outbreaks) • No evidence for intrauterine infection caused by vertical transmission in women who develop the infection late in pregnancy. 6. Risk Factors • Diagnosis should be suspected in patients with fever and/or signs/symptoms of lower respiratory illness (e.g., cough, dyspnea) who reside in, or have traveled to a country/area or territory reporting local transmission of COVID-19 in the 14 days prior to symptom onset • Close contact with infected individual 7. History & Clinical Features • Travel history is key. • Illness – Mild 80% – Severe 14% – Critical 5% • Severe in Older age and Underlying Co morbidities • Incubation period varies from 2-14 days(New reports suggesting more than 20 days) • Most cases deteriorates in 2nd week of illness 8. History & Clinical Features • Fever (83% to 98%) – Children may not present with fever • Cough (59% to 82%) – Usually dry • Dyspnea (31% to 55%) – Symptom onset to dyspnea takes 5-8 days (2nd week of illness) • GI Symptoms – Nausea, Vomiting, Diarrhea • Common – Fatigue(44-69%), Myalgia(11-44%), Anorexia(40%), Sputum Production(26-28%), Sore throat(5-17%) • Bronchial breath sounds, Tachypnea, Tachycardia, Cyanosis, Crepitations in acute respiratory disease • Uncommon – Confusion, Dizziness, Headache, Hemoptysis, Rhinorrhea, Chest pain 9. Diagnostic Criteria A Patients with acute respiratory illness (i.e., fever and at least one sign/symptom of respiratory disease such as cough or shortness of breath) AND with no other etiology that fully explains the clinical presentation AND a history of travel to or residence in a country/area or territory reporting local transmission of COVID-19 disease during the 14 days prior to symptom onset B Patients with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to onset of symptoms C Patients with severe acute respiratory infection (i.e., fever and at least one sign/symptom of respiratory disease such as cough or shortness of breath) AND requiring hospitalization AND with no other etiology that fully explains the clinical presentation 10. Diagnostic Tests Test Result Pulse Oximetry Low saturation ABG Low pO2 CBC Leukopenia,lymphopenia,thrombocytopenia Coagulation Profile Elevated D-dimer, Prolonged PT Metabolic panel Elevated liver enzymes, decreased albumin, renal impairment Procalcitonin, CRP, LDH, Creatine kinase, Troponin Elevated Blood and Sputum Cultures Negative for bacteria RT-PCR (upper and lower resp tract specimens, blood, urine, stool) +ve for SARS-CoV-2 viral RNA Chest X-ray U/L(25%) or B/L(75%) lung infiltrates CT Chest Primary imaging modality in China. Bilateral ground glass opacity or consolidation. Cavity, nodules, pleural effusions, lymphadenopathy were absent 11. Management • No specific treatments are known to be effective for COVID-19 • Mainstay of management is optimized supportive care to relieve symptoms and to support organ function in more severe illness. • Isolation • Infection prevention and control procedures. • Reporting 12. Management With Pneumonia/Comorbities • 23-32% require ICU • Supportive therapy – O2, Fluids, Symptom relief, Antimicrobials • Monitor for clinical deterioration such as respiratory failure, sepsis • Mechanical ventilation for Hypoxemic respiratory failure and ARDS – Low tidal volume(4-8ml/kg PBW) and lower plateau pressures( |
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| Posted by : peter88 | Post date : 2020-03-07 11:15 | ||
| Category : Health & Medicine | Views : 419 | ||
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