Coronavirus

Snapshot

• A 34-year-old woman presents to a local hospital in the United States with a week history of fevers, headaches, myalgias, and nonproductive cough. She stated she started having a nonproductive cough yesterday. Two weeks ago, she traveled to Hong Kong to visit relatives. She visited a nursing home a couple of times but did not have any sick contacts. On physical exam, she is diaphoretic and her oxygen saturation is 93% on room air. A chest radiograph reveals bilateral pulmonary infiltrates. A rapid influenza antigen test is negative. She is admitted for further management

Introduction

• Classification
  • coronavirus (CoV)  
    • an enveloped, linear, positive, single-stranded RNA virus with a helical capsid
    • causes the “common cold” as well as severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS)
      • SARS-CoV
      • MERS-CoV
    • transmission via respiratory secretions
• Epidemiology
  • incidence
    • worldwide
    • MERS-CoV
      • countries around the Arabian Peninsula
    • SARS-COV
      • Asia
  • demographics
    • all ages
  • risk factors
    • recent travel to the Arabian Peninsula or Asia
    • sick contacts
    • immunosuppression
    • healthcare workers
• Pathogenesis
  • replication in tracheobronchial epithelium
• Prognosis
  • worse prognosis
    • higher respiratory virus titer
    • older age
    • underlying comorbidities

Presentation

• Symptoms
  • MERS/SARS presents more acutely and severely than the common cold, often requiring hospitalization
  • prodrome
    • fever and chills
    • malaise
    • myalgias
    • nausea and vomiting
    • headache
  • respiratory phase
    • nonproductive cough
    • shortness of breath
    • sore throat

Imaging

• Chest radiography
  • indication
    • MERS/SARS
  • findings
    • bilateral pulmonary infiltrates

Studies

• Labs
  • detection of viral RNA on reverse-transcriptase polymerase chain reaction
  • serum antibody on enzyme-linked immunosorbent assay
  • may have increased lactate dehydrogenase
• Making the diagnosis
  • based on clinical presentation and confirmed with laboratory evaluation

Differential

• Influenza 
  • distinguishing factors
    • systemic symptoms predominate
    • rapid antigen detection test for influenza is positive

Treatment

• Management approach
  • treatment is typically supportive
• Conservative
  • supportive
    • indication
      • all patients
    • modalities
      • supplemental oxygen
      • hydration

Complications

• Hypoxemic respiratory failure