Case 1
Case 1 was admitted to the hospital on January 26, 2020. She was a 39-year-old woman and had a 6-day history of intermittent coughs, nasal congestion, runny nose, and slight sore throat. She returned from Wuhan to Wenzhou on January 20 and stayed with a friend confirmed with COVID–19 before January 22. She had no history of hypertension, coronary heart disease, diabetes and surgical operations. Her body temperature was elevated to 37.6°C without abnormal pulmonary auscultation on admission. In addition, she had a blood pressure of 112/68 mmHg, pulse of 88 beats per minute and respiratory rate of 20 breaths per minute. Laboratory information (Table 1) showed a normal white-cell count of 4.38×109/L (normal range, 3.5.–9.5 × 109/L), 71.7% neutrophils (normal range, 40.0%–75.0%), and a decreased absolute value of lymphocytes of 0.87×109/L(normal range, 1.1–3.2×109/L and 19.9% lymphocytes (normal range, 20.0%–50.0%). Her C-reactive protein was less than 0.499mg/L(normal range, 0–8mg/L). On admission, non-enhanced chest computed tomography (CT) was performed (Figure 1F), which showed multiple bilateral mixed pattern of ground-glass opacities and consolidation in lungs, including inferior lingual segment of left upper lobe, dorsal segment of left lower lobe, lateral basal segment of left lower lobe, lateral segment of right middle lobe, lateral basal segment of right lower lobe and posterior basal segment of right lower lobe. This patient tested positive RT-PCR nucleic acid 3 days after hospitalization.
Table 1. Laboratory test results of Case1 during the first and second admission
Measure
|
Normal range
|
First admission
|
Readmission
|
day 1
|
day 3
|
day 8
|
day 10
|
day 13
|
day 1
|
day 2
|
day 5
|
white-cell count (X109/L)
|
3.5-9.5
|
4.38
|
2.41*
|
4.83
|
3.02*
|
6
|
4.1
|
4.1
|
5.38
|
percentage of neutrophils (%)
|
40.0%–75.0%
|
71.70
|
34.00*
|
57.20
|
42.80
|
50.20
|
56.40
|
52.90
|
58.70
|
absolute neutrophils count (X109/L)
|
1.8-6.3
|
3.14
|
0.82*
|
2.76
|
1.29*
|
3.01
|
2.31
|
2.17
|
3.16
|
percentage of lymphocyte (%)
|
20.0%–50.0%
|
19.9*
|
55.2#
|
27.7
|
38.7
|
37.2
|
34.1
|
38.3
|
29.4
|
absolute lymphocyte count (X109/L)
|
1.1-3.2
|
0.87*
|
1.33
|
1.34
|
1.17
|
2.23
|
1.4
|
1.57
|
1.58
|
C-reactive protein (turbidimetry, mg/L)
|
0.0-0.8
|
<0.499
|
<3.14
|
<3.14
|
-
|
-
|
<0.499
|
<5.0
|
<5.0
|
Note: *means the value abnormally decreased. #means the value abnormally increased.
After 13 days of treatment, including interferon inhalation, antiviral therapy of lopinaviritonavir tablets and symptomatic supportive care, the patient’s symptoms were remitted and her body temperature became normal. At day 14, chest CT showed decreased ground-glass opacities (Figure 1G). RT-PCR of the patient’s pharyngeal swab became negative in two consecutive tests with one day interval combined with negative stool nucleic acid test. Eighteen days after the hospitalization, the patient met hospital discharge criteria and was discharged. According to the diagnosis and treatment of COVID–19 in China (trial sixth Edition), the criteria for hospital discharge are as follows: (1) normal body temperature lasts for longer than three days, (2) significantly remission in respiratory symptoms, (3) substantially relieved acute exudative lesions on chest CT, and (4) consecutive negative two RT-PCR tests results with at least one day interval [12]. In addition, our hospital also require that the patient’s stool nucleic acid test should be negative.
Case 2
Case 2 was admitted to the hospital on January 30, 2020. He was a 50-year-old man and had a 2-day history of subjective fever accompanied by sore throat, coughs and expectoration. He had no recent Wuhan travelling history. This patient reported a history of smoking for 25 years, 30 cigarettes per day and drinking for 30 years, 500ml of beer daily. However, he had given up smoking for three years. On admission, his highest body temperature reached to 38.2℃. Meanwhile, his lung auscultation was normal and his blood pressure was 133 /94 mmHg, with a pulse of 82 beats per minute, and a respiratory rate of 20 breaths per minute. Laboratory test results showed a normal white-cell count of 4.91×109/L (normal range, 3.5.–9.5 × 109/L), a little increased count of 75.2% neutrophils (normal range, 40.0%–75.0%), a decreased absolute value of lymphoid count of 0.9×109/L (normal range, 1.1–3.2×109/L) and 18.3% lymphocytes (normal range, 20.0%–50.0%). Meanwhile, his C-reactive protein was elevated to 15.6mg/L (normal range, 0–10mg/L). In addition, his chest CT on admission (Figure 2E) showed multiple bilateral and peripheral ground-glass opacities in both lungs, including the superior lingual segment of left upper lobe, dorsal segment, lateral basal segment, posterior basal segment of left lower lobe, anterior and posterior segment of right upper lobe, lateral segment of right middle lobe, dorsal segment, lateral and posterior basal segment of right lower lobe. The patient showed positive RT-PCR nucleic acid results for two times on admission and 8 day after hospitalization.
Table 2. Laboratory test results of Case 2 during the first and second admission
Measure
|
Normal range
|
First admission
|
Readmission
|
day 1
|
day 4
|
day 5
|
day 7
|
day 13
|
day 2
|
day 5
|
white-cell count (X109/L)
|
3.5-9.5
|
4.91
|
6.52
|
6.03
|
4.82
|
4.61
|
5.68
|
4.9
|
percentage of neutrophils (%)
|
40.0%–75.0%
|
75.2#
|
66.2
|
65.2
|
64.5
|
59.1
|
62.3
|
54.2
|
absolute neutrophils count (X109/L)
|
1.8-6.3
|
3.69
|
4.32
|
3.93
|
3.11
|
2.72
|
3.54
|
2.66
|
percentage of lymphocyte (%)
|
20.0%–50.0%
|
18.3*
|
25
|
25.5
|
24.3
|
32.5
|
27.8
|
32.9
|
absolute lymphocyte count (X109/L)
|
1.1-3.2
|
0.9*
|
1.63
|
1.54
|
1.17
|
1.5
|
1.58
|
1.61
|
C-reactive protein (mg/L)
|
0.0-0.10
|
15.6#
|
32.7#
|
32.9#
|
17.1#
|
1.54
|
<5.0
|
<5.0
|
|
|
|
|
|
|
|
|
|
|
Note: *means the value abnormally decreased. #means the value abnormally increased.
After 12 days of treatment, including interferon inhalation, antiviral therapy of lopinaviritonavir tablets, oral administration of abidor granules, moxifloxacin hydrochloride injection for anti-infection, and other symptomatic supportive care, the patient’s symptoms were relieved and his body temperature became normal. The follow-up chest CT on day 14 showed decreasing ground-glass opacities (Figure 2G). On day 16, the patient met the discharge criteria and was discharged.