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Abstract: A middle-aged male with a history of exposure to patients with confirmed novel coronavirus pneumonia recently presented with a low-grade fever with cough for 1 day, elevated routine blood leukocytes, pulmonary CT suggestive of right pneumonia, and pleural effusion. The condition was in remission after 3 days of antiviral and symptomatic treatment.
Basic information】Male, 38 years old
Disease Type】New coronavirus pneumonia
Hospital】Liaoning Provincial People’s Hospital
Date of Consultation】February 2020
Treatment plan】Medication (moxifloxacin hydrochloride tablets + oseltamivir phosphate granules + abidor hydrochloride tablets + Lianhua Qingfei capsule + moxifloxacin hydrochloride injection + ribavirin tablets + acetylcysteine tablets)
[Treatment cycle] Hospitalization for 3 days, transferred to the designated hospital
【Treatment effect】Symptoms improved significantly
I. Initial interview
A middle-aged male with a history of contact with a confirmed patient with novel coronavirus pneumonia was in home isolation. He came to the hospital with a fever with cough for 1 day as the main complaint, and indicated that his temperature was 38.4℃ on self-test, and he came to the hospital after taking ibuprofen suspension. Pulmonary CT, blood count, C-reactive protein, liver and kidney function, myoglobin, and calcitoninogen were completed in the fever clinic, indicating C-reactive protein (acute) 57.32 mg/L, white blood cell count 13.86×10^9/L, neutrophil percentage 83.2%, lymphocyte percentage 10.4%, and calcitoninogen 0.047 ng/mL. The lung CT showed symmetrical thorax, enhanced walking, scattered cords in the lungs, lamellar high-density shadow in the lower lobe of the right lung, patency of each airway, liquid density shadow in the right chest, scattered old lesions in both lungs, and inflammation in the lower lobe of the right lung. After expert consultation, the suspected case of novel coronavirus pneumonia was considered and admitted to hospital for further isolation treatment.
II. Treatment history
After admission, the patient was isolated in a single room with secondary care for respiratory infections, and was advised to rest in bed and eat a light diet. D-dimer <0.21mg/L, myoglobin 21.0ng/mL, calcitoninogen 0.041ng/mL, liver function and renal function tests were not significantly abnormal. Oral anti-infective and antipyretic symptomatic treatment such as moxifloxacin hydrochloride tablets, oseltamivir phosphate granules, abirater hydrochloride tablets and Lianhua Qingfei capsule were given. After admission, nasopharyngeal swabs were sent daily for detection of novel coronavirus pneumonia nucleic acid, and the results returned positive for novel coronavirus pneumonia nucleic acid test, confirming the diagnosis of novel coronavirus pneumonia (common type). Combined with the pulmonary imaging features, a mixed infection was considered, so oral moxifloxacin hydrochloride tablets were changed to moxifloxacin hydrochloride injection for intravenous infusion. Two days after admission, the patient still had fever and respiratory symptoms, and the lung CT lesion was more progressive than before on reexamination. After expert consultation, oseltamivir phosphate granules were stopped and ribavirin tablets with acetylcysteine tablets were added to continue symptomatic treatment such as antiviral and promoting sputum excretion.
III. Treatment effect
The patient was still coughing and feverish after admission, with a maximum temperature of 38.3℃, no chest tightness or shortness of breath, no nausea or vomiting, no respiratory distress, diet and sleep were possible, and oxygen saturation was 97%. After 3 days of drug treatment, the patient’s symptoms improved significantly and the fever gradually subsided. However, the patient is still a general case and still needs to be transferred to a designated hospital for isolation, so it is still necessary to be alert to the possibility of developing to severe disease and to closely monitor the temperature and oxygen saturation.
IV. Notes
We are glad that the patient’s symptoms have been effectively controlled after treatment. However, in view of the fact that the patient is not yet completely free from the risk of infection, the patient is advised to pay attention to the following matters.
1. cooperate with the treatment, rest in bed, strengthen the diet, do personal protection, wear a good mask, face the current situation, be positive and optimistic, increase confidence in overcoming the virus, and do not develop negative emotions, which may affect the treatment and prognosis.
2, new coronavirus pneumonia is a new type of coronavirus infection, from the epidemiological data of the patient, the virus is highly infectious, the patient transferred to the designated hospital, the ward and the entire ward should be disinfected at the end.
3, the patient’s intrapulmonary infection foci, right pleural effusion to be infection control, after recovery, need to strengthen respiratory exercise, improve lung function, to avoid sequelae such as pleural adhesions.
V. Personal insights
1, new coronavirus pneumonia is a new respiratory infectious disease, caused by a new coronavirus, the virus is extremely infectious, the main measures to prevent and treat the disease is to isolate confirmed or suspected patients, cut off the transmission route by wearing a mask, and protect susceptible people by enhancing immunity, vaccination and other measures.
2. the mortality rate of severe and critically ill cases of novel coronavirus pneumonia is high, and the high-risk groups are the elderly, patients with various underlying diseases such as diabetes and hypertension, and those with low immunity, such as HIV patients and patients with malignant tumors.
3. novel coronavirus pneumonia is an RNA virus with easily mutable characteristics that can cause immune escape, and therefore can cause some difficulties in treatment.
4, the disease after active isolation treatment, can achieve better results, as the patient, after 3 days of treatment, discomfort symptoms improved significantly, so the general public do not have to be too afraid or nervous, but also to take precautions on a daily basis.