NEJM | 泰国出租车司机感染新冠病毒全过程

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2020年2月12日,一项新冠肺炎的临床个案研究在顶级医学期刊NEJM(《The New England Journal of Medicine》,新英格兰医学杂志)上在线发表:该临床个案研究详细记录了泰国的一名出租车司机感染上新冠肺炎的整个过程。

 

这名泰国司机感染上新冠肺炎的过程是这样的:

根据这名司机的报告,在中国疫情蔓延之际,他驾驶的出租车经常会与许多中国游客近距离接触,虽然他们是戴着口罩在咳嗽,但最终该名司机也被传染。

 

2020年1月20日,一名51岁的男性出租车司机发烧,咳嗽和肌痛,并去当地一家药店购买未指定的非处方药。当时,他不知道SARS-CoV-2的出现或它引起的疾病(Covid-19)。由于症状持续存在,他决定于1月23日前往曼谷一家私人初级保健诊所。体温为36.8°C(98°F)。临床医生订购了甲型和乙型流感的咽拭子。两种菌株的拭子均为阴性。处方了其他药物来治疗患者的症状。

 

1月24日至27日,患者因为感到不适而无法驾驶出租车,因此他在家休息。1月28日,他到曼谷一家公立综合医院就诊。他被归类为Covid-19接受调查的患者,被隔离,并转介至负责新兴传染病管理的国家机构Bamrasnaradura传染病研究所。

 

到达研究所时,患者发烧和轻度呼吸困难。他被送往空气传染病隔离室。胸部X线摄片显示左下肺网状,片状浸润。患者的喉咙和鼻咽拭子在泰国红十字会新兴传染病卫生局朱拉隆功大学医学院科学中心和公共卫生部医学科学系两个实验室进行的实时逆转录酶-聚合酶链反应(RT-PCR)分析中检测为SARS-CoV-2呈阳性。

 

该患者最初报告自己没有任何潜在疾病,但在入院时发现了高血压和2型糖尿病。他报告说,他的出租车与中国游客接触,他们经常咳嗽但戴着口罩。他没有到中国旅行的历史。

 

该患者病情稳定,于2月5日出院。他的妻子,儿子和侄子(与患者同住一所房屋)无症状,RT-PCR检测出SARS-CoV-2阴性。从其他10个紧密接触者获得的咽喉和鼻咽拭子在RT-PCR分析中测试为SARS-CoV-2阴性。

 

原文

The potential human-to-human transmission of the novel coronavirus (SARS-CoV-2) has been shown in multiple reports, including data from 425 patients in Wuhan, China.1 Local transmission from a Chinese business partner to a German businessman who attended the same meeting has been reported in Munich, Germany.2 We describe a taxi driver infected with SARS-CoV-2 in Thailand, potentially from Chinese tourists; the infection appears not to have spread to others.

On January 20, 2020, a 51-year-old male taxi driver had fever, cough, and myalgia and went to a local pharmacy to get unspecified over-the-counter medications. At the time, he was not aware of the emergence of SARS-CoV-2 or the illness it causes (Covid-19). As the symptoms persisted, he decided to visit a private primary care clinic in Bangkok on January 23. The body temperature was 36.8°C (98°F). The clinic physician ordered a throat swab for influenza A and B; the swab was negative for both strains. Additional medications were prescribed for treatment of the patient’s symptoms.

From January 24 through 27, the patient was unable to drive the taxi because he felt ill, and he rested at home. On January 28, he presented to a public general hospital in Bangkok. He was classified as a patient under investigation for Covid-19, isolated, and referred to the Bamrasnaradura Infectious Diseases Institute, the national authority responsible for the management of emerging infectious diseases.

On arrival at the institute, the patient had a fever and mild dyspnea. He was admitted to the airborne infection isolation room. Chest radiography showed reticular, patchy infiltration of the left lower lung. Throat and nasopharyngeal swabs that were obtained from the patient tested positive for SARS-CoV-2 on real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay performed at two laboratories: the Thai Red Cross Emerging Infectious Diseases Health Sciences Center, Faculty of Medicine, Chulalongkorn University, and the Department of Medical Sciences, Ministry of Public Health.

The patient initially reported that he had no underlying conditions, but hypertension and type 2 diabetes were discovered during the admission. He reported contact with Chinese tourist passengers in his taxi who had had frequent coughing but who wore masks. He had no history of travel to China.

The patient had been in clinically stable condition and was discharged on February 5. His wife, son, and nephew — all of whom lived in the same house as the patient — were asymptomatic and tested negative for SARS-CoV-2 on RT-PCR assay. Throat and nasopharyngeal swabs that were obtained from 10 other close contacts tested negative for SARS-CoV-2 on RT-PCR assay.

 

参考文献:DOI: 10.1056/NEJMc2001621

 

 

         

 




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