A retrospective study published January 29 in the international medical journal Lancet showed that more men than women were among the 99 new coronavirus infections admitted to Wuhan Jinyintan Hospital between January 1 and 20, the same as SARS and SARS and MERS. The paper believes that women’s viral susceptibility to slightly lower may be due to the protection of X chromosomes and gonad hormones, which play an important role in congenital and adaptive immunity.
The paper is entitled “Epidemiological Characteristics and Clinical Manifestations of 99 cases of 2019 New Coronary Pneumonia in Wuhan, China: Descriptive Research”, and the paper is written by Professor Zhang Li of Jinyintan Hospital in Wuhan and Professor Zhang Xinxin of Ruijin Hospital in Shanghai.
The study also found that the new coronavirus may mainly act on lymphocytes, especially T lymphocytes, which, like SARS virus, is recommended to use intravenous immunoglobulin to enhance the resilience of severely ill patients.
49 of the 99 patients had a history of exposure to the South China Seafood Market
The study included all confirmed cases from 1 January to 20 January 2020 at Wuhan Jinyintan Hospital. These cases were confirmed by RT-PCR (Real-time quantitative reverse transcription polymerase chain reaction) and their characteristics and laboratory data were analyzed from epidemiological, demographic, clinical, radiology, and other perspectives. Results followed up to 25 January.
The study showed that 49 of the 99 patients had a history of exposure to the South China seafood market, of which 47 had long exposure and 2 short-term exposure; 50 patients have chronic diseases.
Clinical manifestations of patients are: fever (82 patients), cough (81 patients), shortness of breath (31 patients), muscle pain (11 patients), insanity (9 patients), headache (8 patients), sore throat (5 patients), runny nose (4 patients), chest pain (2 patients), diarrhea (2 patients), Nausea and vomiting (1).
Imaging tests showed that 74 patients showed bi-sided pneumonia, 14 patients showed multiple mottled and glassy turbidity, and one patient had gas chest. Seventeen patients developed acute respiratory distress syndrome, 11 of whom deteriorated in a short period of time and died of multiple organ failure.
The study cautions that early detection and timely treatment are important for 2019-nCoV infection cases. Effective life support and active treatment of complications should be provided to effectively reduce the severity of the patient’s condition while preventing the spread of the virus in China and worldwide.
New coronavirus infection more likely to affect older men with comorbidities
The study notes that the 2019-nCoV infection is clustered, which may affect older men with comorbidities and can lead to severe and even fatal respiratory diseases, such as acute respiratory distress syndrome.
Overall, the characteristics of the patients who died matched the MuLBSTA score, an early warning model for predicting mortality from viral pneumonia. The MuLBSTA scoring system consists of six indicators, namely polyleafy leaching, lymphocyte reduction, bacterial co-infection, smoking history, hypertension, and age.
The researchers observed that out of 99 cases of 2019-nCoV infection, more men than women were. This is the same as SARS and MERS viruses. The researchers believe that women’s slightly lower susceptibility to the virus may be due to the protection of the X chromosome and gonad hormones, both of which play an important role in congenital and adaptive immunity.
Some patients, especially those with severe illness, are infected with bacteria and fungi. Common bacterial cultures in secondary infection patients include Bowman’s bacteria, Clypercitis pneumoniae, aflatoxin, smooth chlorella, and white candida. High resistance rates of Baumann bacteria may make anti-infection treatment more difficult, which can lead to a higher risk of infectious shock.
For severe mixed infections, in addition to the pathogenic factors of pathogens, the patient’s immune status is also an important factor. Older age, obesity and complications may be associated with increased mortality. When people with low immune function, such as the elderly, diabetics, people living with HIV, people with long-term immunosuppressants, and pregnant women, are infected with 2019nCoV, timely use of antibiotics to prevent infection and strengthen immune support therapy may reduce complications and mortality.
New coronaviruses may be mainly in lymphocytes
Laboratory tests showed that the absolute value of lymphocytes in most patients was reduced. This suggests that 2019-nCoV, like SARS virus, may be primarily affected by lymphocytes, especially T lymphocytes.
Some studies have shown that a significant reduction in the total number of lymphocytes suggests that coronaviruses consume many immune cells and inhibit the body’s cellular immune function. Damage to T lymphocytes may be an important factor in the deterioration of the patient’s condition. The low absolute value of lymphocytes can be used as a reference indicator in the clinical diagnosis of new coronavirus infections.
Viral particles spread through the respiratory mucosa and infect other cells, triggering cytokine storms in the body, producing a series of immune responses, and causing changes in peripheral white blood cells and immune cells such as lymphocytes. Some patients develop rapidly into acute respiratory distress syndrome and septicaemia shock, which eventually leads to multi-organ failure.
Therefore, early detection and timely treatment of critical cases are essential. Intravenous immunoglobulin sin is recommended to enhance the resistance to infection in severe lyse patients, and steroids are recommended for patients with acute respiratory distress syndrome (1-2 mg / kg per day) and treatment should be as short as possible.
However, the authors also point out that the study has limitations, including the low number of cases and the exclusion of suspected and undiagnosed cases, and the lack of more detailed clinical information about patients.