2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan, China
Identifieur interne : 000901 ( Pmc/Corpus ); précédent : 000900; suivant : 0009022019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan, China
Auteurs : Wei-Hsuan Huang ; Ling-Chiao Teng ; Ting-Kuang Yeh ; Yu-Jen Chen ; Wei-Jung Lo ; Ming-Ju Wu ; Chun-Shih Chin ; Yu-Tse Tsan ; Tzu-Chieh Lin ; Jyh-Wen Chai ; Chin-Fu Lin ; Chien-Hao Tseng ; Chia-Wei Liu ; Chi-Mei Wu ; Po-Yen Chen ; Zhi-Yuan Shi ; Po-Yu LiuSource :
- Journal of Microbiology, Immunology, and Infection [ 1684-1182 ] ; 2020.
Abstract
We reported two cases with community-acquired pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who returned from Wuhan, China in January, 2020. The reported cases highlight non-specific clinical presentations of 2019 novel coronavirus disease (COVID-19) as well as the importance of rapid laboratory-based diagnosis.
Url:
DOI: 10.1016/j.jmii.2020.02.009
PubMed: 32111449
PubMed Central: 7102546
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan, China</title><author><name sortKey="Huang, Wei Hsuan" sort="Huang, Wei Hsuan" uniqKey="Huang W" first="Wei-Hsuan" last="Huang">Wei-Hsuan Huang</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Teng, Ling Chiao" sort="Teng, Ling Chiao" uniqKey="Teng L" first="Ling-Chiao" last="Teng">Ling-Chiao Teng</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Yeh, Ting Kuang" sort="Yeh, Ting Kuang" uniqKey="Yeh T" first="Ting-Kuang" last="Yeh">Ting-Kuang Yeh</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chen, Yu Jen" sort="Chen, Yu Jen" uniqKey="Chen Y" first="Yu-Jen" last="Chen">Yu-Jen Chen</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Lo, Wei Jung" sort="Lo, Wei Jung" uniqKey="Lo W" first="Wei-Jung" last="Lo">Wei-Jung Lo</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Wu, Ming Ju" sort="Wu, Ming Ju" uniqKey="Wu M" first="Ming-Ju" last="Wu">Ming-Ju Wu</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chin, Chun Shih" sort="Chin, Chun Shih" uniqKey="Chin C" first="Chun-Shih" last="Chin">Chun-Shih Chin</name><affiliation><nlm:aff id="aff3">Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Tsan, Yu Tse" sort="Tsan, Yu Tse" uniqKey="Tsan Y" first="Yu-Tse" last="Tsan">Yu-Tse Tsan</name><affiliation><nlm:aff id="aff4">Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Lin, Tzu Chieh" sort="Lin, Tzu Chieh" uniqKey="Lin T" first="Tzu-Chieh" last="Lin">Tzu-Chieh Lin</name><affiliation><nlm:aff id="aff4">Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chai, Jyh Wen" sort="Chai, Jyh Wen" uniqKey="Chai J" first="Jyh-Wen" last="Chai">Jyh-Wen Chai</name><affiliation><nlm:aff id="aff5">Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Lin, Chin Fu" sort="Lin, Chin Fu" uniqKey="Lin C" first="Chin-Fu" last="Lin">Chin-Fu Lin</name><affiliation><nlm:aff id="aff6">Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Tseng, Chien Hao" sort="Tseng, Chien Hao" uniqKey="Tseng C" first="Chien-Hao" last="Tseng">Chien-Hao Tseng</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Liu, Chia Wei" sort="Liu, Chia Wei" uniqKey="Liu C" first="Chia-Wei" last="Liu">Chia-Wei Liu</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Wu, Chi Mei" sort="Wu, Chi Mei" uniqKey="Wu C" first="Chi-Mei" last="Wu">Chi-Mei Wu</name><affiliation><nlm:aff id="aff7">Department of Nursing, Taichung Veteran General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chen, Po Yen" sort="Chen, Po Yen" uniqKey="Chen P" first="Po-Yen" last="Chen">Po-Yen Chen</name><affiliation><nlm:aff id="aff8">Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Shi, Zhi Yuan" sort="Shi, Zhi Yuan" uniqKey="Shi Z" first="Zhi-Yuan" last="Shi">Zhi-Yuan Shi</name><affiliation><nlm:aff id="aff9">Infection Control Center, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Liu, Po Yu" sort="Liu, Po Yu" uniqKey="Liu P" first="Po-Yu" last="Liu">Po-Yu Liu</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation><affiliation><nlm:aff id="aff10">Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan</nlm:aff></affiliation><affiliation><nlm:aff id="aff11">Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32111449</idno><idno type="pmc">7102546</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102546</idno><idno type="RBID">PMC:7102546</idno><idno type="doi">10.1016/j.jmii.2020.02.009</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000901</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000901</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan, China</title><author><name sortKey="Huang, Wei Hsuan" sort="Huang, Wei Hsuan" uniqKey="Huang W" first="Wei-Hsuan" last="Huang">Wei-Hsuan Huang</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Teng, Ling Chiao" sort="Teng, Ling Chiao" uniqKey="Teng L" first="Ling-Chiao" last="Teng">Ling-Chiao Teng</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Yeh, Ting Kuang" sort="Yeh, Ting Kuang" uniqKey="Yeh T" first="Ting-Kuang" last="Yeh">Ting-Kuang Yeh</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chen, Yu Jen" sort="Chen, Yu Jen" uniqKey="Chen Y" first="Yu-Jen" last="Chen">Yu-Jen Chen</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Lo, Wei Jung" sort="Lo, Wei Jung" uniqKey="Lo W" first="Wei-Jung" last="Lo">Wei-Jung Lo</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Wu, Ming Ju" sort="Wu, Ming Ju" uniqKey="Wu M" first="Ming-Ju" last="Wu">Ming-Ju Wu</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chin, Chun Shih" sort="Chin, Chun Shih" uniqKey="Chin C" first="Chun-Shih" last="Chin">Chun-Shih Chin</name><affiliation><nlm:aff id="aff3">Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Tsan, Yu Tse" sort="Tsan, Yu Tse" uniqKey="Tsan Y" first="Yu-Tse" last="Tsan">Yu-Tse Tsan</name><affiliation><nlm:aff id="aff4">Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Lin, Tzu Chieh" sort="Lin, Tzu Chieh" uniqKey="Lin T" first="Tzu-Chieh" last="Lin">Tzu-Chieh Lin</name><affiliation><nlm:aff id="aff4">Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chai, Jyh Wen" sort="Chai, Jyh Wen" uniqKey="Chai J" first="Jyh-Wen" last="Chai">Jyh-Wen Chai</name><affiliation><nlm:aff id="aff5">Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Lin, Chin Fu" sort="Lin, Chin Fu" uniqKey="Lin C" first="Chin-Fu" last="Lin">Chin-Fu Lin</name><affiliation><nlm:aff id="aff6">Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Tseng, Chien Hao" sort="Tseng, Chien Hao" uniqKey="Tseng C" first="Chien-Hao" last="Tseng">Chien-Hao Tseng</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Liu, Chia Wei" sort="Liu, Chia Wei" uniqKey="Liu C" first="Chia-Wei" last="Liu">Chia-Wei Liu</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Wu, Chi Mei" sort="Wu, Chi Mei" uniqKey="Wu C" first="Chi-Mei" last="Wu">Chi-Mei Wu</name><affiliation><nlm:aff id="aff7">Department of Nursing, Taichung Veteran General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chen, Po Yen" sort="Chen, Po Yen" uniqKey="Chen P" first="Po-Yen" last="Chen">Po-Yen Chen</name><affiliation><nlm:aff id="aff8">Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Shi, Zhi Yuan" sort="Shi, Zhi Yuan" uniqKey="Shi Z" first="Zhi-Yuan" last="Shi">Zhi-Yuan Shi</name><affiliation><nlm:aff id="aff9">Infection Control Center, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Liu, Po Yu" sort="Liu, Po Yu" uniqKey="Liu P" first="Po-Yu" last="Liu">Po-Yu Liu</name><affiliation><nlm:aff id="aff1">Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</nlm:aff></affiliation><affiliation><nlm:aff id="aff10">Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan</nlm:aff></affiliation><affiliation><nlm:aff id="aff11">Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Microbiology, Immunology, and Infection</title><idno type="ISSN">1684-1182</idno><idno type="eISSN">1995-9133</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>We reported two cases with community-acquired pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who returned from Wuhan, China in January, 2020. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Microbiol Immunol Infect</journal-id><journal-id journal-id-type="iso-abbrev">J Microbiol Immunol Infect</journal-id><journal-title-group><journal-title>Journal of Microbiology, Immunology, and Infection</journal-title></journal-title-group><issn pub-type="ppub">1684-1182</issn><issn pub-type="epub">1995-9133</issn><publisher><publisher-name>Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32111449</article-id><article-id pub-id-type="pmc">7102546</article-id><article-id pub-id-type="publisher-id">S1684-1182(20)30037-2</article-id><article-id pub-id-type="doi">10.1016/j.jmii.2020.02.009</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan, China</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Huang</surname><given-names>Wei-Hsuan</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au2"><name><surname>Teng</surname><given-names>Ling-Chiao</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au3"><name><surname>Yeh</surname><given-names>Ting-Kuang</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au4"><name><surname>Chen</surname><given-names>Yu-Jen</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au5"><name><surname>Lo</surname><given-names>Wei-Jung</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au6"><name><surname>Wu</surname><given-names>Ming-Ju</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au7"><name><surname>Chin</surname><given-names>Chun-Shih</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au8"><name><surname>Tsan</surname><given-names>Yu-Tse</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="au9"><name><surname>Lin</surname><given-names>Tzu-Chieh</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="au10"><name><surname>Chai</surname><given-names>Jyh-Wen</given-names></name><xref rid="aff5" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="au11"><name><surname>Lin</surname><given-names>Chin-Fu</given-names></name><xref rid="aff6" ref-type="aff">f</xref></contrib><contrib contrib-type="author" id="au12"><name><surname>Tseng</surname><given-names>Chien-Hao</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au13"><name><surname>Liu</surname><given-names>Chia-Wei</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au14"><name><surname>Wu</surname><given-names>Chi-Mei</given-names></name><xref rid="aff7" ref-type="aff">g</xref></contrib><contrib contrib-type="author" id="au15"><name><surname>Chen</surname><given-names>Po-Yen</given-names></name><xref rid="aff8" ref-type="aff">h</xref></contrib><contrib contrib-type="author" id="au16"><name><surname>Shi</surname><given-names>Zhi-Yuan</given-names></name><email>zyshi@vghtc.gov.tw</email><xref rid="aff9" ref-type="aff">i</xref><xref rid="cor2" ref-type="corresp">∗∗</xref></contrib><contrib contrib-type="author" id="au17"><name><surname>Liu</surname><given-names>Po-Yu</given-names></name><email>pyliu@vghtc.gov.tw</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff10" ref-type="aff">j</xref><xref rid="aff11" ref-type="aff">k</xref><xref rid="cor1" ref-type="corresp">∗</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff2"><label>b</label>Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff3"><label>c</label>Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff4"><label>d</label>Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff5"><label>e</label>Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff6"><label>f</label>Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff7"><label>g</label>Department of Nursing, Taichung Veteran General Hospital, Taichung, Taiwan</aff><aff id="aff8"><label>h</label>Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff9"><label>i</label>Infection Control Center, Taichung Veterans General Hospital, Taichung, Taiwan</aff><aff id="aff10"><label>j</label>Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan</aff><aff id="aff11"><label>k</label>Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan</aff><author-notes><corresp id="cor1"><label>∗</label>Corresponding author. Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sect. 4, Taichung, Taiwan. <email>pyliu@vghtc.gov.tw</email></corresp><corresp id="cor2"><label>∗∗</label>Corresponding author. Infection Control Center, Taichung Veterans General Hospital, 1650, Taiwan Boulevard Sect. 4, Taichung, Taiwan. <email>zyshi@vghtc.gov.tw</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>19</day><month>2</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>19</day><month>2</month><year>2020</year></pub-date><elocation-id></elocation-id><history><date date-type="received"><day>17</day><month>2</month><year>2020</year></date><date date-type="accepted"><day>17</day><month>2</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0010"><p>We reported two cases with community-acquired pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who returned from Wuhan, China in January, 2020. The reported cases highlight non-specific clinical presentations of 2019 novel coronavirus disease (COVID-19) as well as the importance of rapid laboratory-based diagnosis.</p></abstract><kwd-group id="kwrds0010"><title>Keywords</title><kwd>COVID-19</kwd><kwd>SARS-CoV-2</kwd><kwd>Pneumonia</kwd><kwd>Emerging infectious diseases</kwd><kwd>Zoonosis</kwd></kwd-group></article-meta></front><body><sec id="sec1"><title>Introduction</title><p id="p0010">After 17 years, physicians in Taiwan face another novel coronavirus outbreak originating in China.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> With the past experience of severe acute respiratory syndrome (SARS),<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref><sup>,</sup><xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> we respond quickly this time. However, a new pathogen inevitably raises new challenges.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> Clinical data and experience sharing may contribute to the control of emerging infectious diseases.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> Here we present two cases of 2019 novel coronavirus disease (COVID-19).</p></sec><sec id="sec2"><title>Case reports</title><sec id="sec2.1"><title>Case 1</title><p id="p0015">A 74 year-old female visitor from Wuhan City, China presented to the hospital with fever, malaise, and poor appetite. She reported no underlying medical conditions. There was no chillness, cough, rhinorrhea, sore throat, myalgia, chest discomfort, dyspnea, abdominal pain, or diarrhea. Physical examination disclosed body temperature of 38.1 °C, blood pressure of 129/68 mm Hg, heart rate of 79 beats per minute, respiratory rate of 18 breaths per minute. Chest radiography (CXR) revealed mild increased infiltration over bilateral lower lung field. Peripheral-blood white-cell count was 3770 per cubic millimeter (with 62.3% neutrophils and 32.1% lymphocytes). Nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) assay performed by the Centers for Diseases Control in Taiwan (Taiwan CDC).</p><p id="p0020">On day 6 in hospital, the patient remained febrile, malaise and poor appetite. Follow-up CXR revealed increasing opacity at right middle and lower lung fields (<xref rid="fig1" ref-type="fig">Fig. 1</xref>A). Levofloxacin was initiated. On hospital day 12, after a 6-day course of levofloxacin, her fever abated with improved appetite and physical activity. She became free of symptoms afterward.<fig id="fig1"><label>Figure 1</label><caption><p>Chest radiographs of two patients returned from Wuhan, China, with pneumonia caused by SARS-CoV-2 in middle Taiwan. (A) Case 1: increasing opacity at right middle and lower lung fields at hospital day 6. (B) Case 2: patchy consolidation over bilateral lower lung fields of at hospital day 6.</p></caption><alt-text id="alttext0010">Fig. 1</alt-text><graphic xlink:href="gr1_lrg"></graphic></fig></p></sec><sec id="sec2.2"><title>Case 2</title><p id="p0025">A 73 year-old previously health female visitor returning from Wuhan City 3 days ago presented to the hospital with dry cough, fever, malaise and poor appetite. She denied chillness, rhinorrhea, sore throat, chest discomfort, myalgia, dyspnea, abdominal pain, or diarrhea. Her body temperature was 38.7 °C with blood pressure of 117/47 mm Hg, heart rate of 82 beats per minute, respiratory rate of 18 breaths per minute. CXR demonstrated non-specific mild increased infiltration over bilateral lower lung field. Peripheral-blood white-cell count was 3420 per cubic millimeter (with 69.3% neutrophils and 26.9% lymphocytes). Nasopharyngeal swab was positive for SARS-CoV-2 by rRT-PCR assay reported from Taiwan CDC.</p><p id="p0030">On day 6 in hospital, the patient remained febrile, malaise and poor appetite. She reported worsening of cough. Follow-up CXR revealed patchy consolidation over bilateral lower lung field (<xref rid="fig1" ref-type="fig">Fig. 1</xref>B). Parenteral cefepime and oral clarithromycin therapy were initiated. On day 9, she was afebrile with improved general condition. Antimicrobial therapy was shifted to oral moxifloxacin. She remained free of symptoms afterward.</p></sec></sec><sec id="sec3"><title>Discussion</title><p id="p0035">The nonspecific presentations of these two cases are consistent with early reports of COVID-19 from China.<xref rid="bib6" ref-type="bibr"><sup>6</sup></xref><sup>,</sup><xref rid="bib7" ref-type="bibr"><sup>7</sup></xref> Fever remains the most common complain. Some cases didn't have cough, and upper respiratory tract infections (URI) symptoms such as rhinorrhea and sore throat were rare. Similar clinical manifestations have been reported in SARS,<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> since URI symptoms were uncommon and cough was not always present in SARS patients. Although routine laboratory testing was not diagnostic, certain patterns of laboratory abnormalities were observed in COVID-19. Leukopenia, lymphopenia, anemia, elevation of liver enzymes and lactate dehydrogenase, have been reported in different series.<xref rid="bib6" ref-type="bibr"><sup>6</sup></xref><sup>,</sup><xref rid="bib7" ref-type="bibr"><sup>7</sup></xref> Also, a similar observation has been made in SARS.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref></p><p id="p0040">The clinical utility of CXR in the early diagnosis of COVID-19 is questionable. In this report, initial CXR of both cases was non-diagnostic, and more evident radiological abnormalities were detected on day 6. Similar findings were reported in the first case of COVID-19 in the United States, and pulmonary patch/consolidation was not detected by CXR until day 5 in hospital (day 9 of illness).<xref rid="bib9" ref-type="bibr"><sup>9</sup></xref> Similarly, in a case series of SARS patients from the Amoy Gardens housing estate, 29.3% (22/75) cases had normal CXR on admission, however four of 22 cases developed acute respiratory distress syndrome (ARDS) afterward.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> In general, 80% (60/75) of cases experienced radiological worsening at a mean of 7.4 days.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> Both unifocal and bilateral lung infiltration could be observed in our report. Of 99 COVID-19 cases in China, 25% presented with unilateral pneumonia and 75% presented with bilateral pneumonia.<xref rid="bib7" ref-type="bibr"><sup>7</sup></xref></p><p id="p0045">As discussed above, COVID-19 cannot be reliably distinguished by clinical, radiologic, or laboratory criteria from other causes of pneumonia. Moreover, in the clinical setting of community transmission, exposure or travel history alone would be not useful to identify the risk population of COVID-19 cases. Hence, laboratory-based diagnosis is critical. At the present time, RT-PCR assays were most widely used to detect SARS-CoV-2. Current data are insufficient to determine their sensitivity and specificity for SARS-CoV-2. A previous study demonstrated SARS virus could be detected in approximately one-third of patients during early phase of the illness, and most frequently during the second week of illness.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> We believe that the diagnostic performance of molecular testing improves during the decades. However, more data are needed to address the issue.</p><p id="p0050">Another challenge is the surge of clinical needs of laboratory testing. It is anticipated that there will be an overwhelming demand for the supply chain of testing reagents and laboratory equipment, and the availability of well trained and experienced staff during the outbreak. There are several alternative diagnostic strategies under development. Feng et al. proposed a CRISPR-based technique for the diagnosis of COVID-19 (<ext-link ext-link-type="uri" xlink:href="https://www.broadinstitute.org/files/publications/special/COVID-19%20detection%20(updated).pdf" id="intref0010">https://www.broadinstitute.org/files/publications/special/COVID-19%20detection%20(updated).pdf</ext-link>). After RNA extraction, the test result could be read using a dipstick in less than an hour. RNA-based metagenomic sequencing is another promising approach, and has been used to diagnose COVID-19 in the first cluster related to the Huanan Seafood Market in China.<xref rid="bib10" ref-type="bibr"><sup>10</sup></xref></p><p id="p0055">Currently, clinical management and treatment of COVID-19 is largely supportive. In the cases of pneumonia, our diagnostic capacity could be hindered by the nature of isolation units. For example, for the first COVID-19 case in the United States, only point-of-care laboratory testing was permitted initially.<xref rid="bib9" ref-type="bibr"><sup>9</sup></xref> The current rate of co-infection and distribution of coexisting organisms in the cases of COVID-19 remain undefined. Of note, current evidence suggests that co-infection is not uncommon in the patients with community-acquired pneumonia.<xref rid="bib11" ref-type="bibr"><sup>11</sup></xref> In a prospective study of 2259 patients with pneumonia and specimens submitted for comprehensive bacterial and viral testing, etiologic agents were detected in only 38% cases. Among these cases, the percentages of co-infections were associated with the severity and geographic regions.<xref rid="bib11" ref-type="bibr"><sup>11</sup></xref> Clinical guideline for the treatment of community-acquired pneumonia in Taiwan shall be considered for these cases.<xref rid="bib12" ref-type="bibr"><sup>12</sup></xref></p><p id="p0060">In conclusion, we reported the clinical features of two patients with COVID-19 in Taiwan, and highlight the nonspecific nature of clinical presentations of COVID-19 and the importance of laboratory-based diagnosis.</p></sec><sec sec-type="COI-statement"><title>Declaration of Competing Interest</title><p id="p0065">The authors declare no conflicts of interest.</p></sec></body><back><ref-list id="cebib0010"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sref1"><person-group 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