Asymptomatic cases in a family cluster with SARS-CoV-2 infection
Identifieur interne : 000B12 ( Pmc/Corpus ); précédent : 000B11; suivant : 000B13Asymptomatic cases in a family cluster with SARS-CoV-2 infection
Auteurs : Xingfei Pan ; Dexiong Chen ; Yong Xia ; Xinwei Wu ; Tangsheng Li ; Xueting Ou ; Liyang Zhou ; Jing LiuSource :
- The Lancet. Infectious Diseases [ 1473-3099 ] ; 2020.
Url:
DOI: 10.1016/S1473-3099(20)30114-6
PubMed: 32087116
PubMed Central: 7158985
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Asymptomatic cases in a family cluster with SARS-CoV-2 infection</title><author><name sortKey="Pan, Xingfei" sort="Pan, Xingfei" uniqKey="Pan X" first="Xingfei" last="Pan">Xingfei Pan</name><affiliation><nlm:aff id="aff1">Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Chen, Dexiong" sort="Chen, Dexiong" uniqKey="Chen D" first="Dexiong" last="Chen">Dexiong Chen</name><affiliation><nlm:aff id="aff2">Emergency Department, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Xia, Yong" sort="Xia, Yong" uniqKey="Xia Y" first="Yong" last="Xia">Yong Xia</name><affiliation><nlm:aff id="aff3">Department of Clinical Laboratory, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Wu, Xinwei" sort="Wu, Xinwei" uniqKey="Wu X" first="Xinwei" last="Wu">Xinwei Wu</name><affiliation><nlm:aff id="aff5">Department of Microbiology, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China</nlm:aff></affiliation></author><author><name sortKey="Li, Tangsheng" sort="Li, Tangsheng" uniqKey="Li T" first="Tangsheng" last="Li">Tangsheng Li</name><affiliation><nlm:aff id="aff4">Department of Radiology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Ou, Xueting" sort="Ou, Xueting" uniqKey="Ou X" first="Xueting" last="Ou">Xueting Ou</name><affiliation><nlm:aff id="aff1">Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Zhou, Liyang" sort="Zhou, Liyang" uniqKey="Zhou L" first="Liyang" last="Zhou">Liyang Zhou</name><affiliation><nlm:aff id="aff1">Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Liu, Jing" sort="Liu, Jing" uniqKey="Liu J" first="Jing" last="Liu">Jing Liu</name><affiliation><nlm:aff id="aff6">Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China</nlm:aff></affiliation><affiliation><nlm:aff id="aff7">Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, Hubei, China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32087116</idno><idno type="pmc">7158985</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158985</idno><idno type="RBID">PMC:7158985</idno><idno type="doi">10.1016/S1473-3099(20)30114-6</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000B12</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B12</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Asymptomatic cases in a family cluster with SARS-CoV-2 infection</title><author><name sortKey="Pan, Xingfei" sort="Pan, Xingfei" uniqKey="Pan X" first="Xingfei" last="Pan">Xingfei Pan</name><affiliation><nlm:aff id="aff1">Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Chen, Dexiong" sort="Chen, Dexiong" uniqKey="Chen D" first="Dexiong" last="Chen">Dexiong Chen</name><affiliation><nlm:aff id="aff2">Emergency Department, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Xia, Yong" sort="Xia, Yong" uniqKey="Xia Y" first="Yong" last="Xia">Yong Xia</name><affiliation><nlm:aff id="aff3">Department of Clinical Laboratory, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Wu, Xinwei" sort="Wu, Xinwei" uniqKey="Wu X" first="Xinwei" last="Wu">Xinwei Wu</name><affiliation><nlm:aff id="aff5">Department of Microbiology, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China</nlm:aff></affiliation></author><author><name sortKey="Li, Tangsheng" sort="Li, Tangsheng" uniqKey="Li T" first="Tangsheng" last="Li">Tangsheng Li</name><affiliation><nlm:aff id="aff4">Department of Radiology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Ou, Xueting" sort="Ou, Xueting" uniqKey="Ou X" first="Xueting" last="Ou">Xueting Ou</name><affiliation><nlm:aff id="aff1">Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Zhou, Liyang" sort="Zhou, Liyang" uniqKey="Zhou L" first="Liyang" last="Zhou">Liyang Zhou</name><affiliation><nlm:aff id="aff1">Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</nlm:aff></affiliation></author><author><name sortKey="Liu, Jing" sort="Liu, Jing" uniqKey="Liu J" first="Jing" last="Liu">Jing Liu</name><affiliation><nlm:aff id="aff6">Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China</nlm:aff></affiliation><affiliation><nlm:aff id="aff7">Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, Hubei, China</nlm:aff></affiliation></author></analytic><series><title level="j">The Lancet. Infectious Diseases</title><idno type="ISSN">1473-3099</idno><idno type="eISSN">1474-4457</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zhu, N" uniqKey="Zhu N">N Zhu</name></author><author><name sortKey="Zhang, D" uniqKey="Zhang D">D Zhang</name></author><author><name sortKey="Wang, W" uniqKey="Wang W">W Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, C" uniqKey="Huang C">C Huang</name></author><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y Wang</name></author><author><name sortKey="Li, X" uniqKey="Li X">X Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Jf W" uniqKey="Chan J">JF-W Chan</name></author><author><name sortKey="Yuan, S" uniqKey="Yuan S">S Yuan</name></author><author><name sortKey="Kok, K H" uniqKey="Kok K">K-H Kok</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Lancet Infect Dis</journal-id><journal-title-group><journal-title>The Lancet. Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">1473-3099</issn><issn pub-type="epub">1474-4457</issn><publisher><publisher-name>Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32087116</article-id><article-id pub-id-type="pmc">7158985</article-id><article-id pub-id-type="publisher-id">S1473-3099(20)30114-6</article-id><article-id pub-id-type="doi">10.1016/S1473-3099(20)30114-6</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Asymptomatic cases in a family cluster with SARS-CoV-2 infection</article-title></title-group><contrib-group><contrib contrib-type="author" id="au10"><name><surname>Pan</surname><given-names>Xingfei</given-names></name><email>panxf0125@163.com</email><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Chen</surname><given-names>Dexiong</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au30"><name><surname>Xia</surname><given-names>Yong</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au40"><name><surname>Wu</surname><given-names>Xinwei</given-names></name><xref rid="aff5" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="au50"><name><surname>Li</surname><given-names>Tangsheng</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="au60"><name><surname>Ou</surname><given-names>Xueting</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au70"><name><surname>Zhou</surname><given-names>Liyang</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au80"><name><surname>Liu</surname><given-names>Jing</given-names></name><email>liujing_GI@whu.edu.cn</email><xref rid="aff6" ref-type="aff">f</xref><xref rid="aff7" ref-type="aff">g</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Department of Infectious Diseases, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</aff><aff id="aff2"><label>b</label>Emergency Department, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</aff><aff id="aff3"><label>c</label>Department of Clinical Laboratory, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</aff><aff id="aff4"><label>d</label>Department of Radiology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, China</aff><aff id="aff5"><label>e</label>Department of Microbiology, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China</aff><aff id="aff6"><label>f</label>Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China</aff><aff id="aff7"><label>g</label>Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, Hubei, China</aff><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><permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Ltd</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></article-meta></front><body><p id="para10">Since December, 2019, an outbreak of pneumonia caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a serious epidemic in China and other countries, resulting in worldwide concern.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> Family clusters of infected individuals have been reported, and this phenomenon could present a serious threat to public health if not strictly controlled. In a previously reported family cluster, most infected individuals had clinical symptoms, decreased lymphocyte counts, and abnormal chest CT images, and were positive for the virus on quantitative RT-PCR (qRT-PCR) analysis.<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref> However, some of the family members had abnormal chest CT images and positive qRT-PCR results without any clinical symptoms.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> Here, we report the clinical characteristics of a family cluster of SARS-CoV-2 infection. In this family of three, one 35-year-old man (patient 1) had clinical symptoms, a decreased lymphocyte count, abnormal chest CT images, and a positive result on qRT-PCR. By contrast, the other two family members—a 33-year-old woman (patient 2) and a 3-year-old boy (patient 3)—were both asymptomatic, with normal lymphocyte counts and chest CT images but positive qRT-PCR results (<xref rid="fig1" ref-type="fig">figure</xref>).<fig id="fig1"><label>Figure</label><caption><p>Chronology of symptom onset and identification of positive SARS-CoV-2 findings on qRT-PCR and CT among the family cluster</p><p>qRT-PCR=quantitative RT-PCR.</p></caption><graphic xlink:href="gr1_lrg"></graphic></fig></p><p id="para20">On Jan 22, 2020, patient 1 travelled from Wuhan (Hubei, China) to Guangzhou (Guangdong, China) with his wife (patient 2) and son (patient 3) by high-speed rail. On Jan 26, patient 1 developed a fever of 37·5°C, which lasted for 1 day. The next day, the patient presented to the Third Affiliated Hospital of Guangzhou Medical University with a body temperature of 37·4°C, and on the same day developed a sore throat, arthralgia, and myalgia, without chills or headache. Patient 1 was observed from Jan 27 to Jan 29, during which time his body temperature normalised. On Jan 27, routine blood tests showed normal white blood cell and lymphocyte counts, but decreased lymphocyte percentage (<xref rid="sec1" ref-type="sec">appendix</xref>). Chest CT scans taken 2 days after symptom onset showed bilateral multiple lobular and subsegmental areas of ground-glass opacities and consolidation (<xref rid="sec1" ref-type="sec">appendix</xref>). Two sets of nasopharyngeal swab samples from patient 1 tested positive for SARS-CoV-2 on qRT-PCR.</p><p id="para30">Patients 2 and 3 had no signs or clinical symptoms during the same observation period (Jan 27–29), with no decreases in white blood cell or lymphocyte counts (<xref rid="sec1" ref-type="sec">appendix</xref>). Chest CT images taken from these two patients on Jan 28 did not show significant abnormalities. However, two sets of nasopharyngeal swab samples, taken at the same time as those from patient 1, tested positive for SARS-CoV-2 on qRT-PCR. All three family members were diagnosed with SARS-CoV-2 infection and were thus transferred to the Infectious Diseases Unit of the Eighth People's Hospital of Guangzhou for isolation and treatment.</p><p id="para40">In this family cluster, although all individuals tested positive for SARS-CoV-2 infection on qRT-PCR, only patient 1 showed clinical symptoms, decreased lymphocyte count, and abnormal chest CT images (<xref rid="fig1" ref-type="fig">figure</xref>). However, any of the three individuals could have been the first one to become infected and thus transmitted the virus to the other two family members. Importantly, asymptomatic patients (such as patients 2 and 3) might be unaware of their disease and therefore not isolate themselves or seek treatment, or they might be overlooked by health-care professionals and thus unknowingly transmit the virus to others.</p><p id="para50">To prevent and control this highly infectious disease as early as possible, people with family members with SARS-CoV-2 infection should be closely monitored and examined to rule out infection, even if they do not have any symptoms. In the case of this family, since the time between presentation and identification of SARS-CoV-2 infection was short, more studies are needed to observe the symptoms and test results of infected individuals in greater detail.</p></body><back><ref-list id="bibl10"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>N</given-names></name><name><surname>Zhang</surname><given-names>D</given-names></name><name><surname>Wang</surname><given-names>W</given-names></name></person-group><article-title>A novel coronavirus from patients with pneumonia in China, 2019</article-title><source>N Engl J Med</source><year>2020</year><comment>published online Jan 24.</comment><pub-id pub-id-type="doi">10.1056/NEJMoa2001017</pub-id></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal" id="sbref20"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>C</given-names></name><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>X</given-names></name></person-group><article-title>Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China</article-title><source>Lancet</source><volume>395</volume><year>2020</year><fpage>497</fpage><lpage>506</lpage><pub-id pub-id-type="pmid">31986264</pub-id></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="journal" id="sbref30"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>JF-W</given-names></name><name><surname>Yuan</surname><given-names>S</given-names></name><name><surname>Kok</surname><given-names>K-H</given-names></name></person-group><article-title>A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster</article-title><source>Lancet</source><volume>395</volume><year>2020</year><fpage>514</fpage><lpage>523</lpage><pub-id pub-id-type="pmid">31986261</pub-id></element-citation></ref></ref-list><sec id="sec1" sec-type="supplementary-material"><title>Supplementary Material</title><p id="para70"><supplementary-material content-type="local-data" id="ecomp10"><caption><title>Supplementary appendix</title></caption><media xlink:href="mmc1.pdf"></media></supplementary-material></p></sec><ack><p>We declare no competing interests. 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