Coronavirus: Difference between revisions
 
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==Background==
==Background==
*Coronaviruses are enveloped, positive-stranded RNA viruses that were first discovered in the 1960s and named after the crown-like spikes on their surface seen on electron microscopy.
* Enveloped, positive-sense single-stranded RNA viruses with nucleocapsid
*They have a nucleocapsid around them and are the largest RNA virus.
* Very common cause of [[upper respiratory infection]], especially during fall and winter, and some diarrhea in pediatric patients
*Four main subtypes of Coronavirus:  alpha, beta, gamma, delta.
* Emerging pathogen for respiratory disease outbreaks
*Coronavirus is very common and most people will get infected atleast once in their lifetime, esp children but route of infection is controversial.  Most common time of infection is fall or winter.
* Probably originated from bats, then spread to other mammalian hosts
*The cause of Coronavirus is hard to assess since it cannot be grown in laboratories, the way Rhinovirus can be grown (another common cold virus). 
** [[SARS]]-CoV – Himalayan palm civets
*Commonly cause up to one-third of upper respiratory tract infections in adults and children.
** [[MERS]]-CoV – Dromedary camels
**Also thought to cause diarrhea in infants, children, and farm animals.
** [[COVID-19|SARS-CoV-2]] – Suspected to be from pangolins
*MERS-CoV and SARS-CoV types of Coronavirus cause the most severe infections.
**SARS began in 2002 in Asia.  (SARS stands for severe acute respiratory syndrome.)


==Method of Replication==
{{Specific Coronavirus Sub-Types of Clinical Importance}}
*Coronavirus enters the cell cytoplasm and viral particle is uncoated causing RNA genome to deposit into cytoplasm.
*RNA viral genome is transcribed into new RNA copies via replicase protein.


==Clinical Features==
==Clinical Features==
*Coronavirus usually presents like the common cold with an upper respiratory tract infection: runny nose, cough, fever, sore throat.
*Incubation period: 2-4 days
*Pulmonary - coughing, dyspnea/wheezing, respiratory failure (seen in elderly/immunocompromised), pneumonia, secondary bacterial pneumonia.
*Upper respiratory symptoms
*GI - vomiting, diarrhea, [[Necrotizing enterocolitis]] (in neonates)
**[[Rhinorrhea]], [[cough]], [[sore throat]], earache, [[fever]], malaise
*HEENT - otalgia, coryza, rhinorrhea, sneezing
**Respiratory symptoms may be more severe in elderly/immunocompromised (e.g. [[pneumonia]], secondary bacterial [[pneumonia]])
*GI symptoms - [[vomiting]], [[diarrhea]], [[Necrotizing enterocolitis]] (in neonates)


==Differential Diagnosis==
==Differential Diagnosis==
*[[Rhinovirus]]: most common cold virus.  Causes around 40% colds.  
*[[Rhinovirus]]: most common cold virus.  Causes around 40% colds.  
**as opposed to Coronavirus, this causes cold in other seasons besides winter.  
**as opposed to Coronavirus, this causes cold in other seasons besides winter.  
**Rhinovirus is NOT encapsulated as opposed to Coronavirus.
*[[respiratory syncytial virus]] (RSV)
*[[respiratory syncytial virus]] (RSV)
*[[influenza]]
*[[influenza]]
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==Evaluation==
==Evaluation==
*Generally no evaluation indicated
*PCR Testing
*If needed, nasal swabs can be sent for PCR and immunofluorescent antigen assay
**Should be obtained on nasopharyngeal swab preferably one with synthetic fibers and plastic tip and under isolation
 
**Criteria for who to test is constantly evolving at this time. The CDC currently recommends clinicians to refer to local and/or institutional guidelines and test availability when deciding who should be tested.
==Prevention==
*Laboratory Abnormalities
*No vaccines have been made thus far to prevent Coronavirus.  
**Lymphocytosis
*Measures to reduce risk of transmission: fully wash hands, do not touch face without washing hands, avoid close contact with sick contacts.
***Present in 70-80% of patients<ref name="clinical characteristics">Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published online ahead of print, 2020 Feb 7]. JAMA. 2020;10.1001/jama.2020.1585. doi:10.1001/jama.2020.1585</ref>
***Severity of lymphocytosis and leukopenia shown to be associated with severe of illness<ref name="clinical characteristics"></ref><ref name="disease 2019">Wei-jie Guan, Ph.D., Zheng-yi Ni, M.D., Yu Hu, M.D., et al. Clinical Characteristics of Coronavirus Disease 2019 in China. China Medical Treatment Expert Group for Covid-19. The New England Journal Of Medicine website. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 Published February 28, 2020. Accessed March 31, 2020</ref>
**Thrombocytopenia, elevated lactate dehydrogenase, elevated C-reactive protein, and prolonged prothrombin time have been reported<ref name="clinical characteristics"></ref><ref name="disease 2019"></ref>


==Management==
==Management==
*Supportive care
*There is no specific treatment for Coronavirus, since most infections spontaneously resolve.   
*There is no specific treatment for Coronavirus, since most infections spontaneously resolve.   
*Pain and fever medications can be taken (do not give aspirin to kids).  
*Supportive care, no specific treatment
**Rest, hydration, [[analgesia]], antipyretics
*Hand hygiene to prevent spread
 
==Disposition==
 
==Prevention==
*The first vaccines produced against a coronavirus were developed during the [[COVID-19]] pandemic
*Measures to reduce risk of transmission: fully wash hands, do not touch face without washing hands, avoid close contact with sick contacts.


==See Also==
==See Also==
 
*[[Upper respiratory infection]]
*[[Fever]]
*[[COVID-19]]


==External Links==
==External Links==
http://www.cdc.gov/coronavirus/about/
*http://www.cdc.gov/coronavirus/about/
https://en.wikipedia.org/wiki/Coronavirus
*https://en.wikipedia.org/wiki/Coronavirus


==References==
==References==

Latest revision as of 23:41, 6 March 2021

Background

  • Enveloped, positive-sense single-stranded RNA viruses with nucleocapsid
  • Very common cause of upper respiratory infection, especially during fall and winter, and some diarrhea in pediatric patients
  • Emerging pathogen for respiratory disease outbreaks
  • Probably originated from bats, then spread to other mammalian hosts
    • SARS-CoV – Himalayan palm civets
    • MERS-CoV – Dromedary camels
    • SARS-CoV-2 – Suspected to be from pangolins

Specific Coronavirus Sub-Types of Clinical Importance

Clinical Features

Differential Diagnosis

  • Rhinovirus: most common cold virus. Causes around 40% colds.
    • as opposed to Coronavirus, this causes cold in other seasons besides winter.
    • Rhinovirus is NOT encapsulated as opposed to Coronavirus.
  • respiratory syncytial virus (RSV)
  • influenza
  • parainfluenza

Evaluation

  • PCR Testing
    • Should be obtained on nasopharyngeal swab preferably one with synthetic fibers and plastic tip and under isolation
    • Criteria for who to test is constantly evolving at this time. The CDC currently recommends clinicians to refer to local and/or institutional guidelines and test availability when deciding who should be tested.
  • Laboratory Abnormalities
    • Lymphocytosis
      • Present in 70-80% of patients[1]
      • Severity of lymphocytosis and leukopenia shown to be associated with severe of illness[1][2]
    • Thrombocytopenia, elevated lactate dehydrogenase, elevated C-reactive protein, and prolonged prothrombin time have been reported[1][2]

Management

  • There is no specific treatment for Coronavirus, since most infections spontaneously resolve.
  • Supportive care, no specific treatment
  • Hand hygiene to prevent spread

Disposition

Prevention

  • The first vaccines produced against a coronavirus were developed during the COVID-19 pandemic
  • Measures to reduce risk of transmission: fully wash hands, do not touch face without washing hands, avoid close contact with sick contacts.

See Also

External Links

References

  1. ↑ 1.0 1.1 1.2 Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published online ahead of print, 2020 Feb 7]. JAMA. 2020;10.1001/jama.2020.1585. doi:10.1001/jama.2020.1585
  2. ↑ 2.0 2.1 Wei-jie Guan, Ph.D., Zheng-yi Ni, M.D., Yu Hu, M.D., et al. Clinical Characteristics of Coronavirus Disease 2019 in China. China Medical Treatment Expert Group for Covid-19. The New England Journal Of Medicine website. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 Published February 28, 2020. Accessed March 31, 2020
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