Coronavirus

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

• MERS-CoV
• SARS-CoV
• SARS-CoV-2 (COVID-19)

Clinical Features

• Incubation period: 2-4 days
• Upper respiratory symptoms
  • Rhinorrhea, cough, sore throat, earache, fever, malaise
  • 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

• 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
    • Severity of lymphocytosis and leukopenia shown to be associated with severe of illness
  • Thrombocytopenia, elevated lactate dehydrogenase, elevated C-reactive protein, and prolonged prothrombin time have been reported

Management

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

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

• Upper respiratory infection
• Fever
• COVID-19

External Links

• http://www.cdc.gov/coronavirus/about/
• https://en.wikipedia.org/wiki/Coronavirus