key: cord-0768397-2et3gcb5
authors: Zeng, Jie; Peng, Shengkun; Lei, Yu; Huang, Jianxin; Guo, Yang; Zhang, Xiaoqin; Huang, Xiaobo; Pu, Hong; Pan, Lingai
title: Clinical and Imaging features of COVID-19 Patients: Analysis of Data from High-Altitude Areas
date: 2020-04-08
journal: J Infect
DOI: 10.1016/j.jinf.2020.03.026
sha: b16f96e24cce34c88a625b565563af011ecaecfe
doc_id: 768397
cord_uid: 2et3gcb5

nan

SARS-CoV-2 has spread worldwide. We read Wenjie's [1] report about the characteristics of the COVID-19 outside Hubei. Due to the inclusion of the center, these data are basically from large cities. But about 100 million residents around the world live above 2500 meters all year around [2] , the residents in high altitude areas may have pathophysiology changes especially in cardiopulmonary function [3] . If they are combined with COVID-19, these may cause more uncertainty to diagnosis and treatment. Given the rapid spread of COVID -19, we determined that an updated analysis of 68 cases from high altitude area from Sichuan province, which might help the physicians to learn more about the COVID-19. Images from all cases were collected and analyzed by two radiologists. Each segment of the lung was examined to determine whether there were Ground Glass Opacities (GGO), Consolidation, Mix GGO and Consolidation, reticular shadows, and the affected lung segment, range, location of the lesion, whether there was pleural effusion, and lymphadenopathy. We use semi-quantitative score system to evaluate the area of the lesion [4] . CT imaging features recorded from our cohort were summarized in supplementary Table 2 .

The infected people ranged in age from 3 to 77 years old. The patient under the age of 14 accounts for 7/68 (10%). Most of the patients had no specific COVID-19 symptoms, which is quite different from previous research. Laboratory results suggest that lymphocytes had varying degrees decreased. CRP was not too high (75% patients were in the normal range) and 79% patients with normal PCT level. Among all patients, 22 patients had negative initial CT and follow-up of lung CT, 5 patients had negative first CT scan, and positive after follow-up.The involvement range of the lung can be seen in the supplementary as Table 2 .

The total lung severity score of 46 CT-positive patients was 161, with an average score of 3.5 (range 1-10). Pulmonary cavity and tree bud signs appeared in 3 patients with tuberculosis, and the other patients did not present similar lesions. There were 3 cases of pleural effusion (3/46) (small-medium amount of left pleural effusion). There were 7 / 46 patients with old tuberculosis signs.

During the study period, 65 patients underwent a CT review. The average time between first chest CT and follow-up rescan was 3.7 days (2-10 days). 3 patients developed pleural effusion, but all of them had a history of tuberculosis. Emphysema in 3 people. There were 7 patients with previous tuberculosis.

SARS-CoV-2 is highly contagious and spread quickly among the population and spread to 79 countries worldwide in recent 3 months. Some of the patient can progress to severe or critical condition which might need the oxygen supplementary or ventilation support. It was estimated that patients who were initial infected with SARS-CoV-2 due to exposure to wildlife. But in our study, none of the patients have been exposed to wildlife, nor have they been to Wuhan since the outbreak. Therefore, the cases mentioned in our study are all infections caused by imported epidemic areas.

The oxygen content is low in high altitude areas. The incidence of SARS-CoV-2 infection in this region is unclear. This is the first report talking about the COVID-19 from high altitude areas. In our study, the patient under the age of 14 accounts for 7/68 (10%), which is higher than previous reports, we thought that may be related to family clustering. This is different with previously reported clinical data that 2% of the 72314 infected patients were younger than 20 years old [5] It may be because these groups do not have such a large range of social activities and have fewer opportunities to contact the source of infection.

The clinical symptoms of patients in this study group are quite different，most of the patients had no specific COVID-19，they had significantly lower rate of fever symptoms than other studies present before [4, 6, 7] . We believe that most of our patients are not from the epidemic area, and the virus may have been passaged several generations. Due to the strengthening of the epidemic prevention from the health department, they also received early diagnosis and treatment and changed the natural course development of COVID-19. However, among these patients, 6 severe patientsstill need oxygen therapy to relieve the dyspnea symptoms. We analyzed that these patients were older and combined more comorbidities than mild patients. It is worth mentioning that a 77-years-old female patient had a history of tuberculosis, although only one lobe was involved with SARS-CoV-2, but still progresses to severe illness. Therefore, the severity of COVID-19 is closely related to the underlying lung disease.

Like clinical symptoms, the imaging of this group of patients is also diverse.

Among the patients in this group, 41 CT tests were positive at the initial scan. In terms of lesion distribution, most of the patients' lung CT lesions were distributed at subpleural site, and the right lower lung involvement was the most common (33/46). Follow-up CT scans in 5 exacerbated patients indicated lung disease progression.

There were 5 patients who had a negative initial CT scan but positive follow-up CT， which means that negative CT images cannot completely rule out COVID-19. We can also found the pleural effusion in COVID-19 patients, which was similar with previous research [8] , and the pleural effusion was completely absorbed after treatment. In terms of treatment, most patients have a negative nucleic acid review after 1-2 weeks. The respiratory symptoms relief, the severe patients are still being followed up.

In conclusion, this is the first report of COVID-19 in high altitude area in the world. In high altitude area, the population is generally susceptible, including children, so everyone should be well protected. Residents high altitude area may face more complicated medical and social conditions (such as hypoxia, tuberculosis, and relative lack of medical resources), which may increase the complexity and severity of the disease. Our research shows that patients who underwent early screening and intervention could significantly reduce the severity of the disease，and patients with pulmonary tuberculosis would significantly increase the severity of the disease.

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