Diagnosis, treatment and the reasons for re-detectable positive RNA test of one case of imported COVID-19 in Chengdu

Abstract

Summarizing the clinical characteristics and the process of two times of nucleic acid turning re-positive after discharge of an imported COVID-19 case in Chengdu in order to provide experience for clinical management of such cases. A retrospective research method was used to analyze the diagnosis and treatment process, as well as the clinical symptoms and examination results 15 days after discharge of an imported COVID-19 case in Chengdu. The case was tested positive for SARS-CoV-2 nucleic acid in Thailand on March 7, 2020. After arriving in Chengdu on March 10, 2020, he was sent to Chengdu Public Health Clinical Medical Center for isolation treatment. On March 11, the SARS-CoV-2 nucleic acid test of nasopharyngeal swab was suspiciously positive and the result of anal swab was positive. The case was admitted to the hospital as an asymptomatic accompanied by a decline in cellular immune function, his physical examination showed no positive signs. Then he was converted to a confirmed case after 22 days of hospitalization. After the case was discharged 15 days from the hospital, his virus nucleic acid had returned re-positive for 2 times. He was accompanied by neurological symptoms and was diagnosed as anxious and depressive when nucleic acid returned re-positive for the second time, and his symptoms resolved after treatment with psychiatric drugs.Asymptomatic patients of COVID-19 can be converted to confirmed cases. Nucleic acid returning re-positive does not mean that the patient's condition has relapsed or worsened. Patients with COVID-19 may have mental disorder, medical staff need to find it out in time and provide psychological intervention or necessary medication. 摘要： 总结成都市一例输人型新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)病例的临床特点及出院后2 次新冠病毒核酸检测阳性的过程,为临床管理此类病例提供经验。回顾性分析成都市一例输人型COVID-19病例的诊 疗过程及出院15d后复诊时的临床症状及检査结果。调査结果显示,病例于2020年3月7日在泰国査SARS-CoV-2 核酸阳性,2020年3月10日抵蓉,由机场送人成都市公共卫生临床医疗中心隔离治疗。3月11日鼻咽拭子新型 冠状病毒核酸检测可疑阳性,肛拭子査新型冠状病毒核酸阳性。体格检査无阳性体征,以“新型冠状病毒肺炎无 症状感染者”收人院治疗,伴有细胞免疫功能下降,在住院22 d(病程第25天)后转为确诊病例。出院后15 d复査新冠 病毒核酸复阳,再次治疗出院后病毒核酸第二次复阳。病例在第二次核酸复阳时伴有神经系统症状,完善检査后排除 颅内感染及占位病变,诊断为焦虑抑郁状态,予精神科药物治疗后症状缓解。COVID-19无症状感染者可转为确诊病 例,核酸复阳不代表患者病情复发或加重。COVID-19患者可出现心理障碍,医务人员需及时发现并予以心理干预及 必要的药物治疗。