ZT:研究确定了六种不同“类型”的COVID-19

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ZT: Study identifies six different "types" of COVID-19

来源: fuz 于 2020-07-25 18:35:50

临床分型,对治疗有指导意义。

所有六种都有Loss of smell -dudaan-

Study identifies six different "types" of COVID-19

A new study of COVID-19, based on data from a symptom tracker app, determined that there are six distinct "types" of the disease involving different clusters of symptoms. The discovery could potentially open new possibilities for how doctors can better treat individual patients and predict what level of hospital care they would need.

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The six clusters of symptoms outlined in the study are:

1. Flu-like with no fever: Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.

2. Flu-like with fever: Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.

3. Gastrointestinal: Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.

4. Severe level one, fatigue: Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.

5. Severe level two, confusion: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.

6. Severe level three, abdominal and respiratory: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

The first level, "flu-like with no fever," is associated with headaches, loss of smell, muscle pains, cough, sore throat and chest pain. Patients at this level have a 1.5% chance of needing breathing support such as oxygen or a ventilator.

The second type, "flu-like with fever," includes symptoms like loss of appetite, headache, loss of smell, cough, sore throat, hoarseness and fever. Researchers say about 4.4% of patients at this level needed breathing support.

Patients with the third type, simply described as "gastrointestinal," do not have a cough as part of their illness. Instead, they experience headache, diarrhea, loss of smell, loss of appetite, sore throat and chest pain, and about 3.3% needed breathing support.

Lahita referred to the following three clusters of COVID-19 as the "really severe types."

In type four, or "severe level one," patients experience fatigue along with headache, loss of smell, cough, fever, hoarseness and chest pain. Patients at this level needed breathing support at a rate of 8.6%.

Type five, "severe level two," includes the symptoms of type four along with loss of appetite, sore throat and muscle pain, and is mainly distinguished by confusion.

"That means you don't know where you are or where you live, whether you are in or out of the hospital, who your relatives are," Lahita explained. "That is very scary." Almost 10% of patients at that level need breathing support.

How the coronavirus almost killed a healthy woman with "no normal symptoms"

The most severe type of COVID-19 is referred to as "severe level three, abdominal and respiratory," and has all the above symptoms along with abdominal pain, shortness of breath and diarrhea. Nearly 20% of these patients need breathing support.

"Those are the severe level threes who wind up on a ventilator, and then it is touch-and-go as to whether they survive the infection entirely," Lahita said.

The U.K. researchers also found that only 16% of patients with type one COVID-19 required hospitalization, compared with nearly half of the patients with type six.

Patients in the severe clusters also tended to be older or with pre-exisiting conditions and weakened immune systems, compared to those in the first three.

 

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Why do some coronavirus patients lose sense of smell? Harvard researchers have an answer

COVID-19 infection is unlikely to cause lasting damage, researchers say

Temporary loss of smell, or anosmia, is a common symptom of COVID-19, and one study recently determined the cell types in the upper nasal cavity most vulnerable to SARS-CoV-2 infection.

The research team led by neuroscientists at Harvard Medical School (HMS) found that non-neuronal cell types may be responsible for loss of smell in coronavirus patients. Their findings were recently published in Science Advances.

“Our findings indicate that the novel coronavirus changes the sense of smell in patients not by directly infecting neurons but by affecting the function of supporting cells,” said Sandeep Robert Datta, senior study author and associate professor of neurobiology in the Blavatnik Institute at HMS, in a university news release.


Researchers say olfactory support cells, not neurons, are vulnerable to SARS-CoV-2 infection. (iStock)


Researchers say olfactory support cells, not neurons, are vulnerable to SARS-CoV-2 infection. (iStock)

This finding implies that infection is unlikely to cause lasting damage and persistent loss of smell.

“I think it’s good news because once the infection clears, olfactory neurons don’t appear to need to be replaced or rebuilt from scratch,” Datta said. “But we need more data and a better understanding of the underlying mechanisms to confirm this conclusion.”

A separate, unrelated study found that nearly 90 percent of a given subset of coronavirus patients saw improvement in smell over four weeks. Researchers evaluated 202 mildly symptomatic adults at Treviso Regional Hospital in Italy. At four weeks, 89 percent of patients who reported a sudden onset of altered sense of smell or taste saw a complete resolution or improvement of the symptoms.

According to the Harvard researchers, other viral infections (including coronaviruses) are known to have months-long recovery times for smell. These infections are known to inflict direct damage to olfactory sensory neurons. In these viruses, inflammatory responses can cause changes in odor perception, though some cases of COVID-19 related anosmia have happened without nasal inflammation.

 
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