此病例報告描述一位以腹瀉為新冠肺炎臨床表現的患者。22歲男性,2020年1月29日因持續腹瀉4天及輕度發燒至地方發燒門診就醫。因曾在1月22日短暫停留武漢,入住院接受系列檢查。入院時,沒有發燒,也無咳嗽、呼吸困難及胸痛症狀,生命徵象均正常。患者2月2日鼻咽拭子呈現SARS-CoV-2核酸陽性結果、胸部電腦斷層可見兩側肺炎,因而確診為COVID-19。糞便並未培養出常見腹瀉細菌病原、呼吸道檢體也未測得其它呼吸道病毒。住院過程除了支持療法外,病人服用口服抗病毒藥物(lopinavir and ritonavir)及interferon alpha-2b霧化吸入治療。之後腹瀉逐漸緩解,體溫及血液肝功能指數也都維持正常。兩星期後(2月16日)的鼻咽拭子核酸檢驗已測不到SARS-CoV-2,電腦斷層顯示肺炎病灶已改善。

過去研究指出,約有30%的中東呼吸症候群冠狀病毒感染症(MERS)患者及10.6%的嚴重急性呼吸道症候群(SARS)患者會出現腹瀉症狀。此病例報告也有類似觀察,強調腹瀉、無明顯呼吸道症狀也是COVID-19的臨床表現之一。

(財團法人國家衛生研究院 吳綺容醫師摘要整理)

We read with great interest the recent publication by Kumar et al, concerning gastrointestinal tract (GIT) symptoms (vomiting, diarrhoea and abdominal pain) among hospitalised children admitted with H1N1 influenza A virus infection.1 They have concluded that patients with GIT symptoms should not be ignored for the virus infectivity, especially during the outbreak period. Now the coronavirus disease 2019 (COVID-19) beginning in Wuhan has rapidly spread around China and other countries.2 According to the latest reports, the most common symptoms at onset of illness included fever, fatigue, dry cough, myalgia and dyspnoea, and the less common symptoms were headache, abdominal pain, diarrhoea, nausea and vomiting.3 Few patients initially presented with only GIT symptoms were reported.

On 29 January 2020, a 22-year-old man presented himself to the local fever clinic, with a 4-day history of diarrhoea and low-grade fever. The highest temperature was 38.3°C, and diarrhoea was about 3–4 times a day. No other abnormalities were observed. He took two kinds of Chinese patent medicines for gastrointestinal discomfort for 3 days while the symptoms were not significantly improved. Regular stool examination and bacterial cultures showed negative results for common pathogens. Lung auscultation revealed rhonchi, and chest radiography was performed, showing pneumonia in the bilateral lungs (see figure 1). He confessed that he had a history of short stay in Wuhan on 22 January. Considering his travel history, a clinical diagnosis of suspected COVID-19 was made and the local health departments were immediately notified.

Author:Y Song, P Liu, X L Shi, et al.
原文連結:https://gut.bmj.com/content/early/2020/03/22/gutjnl-2020-320891

By LL