A new study, published in the prestigious journal The Lancet Infectious Diseases, provides details on three different possibilities for the evolution of the clinical pictures of the new coronavirus. It relates to the first five cases of Covid-19 identified in France, and in Europe, between January 24 and 29, admitted to the Bichat hospital in Paris and to the Bordeaux University Hospital (Gironde).
It was carried out by the teams from the infectious and tropical diseases department of these two hospitals, in collaboration with researchers from the University of Paris, Inserm and the Pasteur Institute, the Hospices Civils de Lyon, the CNRS – UMR 5308, Ecole normale supérieure de Lyon and Claude-Bernard-Lyon University.
Initially detected by the Pasteur Institute, these cases concern three men (aged 31, 48 and 80) and two women (aged 30 and 46), all of Chinese origin, who had traveled to France since China around mid-January. “Despite the very limited number of patients, the work carried out, which was published on March 27, 2020 in the journal The Lancet Infectious Diseases, has made it possible to identify three very different types of clinical presentation “, Writes the Assistance Publique – Hôpitaux de Paris (AP-HP) in a press release.
Sometimes worsening around 10 days
“The first type is a frustrating clinical presentation, very little symptomatic, with spontaneous evolution quickly favorable despite a strong presence of SARS-CoV-2 virus at the nasopharyngeal level from the beginning of the disease”.
“The second type of presentation has two phases. With a reassuring initial phase and a secondary worsening approximately 10 days after the onset of the disease, despite a decrease in viral load during this period in the nasopharyngeal samples ”.
“The third type is a severe presentation that quickly progresses to multiple organ failure with a persistent high viral load in the upper and lower respiratory tract and the detection of viruses in the plasma.”
Severe immediately in the elderly patient
The study adds that these three different clinical pictures appeared in fairly distinct patient profiles: “the frustrated form in the two patients, the two-phase form in the two young patients and the severe form immediately in the elderly patient “
“Despite the time that has passed and the events since the description of these first cases, this typology of different clinical presentations seems to be confirmed through clinical experience during the epidemic phase. It seems interesting to better understand the natural history of the COVID-19 disease and contribute to the therapeutic management adapted to each situation, “believes, in a comment cited in the press release, Professor Xavier Lescure, first author of this study , deputy to Professor Yazdan Yazdanpanah, head of the infectious and tropical diseases department of Bichat hospital, and last author of this study initiated under the aegis of the REACTing network.
