First Case of 2019 Novel Coronavirus in the United States

美国首例新型冠状病毒（2019-nCoV）

编译丨海南医学院第一附属医院内分泌科王新军

Summary 

An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient's initial mild symptoms atpresentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and publichealth authorities at the local, state, and federal levels, as well as the needfor rapid dissemination of clinical information related to the care of patients with this emerging infection.

摘要

一场始于中国武汉的新型冠状病毒（2019-nCoV）疫情迅速蔓延，目前已在多个国家确诊病例。我们报告了在美国确诊的第1例2019-nCoV感染病例，并描述了该病例的识别、诊断、临床过程和治疗，包括患者在发病第9天出现进展为肺炎的初始轻度症状。本病例强调了在地方、州和联邦各级临床医生和公共卫生当局之间密切协调的重要性，以及迅速传播与治疗这种新感染患者有关的临床信息的必要性。 

on December 31, 2019, China reporteda cluster of cases of pneumonia in people associated with the Huanan SeafoodWholesale Market in Wuhan, Hubei Province.1 On January 7, 2020, Chinese healthauthorities confirmed that this cluster was associated with a novel coronavirus, 2019-nCoV.2 Although cases were originally reported to be associated with exposure to the seafood market in Wuhan, current epidemiologic data indicate that person-to-person transmission of 2019-nCoV isoccurring.3-6 As of January 30, 2020, a total of 9976 cases had been reported in at least 21 countries,7 including the first confirmed case of 2019-nCoV infection in the United States, reported on January 20, 2020.Investigations are under way worldwide to better understand transmission dynamicsand the spectrum of clinical illness. This report describes the epidemiologicand clinical features of the first case of 2019-nCoV infection confirmed in theUnited States.

2019年12月31日，中国报告了湖北省武汉市华南海鲜批发市场相关人群中的一组肺炎病例。2020年1月7日，中国卫生当局证实，这一组肺炎病例与一种新型冠状病毒有关：2019-nCoV。尽管最初报告病例与暴露于武汉海鲜市场有关，但目前的流行病学数据表明，2019-nCoV正在发生人与人之间的传播。截至2020年1月30日，至少21个国家报告了9976例病例，包括美国于2020年1月20日报告的2019-nCoV感染的首例确诊病例。全世界正在进行调查，以更好地了解传播动力学和临床疾病谱。本报告描述了在美国确诊的2019-nCoV感染的流行病学和临床特征。

CaseReport

病例报告

2020年1月19日，一名35岁男子来到华盛顿州斯诺霍米什县的一家急诊诊所，他有4天的咳嗽和主观性发热史。病人一进诊所，就在候诊室戴上口罩。等待约20分钟后，他被送进检查室并由医生进行评估。他透露，他在中国武汉探亲后，已于1月15日返回华盛顿州。这位病人说，他看到了美国疾病控制和预防中心（CDC）关于中国新的冠状病毒爆发的健康警报，由于他的症状和最近的旅行，他决定去看医生。 

Apart from a history of hypertriglyceridemia, the patient was an otherwise healthy nonsmoker. Thephysical examination revealed a body temperature of 37.2°C, blood pressure of 134/87mmHg, pulse of 110 beats per minute, respiratory rate of 16 breaths perminute, and oxygen saturation of 96% while the patient was breathing ambientair. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1). A rapid nucleicacid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viralrespiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, andOC43).

除了有高甘油三酯血症的病史外，病人是一个健康的不吸烟者。体格检查显示患者呼吸环境空气时体温37.2℃，血压134/87mmHg，脉搏110次/分，呼吸频率16次/分，血氧饱和度96%。肺部听诊显示湿罗音，并进行胸片检查，报告显示没有异常（图1）。甲型和乙型流感的快速核酸扩增试验（NAAT）均为阴性。获得一个鼻咽拭子样本，并通过NAAT进行病毒性呼吸道病原体的检测；48小时内，所有被检测的病原体均呈阴性，包括甲型和乙型流感、副流感、呼吸道合胞病毒、鼻病毒、腺病毒和四种已知会导致人类疾病的常见冠状病毒株（HKU1、NL63、229E和OC43）。

Given the patient's travel history, the local and state health departments were immediately notified. Together with the urgent care clinician, the Washington Department of Health notified the CDC Emergency Operations Center. Although the patient reported that he had not spent time at the Huanan seafood market and reported no known contact with ill persons during his travel to China, CDC staff concurred with the need to testthe patient for 2019-nCoV on the basis of current CDC “persons underinvestigation” case definitions.8Specimens were collected in accordance with CDC guidance andincluded serum and nasoph-aryngeal and oropharyngeal swab specimens. After specimen collection, the patient was discharged to home isolation with active monitoring by the local health department.

鉴于患者的旅行史，当地和州卫生部门立即得到通知。华盛顿卫生部与紧急护理临床医生一起通知了疾病预防控制中心紧急行动中心。尽管病人说他没有在华南海鲜市场呆过，也没有报告他在中国旅行期间接触过病人，疾病预防控制中心的工作人员同意需要根据当前疾病预防控制中心“被调查人员”的病例定义对患者进行2019-nCoV测试。根据疾病预防控制中心的指导收集了8份样本，包括血清样本、鼻咽和口咽拭子样本。标本采集后，病人在当地卫生部门的积极监测下出院至家中隔离。

On January 20, 2020, the CDC confirmed that the patient's nasopharyngeal and oropharyngeal swabs tested positive for 2019-nCoV by real-time reverse-transcriptase-polymerase-chain-reaction(rRT-PCR) assay. In coor-dination with CDC subject-matter experts, state andlocal health officials, emergency medical services, and hospital leadership and staff, the patient was admitted to an airborne-isolation unit at Providence Regional Medical Center for clinical observation, with health care workers following CDC recommendations for contact, droplet, and airborne precautionswith eye protection.9

2020年1月20日，疾控中心通过实时逆转录-聚合酶链反应（rRT-PCR）检测证实患者的鼻咽和口咽拭子检测出2019-nCoV阳性。在与疾病预防控制中心专家、州和地方卫生官员、紧急医疗服务部门以及医院领导和工作人员的协调下，患者被送入普罗维登斯地区医疗中心的空气隔离病房进行临床观察，医护人员按照疾病预防控制中心的建议进行接触、滴入，空气中的预防措施和眼睛保护。

On admission, the patient reported persistent dry cough and a 2-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain. Vital signs were within normal ranges. On physicalexamination, the patient was found to have dry mucous membranes. The remainder of the examination was generally unremarkable. After admission, the patient received supportive care, including 2 liters of normal saline and ondansetronfor nausea.

入院时，患者报告持续干咳伴恶心呕吐2天，无呼吸短促或胸痛。生命体征在正常范围内。经体格检查，发现病人粘膜干燥。其他体格检查基本正常。入院后，患者接受支持治疗，包括2升生理盐水和昂丹司琼治疗恶心。 

On days 2 through 5 of hospitalization(days 6 through 9 of illness), the patient's vital signs remained largely stable, apart from the development of intermittent fevers accompanied byperiods of tachycardia (Figure 2). The patient continued to report a nonproductive cough and appeared fatigued. On the afternoon of hospital day 2, the patient passed a loose bowel movement and reported abdominal discomfort. A second episode of loose stool was reported overnight; a sample of this stool was collected for rRT-PCR testing, along with additional respiratory specimens (nasopharyngeal and oropharyngeal) and serum. The stool and both respiratory specimens later tested positive by rRT-PCR for2019-nCoV, whereas the serum remained negative.

在住院的第2至5天（疾病的第6至9天），患者的生命体征基本保持稳定，除了出现间歇性发热并伴有心动过速（图2）。病人继续报告说他咳嗽无好转，看上去很疲倦。住院第2天下午，病人排便不畅，腹部不适。第二次出现的大便稀薄；收集大便样本进行rRT-PCR检测，同时收集额外的呼吸样本（鼻咽和口咽）和血清。粪便和两个呼吸道标本后来用rRT-PCR对2019-nCoV检测呈阳性，而血清仍然呈阴性。

Treatment during this time was largely supportive. For symptom management, the patient received, as needed, antipyretic therapy consisting of 650mg of acetaminophen every 4 hours and 600mg of ibuprofen every 6 hours. He also received 600mg of guaifenesin for his continued cough and approximately 6 liters of normal saline over the first 6 days of hospitalization.

这段时间的治疗基本上是支持性的。对症治疗，患者根据需要接受退热治疗，包括每4小时650mg对乙酰氨基酚和每6小时600mg布洛芬。他还接受了600mg的愈创木酚素治疗持续咳嗽，在住院的头6天大约6升的生理盐水。 

The nature of the patient isolationunit permitted only point-of-care laboratory testing initially; complete blood counts and serum chemical studies were available starting on hospital day 3. Laboratory results on hospital days 3 and 5 (illness days 7 and 9) reflected leukopenia, mild thrombocytopenia, and elevated levels of creatine kinase (Table 1). Inaddition, there were alterations in hepatic function measures: levels of alkaline phosphatase (68 U per liter), alanine aminotransferase (105 U perliter), aspartate aminotransferase (77 U per liter), and lactate dehydrogenase(465 U per liter) were all elevated on day 5 of hospitalization. Given the patient's recurrent fevers, blood cultures were obtained on day 4; these have shown no growth to date.

患者隔离单元的性质最初只允许进行床旁测试；全血细胞计数和血清化学研究从第3天开始。住院第3天和第5天（疾病第7天和第9天）的实验室结果反映了白细胞减少、轻度血小板减少和肌酸激酶水平升高（表1）。此外，肝功能指标也有变化：住院第5天，碱性磷酸酶（68u/L）、丙氨酸转氨酶（105u/L）、天冬氨酸转氨酶（77u/L）和乳酸脱氢酶（465u/L）均升高。考虑到病人反复发烧，在第4天进行了血液培养；到目前为止，没有任何生长。 

A chest radiograph taken on hospitalday 3 (illness day 7) was reported as showing no evidence of infiltrates orabnormalities (Figure 3). However, a second chest radiograph from the night of hospital day 5 (illnessday 9) showed evidence of pneumonia in the lower lobe of the left lung (Figure 4).These radiographic findings coincided with a change in respiratory statusstarting on the evening of hospital day 5, when the patient's oxygen saturationvalues as measured by pulse oximetry dropped to as low as 90% while he was breathing ambient air. On day 6, the patient was started on supplemental oxygen, delivered by nasal cannula at 2 liters per minute. Given the changing clinical presentation and concern about hospital-acquired pneumonia, treatmentwith vancomycin (a 1750-mg loading dose followed by 1 g administered intravenouslyevery 8 hours) and cefepime (administered intravenously every 8 hours) wasinitiated.

在医院第3天（疾病第7天）拍摄的胸片显示没有炎症或异常的迹象（图3）。然而，第5天晚上（第9天）的第二次胸片显示左肺下叶有肺炎迹象（图4）。当患者呼吸环境空气时，指脉氧下降到低至90%，胸片结果与呼吸状况的变化一致。在第6天，患者开始吸氧，以每分钟2升的速度通过鼻导管输送。考虑到临床表现的变化和对医院获得性肺炎的关注，开始用万古霉素（1750mg负荷量，然后每8小时静脉注射1g）和头孢吡肟（每8小时静脉注射一次）进行治疗。

On hospital day 6 (illness day 10), a fourth chest radiograph showed basilar streaky opacities in both lungs, a finding consistent with atypical pneumonia (Figure 5), and rales were noted in both lungson auscultation. Given the radiographic findings, the decision to administer oxygen supplementation, the patient's ongoing fevers, the persistent positive 2019-nCoV RNA at multiple sites, and published reports of the develop-ment of severe pneumonia3,4 at a period consistent with the development of radiographic pneumonia in thispatient, clinicians pursued compassion-ate use of an investigational antiviraltherapy. Treatment with intravenous remdesivir (a novel nucleotide analogueprodrug in develop-ment) was initiated on the evening of day 7, and no adverse events were observed inassociation with the infusion. Vancomycin was discontinued on the evening ofday 7, and cefepime was discontinued on the following day, after serialnegative procalcitonin levels and negative nasal PCR testing formethicillin-resistant Staphylococcus aureus.

在住院第6天（疾病第10天），第四次胸片显示两肺基底层条纹状混浊，这一发现与非典型肺炎（图5）一致，听诊时发现两肺有罗音。鉴于放射学检查结果，决定给病人吸氧，病人持续发烧，多个部位2019nCoV RNA呈持续阳性，并公布了严重肺炎的发展报告，该时期与该病人的放射学肺炎发展一致，临床医生寻求富有同情心的使用研究抗病毒治疗。在第7天晚上开始静脉注射remdesivir（一种新开发的核苷酸类似物前药），没有观察到与输液相关的不良事件。在对耐甲氧西林金黄色葡萄球菌进行连续的降钙素原阴性和鼻腔PCR阴性检测后，万古霉素于第7天晚上停用，头孢吡肟于第二天停用。

On hospital day 8 (illness day 12), the patient’s clinical condition improved.Supplemental oxygen was discontinued, and his oxygen saturation values improvedto 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptomshave resolved with the exception of his cough, which is decreasing in severity.

在住院第8天（病患第12天），患者的临床状况有所改善。停止吸氧，当他呼吸环境空气时，他的血氧饱和度值提高到94%到96%。以前的双肺下叶罗音不再出现，食欲有所改善，除了间歇性干咳和流鼻涕外，无任何症状。截至2020年1月30日，患者仍在住院治疗。未发烧，除咳嗽外，其他症状均消失，咳嗽的严重程度正在减轻。

Methods方法

SPECIMENCOLLECTION 标本采集

Clinical specimens for 2019-nCoV diagnostic testing were obtained in accordance with CDC guidelines.12 Nasopharyngeal and oropharyngeal swab specimens were collected with synthetic fiber swabs; each swab was inserted into a separate sterile tube containing 2 to 3 ml of viral transport medium. Serum was collected in a serum separator tube and then centrifuged in accordance with CDC guidelines. The urine and stool specimens were each collected in sterilespecimen containers. Specimens were stored between 2°C and 8°C until ready forshipment to the CDC. Specimens for repeat 2019-nCoV testing were collected onillness days 7, 11, and 12 and included nasopharyngeal and oropharyngeal swabs,serum, and urine and stool samples.

根据CDC指南采集了2019-nCoV诊断试验的临床样本。12份鼻咽和口咽拭子样本用合成纤维拭子采集；每个拭子插入含有2-3ml病毒传输介质的单独无菌管中。在血清分离管中收集血清，然后按照CDC指南离心。尿液和粪便标本均收集在无菌标本容器中。标本保存在2°C到8°C之间，直到准备好运往疾病预防控制中心。在疾病第7、11和12天收集用于重复2019-nCoV检测的样本，包括鼻咽和口咽拭子、血清、尿液和粪便样本。

DIAGNOSTICTESTING FOR 2019-NCOV

2019-NCOV诊断检验

临床标本用从公开发布的病毒序列设计而来的rRT-PCR检测。与以往严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV）的诊断试验相似，它有三个核衣壳基因靶点和一个阳性对照靶点。该分析的描述和rRT-PCR面板引物和probes14的序列信息可在疾病预防控制中心2019年nCoV实验室信息网站上获得。 

GENETICSEQUENCING 基因测序

On January 7, 2020, Chinese researchers shared the full geneticsequence of 2019-nCoV through the National Institutes of Health GenBank database16 and the Global Initiative on Sharing All InfluenzaData (GISAID)17 database; a report about the isolation of 2019-nCoVwas later published.18 Nucleic acid was extracted from rRT-PCR–positivespecimens (oropharyngeal and nasopharyngeal) and used for whole-genome-sequencing on both Sanger and next-generation sequencing platforms (Illuminaand MinIon). Sequence assembly was completed with the use of Sequenchersoftware, version 5.4.6 (Sanger); minimap software, version 2.17 (MinIon); and freebayes software, version 1.3.1 (MiSeq). Complete genomes were compared withthe available 2019-nCoV reference sequence (GenBank accession numberNC_045512.2).

2020年1月7日，中国研究人员通过国家卫生研究院GenBank数据库16和全球共享流感数据倡议（GISAID）数据库共享了2019-nCoV的完整基因序列；随后发表了一份关于2019-nCoV分离的报告。核酸从rRT-PCR阳性标本中提取（口咽和鼻咽）并用于Sanger和下一代测序平台（Illumina和MinIon）上的全基因组测序。使用Sequencher软件5.4.6版（Sanger）、minimap软件2.17版（MinIon）和freebayes软件1.3.1版（MiSeq）完成序列组装。将完整基因组与2019年可用的nCoV参考序列（GenBank登录号NC_045512.2）进行比较。 

Results结果

SPECIMENTESTING FOR 2019-NCOV

2019-NCOV标本检测

The initial respiratory specimens (nasopharyngeal and oropharyngeal swabs) obtained from this patient on day 4 of his illness were positive for 2019-nCoV (Table 2). The low cycle threshold (Ct) values (18 to 20 in nasopharyngeal specimens and 21 to 22 inoropharyngeal specimens) on illness day 4 suggest high levels of virus in these specimens, despite the patient's initial mild symptom presentation. Both upper respiratory specimens obtained on illness day 7 remained positive for 2019-nCoV, including persistent high levels in a nasopharyngeal swab specimen (Ctvalues, 23 to 24). Stool obtained on illness day 7 was also positive for2019-nCoV (Ct values, 36 to 38). Serum specimens for both collection dates werenegative for 2019-nCoV. Nasopharyngeal and oropharyngeal specimens obtained onillness days 11 and 12 showed a trend toward decreasing levels of virus. The oropharyngeal specimen tested negative for 2019-nCoV on illness day 12. The rRT-PCR results for serum obtained on these dates are still pending.

患者发病第4天获得的初始呼吸样本（鼻咽和口咽拭子）对2019-nCoV呈阳性（表2）。发病第4天的低循环阈值（鼻咽标本18到20，口咽标本21到22）表明，尽管患者最初症状轻微，但这些标本中的病毒水平较高。在疾病第7天获得的两个上呼吸道样本2019-nCoV均保持阳性，包括鼻咽拭子样本中的持续高水平（Ct值，23至24）。疾病第7天获得的粪便也呈2019-nCoV阳性（Ct值，36至38）。两个采集日期的血清样本均为2019-nCoV阴性。在发病第11天和第12天获得的鼻咽和口咽标本显示出病毒水平下降的趋势。口咽标本在发病第12天检测到2019-nCoV呈阴性。在这些日期获得的血清的rRT-PCR结果仍有待确定。 

GENETICSEQUENCING 基因测序

The full genome sequences from oropharyngeal and nasopharyngeal specimens were identical to one another and were nearly identical to other available 2019-nCoV sequences. There were only 3 nucleotides and 1 amino acidthat differed at open reading frame 8 between this patient's virus and the 2019-nCoV reference sequence (NC_045512.2). The sequence is available through GenBank(accession number MN985325).16

口咽和鼻咽标本的全基因组序列彼此相同，几乎与其他目前2019-nCoV序列相同。只有3个核苷酸和1个氨基酸在该患者的病毒和2019年nCoV参考序列（NC_045512.2）的开放阅读框8处不同。序列可通过GenBank（登录号MN985325）获得。 

DISCUSSION讨论

Our report of the first confirmed case of 2019-nCoV in the United States illustrates several aspects of this emerging outbreak that are not yet fully understood, including transmission dynamics and the full spectrumof clinical illness. Our case patient had traveled to Wuhan, China, but reported that he had not visited the wholesale seafood market or health care facilities or had any sick contacts during his stay in Wuhan. Although thesource of his 2019-nCoV infection is unknown, evidence of person-to-person transmission has been published. Through January 30, 2020, no secondary casesof 2019-nCoV related to this case have been identified, but monitoring of close contacts continues.19

我们对美国第1例2019-nCoV确诊病例的报告说明了这一新爆发的几个方面，包括传播动力学和临床疾病的全谱尚不完全了解。我们的病例患者曾前往中国武汉，但报告说，他在武汉期间没有去过海鲜批发市场或保健设施，也没有任何生病的接触者。尽管他2019-nCoV感染来源不明，但已公布了人与人之间传播的证据。截至2020年1月30日，未发现与本案有关的2019-nCoV二级案件，但密切接触的监测仍在继续。 

Detection of 2019-nCoV RNA in specimens from the upperrespiratory tract with low Ct values on day 4 and day 7 of illness is suggestive of high viral loads and potential for transmissibility. It is notable that we also detected 2019-nCoV RNA in a stool specimen collected onday 7 of the patient's illness. Although serum specimens from our case patientwere repeatedly negative for 2019-nCoV, viral RNA has been detected in blood inseverely ill patients in China.4 However, extrapulmonary detection of viral RNA does not necessarily mean that infectious virus is present, and the clinical significance of the detection of viral RNA outside the respiratory tract is unknown at this time.

在发病的第4天和第7天，在Ct值较低的上呼吸道样本中检测到2019-nCoV RNA，表明病毒载量高，且传播潜力大。值得注意的是，我们还在患者发病第7天收集的粪便样本中检测到2019-nCoVRNA。尽管我们病例患者的血清标本在2019-nCoV中多次呈阴性，但在中国的重病患者血液中已检测到病毒RNA。然而，肺外检测到病毒RNA并不一定意味着存在感染性病毒，而检测呼吸道外病毒RNA的临床意义目前尚不清楚。 

Currently, our understanding of the clinical spectrum of 2019-nCoV infection is very limited. Complications such as severe pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), and cardiacinjury, including fatal outcomes, have been reported in China. However, it is important to note that these caseswere identified on the basis of their pneumonia diagnosis and thus may biasreporting toward more severe outcomes.

目前，我们对2019-nCoV感染临床谱的了解非常有限。严重肺炎、呼吸衰竭、急性呼吸窘迫综合征（ARDS）和心脏损伤等并发症，包括死亡结局，在中国已有报道，值得注意的是，这些病例是根据肺炎诊断确定的，因此可能会偏向于更严重的结果。 

Our case patient initially presented with mild cough and low-grade intermittent fevers, without evidence of pneumonia on chest radiography on day 4 of his illness, before having progression to pneumonia by illness day 9. These nonspecific signs and symptoms of mild illness early inthe clinical course of 2019-nCoV infection may be indistinguishable clinically from many other common infectious diseases, particularly during the winter respiratory virus season. In addition, the timing of our case patient’sprogression to pneumonia on day 9 of illness is consistent with later onset of dyspnea (at a median of 8 days from onset) reported in a recent publication.4 Although a decision to administer remdesivir for compassionate use was based on the case patient's worsening clinical status, randomized controlled trials are needed to determine the safety and efficacy ofremdesivir and any other investigational agents for treatment of patients with 2019-nCoV infection.

我们的病例患者最初表现为轻度咳嗽和低度间歇性发热，在发病的第4天胸片上没有肺炎的迹象，然后在第9天进展为肺炎。在2019-nCoV感染的临床早期，这些非特异性的症状和体征可能在临床上与许多其他常见传染病难以区分，特别是在冬季呼吸道病毒季节。此外，我们的病例患者在发病第9天进展为肺炎的时间与最近一份出版物中报告的晚发呼吸困难（发病后8天的中位数）相一致。尽管决定给予remdesivir用于同情性使用是基于病例患者恶化的临床状态，需要进行随机对照试验，以确定remdesivir和任何其他研究药物治疗2019-nCoV感染患者的安全性和有效性。 

We report the clinical features of the first reported patient with 2019-nCoV infection in the United States. Key aspects of this case included the decisionmade by the patient to seek medical attention after reading public health warnings about the outbreak; recognition of the patient's recent travel historyto Wuhan by local providers, with subsequent coordination among local, state,and federal public health officials; and identification of possible 2019-nCoV infection, which allowed for prompt isolation of the patient and subsequent laboratory confirmation of 2019-nCoV, as well as for admission of the patientfor further evaluation and management. This case report highlights theimportance of clinicians eliciting a recent history of travel or exposure tosick contacts in any patient presenting for medical care with acute illnesssymptoms, in order to ensure appropriate identification and prompt isolation ofpatients who may be at risk for 2019-nCoV infection and to help reduce further transmission. Finally, this report highlights the need to determine the fullspectrum and natural history of clinical disease, pathogenesis, and duration ofviral shedding associated with 2019-nCoV infection to inform clinical management and public health decision making.

我们报告了美国第1例的2019-nCoV感染患者的临床特征。该病例的主要方面包括：患者在阅读了有关疫情的公共卫生警告后决定寻求医疗救助；当地医疗机构确认患者最近到武汉的旅行记录，随后在当地、州和联邦公共卫生官员之间进行协调；以及确定可能的2019-nCoV感染，允许立即隔离患者，随后实验室确认2019-nCoV，并允许患者入院接受进一步评估和管理。本病例报告强调了临床医生在任何出现急性疾病症状的医疗护理患者中获取最近旅行或接触病患接触史的重要性，以确保适当识别和及时隔离可能有2019-nCoV感染风险的患者，并帮助减少进一步传播。最后，本报告强调需要确定与2019-nCoV感染相关的临床疾病、发病机制和病毒脱落持续时间的全面情况和自然史，以便为临床管理和公共卫生决策提供信息。

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Controland Prevention.

本报告中的发现和结论是作者的发现和结论，不一定代表疾病预防控制中心的官方立场。

This article was published on January 31, 2020, at NEJM.org.

本文于2020年1月31日在NEJM.org上发表。 

我们感谢病人；为病人提供护理的护士和临床工作人员；地方和州卫生部门的工作人员；华盛顿州卫生部公共卫生实验室和病毒病实验室疾病控制和预防中心（CDC）部门的工作人员；紧急行动中心的疾控中心工作人员；以及地方、州和国家各级2019-nCoV响应小组的成员。

文献来源：DOI:10.1056/NEJMoa2001191

编译丨海南医学院第一附属医院内分泌科王新军 

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