The novel coronavirus (COVID-19) pneumonia with negative detection of viral ribonucleic acid from nasopharyngeal swabs: a case report

• Published in: BMC infectious diseases 2020-04, Vol.20 (1), p.317-7, Article 317
• Main Authors: Zhang, Peiyan, Cai, Zhao, Wu, Weibo, Peng, Ling, Li, Yinfeng, Chen, Chuming, Chen, Li, Li, Jianming, Cao, Mengli, Feng, Shiyan, Jiang, Xiao, Yuan, Jing, Liu, Yingxia, Yang, Liang, Wang, Fuxiang
• Format: Article
• Language: English
• Subjects: Alveoli; Antigens; Antiviral Agents - therapeutic use; Betacoronavirus; Blood; Bronchoalveolar Lavage Fluid - virology; Bronchoalveolar-lavage fluid; Bronchus; Case Report; Case reports; China; Computed tomography; Coronaviridae; Coronavirus; Coronavirus Infections - diagnosis; Coronavirus Infections - drug therapy; Coronaviruses; Cough - etiology; COVID-19; Cytomegalovirus; Diagnosis; Disease transmission; Fever; Fever - etiology; Fibrosis; Genomes; Health aspects; Hospitals; Humans; Humidification; Infectious diseases; Influenza; Interferon; Intestine; Lopinavir; Lung - diagnostic imaging; Lung diseases; Lungs; Male; Medical imaging; Microorganisms; Middle Aged; Nasopharynx - virology; Nucleic acids; Oxygen; Oxygen therapy; Pain; Pandemics; Pharmaceuticals; Pneumonia; Pneumonia, Viral - diagnosis; Pneumonia, Viral - drug therapy; Respiratory syncytial virus; Ribavirin; Ribonucleic acid; Ritonavir; RNA; RNA, Viral - isolation & purification; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Tightness; Tracheoscopy; Viral diseases
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05045-z

The novel coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, Hubei, China since Dec 2019 and cases of infection have been continuously reported in various countries. It is now clear that the SARS-COV-2 coronavirus is transmissible from human to human. Nucleic acid detection is considered as the gold standard for the diagnosis of COVID-19. In this case report, we describe our experience in detection of SARS-COV-2 from a confirmed patient using nucleic acid test of bronchoalveolar-lavage fluid (BALF) samples but not nasopharyngeal swabs. We present a case of severely ill SARS-COV-2 infected 46-year-old man with fever, coughing and chest tightness. We performed viral detection using his BALF samples and imaging method (CT) for confirmation. The patient received combination of interferonalfa-1b and ribavirin, lopinavir and ritonavir for antiviral treatment at different stages. Other medication was also given to him in combination for anti-inflammation, intestinal microbial regulation, phlegm elimination, liver protection and pulmonary fibrosis prevention purposes. We provided oxygen supply to him using BIPAP ventilator and high-flow humidification oxygen therapy instrument to facilitate respiration. The patient was cured and discharged. This case report described an effective supportive medication scheme to treat SARS-COV-2 infected patient and emphasized the necessity of detection of the viral genome using BALF samples and its significance in the diagnosis and prognosis of the disease.