information regarding corona virus

1. CORONA VIRUS
- Dr. Neha Bhosale
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2. • Introduction
• History
• Morphology
• Pathogenesis
• Clinical features
• Risk factors
• Diagnosis
• Treatment
• Precautions
• Recent advances
• References
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Contents

3. Introduction
• Corona viruses constitute the subfamily “Orthocoronavirinae”, in the
family “Coronaviridae”, order “Nidovirales”, and
kingdom “Riboviria”.
• Coronaviruses (CoV) are a large family of viruses that cause illness
ranging from the common cold to more severe diseases such as
Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute
Respiratory Syndrome (SARS-CoV).
• Coronaviruses are zoonotic, meaning they are transmitted between
animals and people.
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4. • The name coronavirus is derived from the Latin corona,
meaning "crown" or "halo", which refers to the characteristic
appearance reminiscent of a crown or a solar corona around
the virions (virus particles) when viewed under two-
dimensional transmission electron microscopy, due to the
surface covering in club-shaped protein spikes.
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5. History
5
Year Virus Reservoir Intermediat
e Host
Mortali
ty Rate
Place
2002 SARS Bat Civet Cat Human 10% Southern
China
2012 MERS Bat Camel Human 34% Saudi
Arabia
2019 COVID -
19
Bat Pangolin Human 3.7% Wuhan,
china

6. • 31st December 2019 – WHO declared Corona in China.
• 30th Jan 2020 – Declared as Emergency Outbreak
• 11th Feb 2020 – It was named as COVID-19 (Corona Virus
Disease 2019 )
• 11th March 2020 – It was declared as Pandemic by WHO
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7. Morphology
• Coronaviruses are large pleomorphic spherical particles
with bulbous surface projections.
• The diameter of the virus particles is around 120 nm.
• The envelope of the virus in electron micrographs
appears as a distinct pair of electron dense shells with
a positive-sense single-stranded RNA genome and
a nucleocapsid of helical symmetry.
• The viral envelope consists of a lipid bilayer where the
membrane (M), envelope (E) and spike (S) structural
proteins are anchored.
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8. • A subset of coronaviruses (specifically the members
of Betacoronavirus subgroup A) also have a shorter spike-
like surface protein called hemagglutinin esterase (HE).
• Inside the envelope, there is the nucleocapsid, which is
formed from multiple copies of the nucleocapsid (N)
protein, which are bound to the positive-sense single-
stranded RNA genome in a continuous beads-on-a-
string type conformation.
• The genome size for coronaviruses ranges from
approximately 27 to 34 kilobases.
• The lipid bilayer envelope, membrane proteins, and
nucleocapsid protect the virus when it is outside the host
cell.
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10. Transmission
The virus spreads through :-
1. Faecal-oral route
2. Respiratory Droplet – Spread occurs within 3-6 fts. They
stay on surfaces for 24 hrs. Potentially active for 3 hours.
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12. Clinical features
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13. • Further development can lead to severe pneumonia, acute
respiratory distress syndrome, sepsis, septic shock, and death.
• Some of those infected may be asymptomatic, returning test
results that confirm infection but show no clinical symptoms,
so researchers have issued advice that those with close contact
to confirmed infected people should be closely monitored and
examined to rule out infection.
• The usual incubation period ( the time between infection and
symptom onset) ranges from 1 to 14 days.
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14. Risk Factors
• Cardiovascular disease
• Pulmonary disease
• Diabetes mellitus type-2
• Immunosuppressed patient (Cancer)
• Mortality rate increases with age (>60 years)
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15. Diagnosis
• Rule out Influenza
• Infection by the virus can be provisionally diagnosed on the
basis of symptoms, though confirmation is ultimately
by reverse transcription polymerase chain reaction (rRT-PCR)
of infected secretions (71% sensitivity) and CT imaging (98 %
sensitivity).
• Nuclei acid amplification tests
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16. • Specimens should be collected as soon as possible once a PUI
is identified, regardless of the time of symptom onset.
• Maintain proper infection control when collecting specimens.
• Keep refrigerated (2-8 °C) if it is to be processed (or sent to a
reference laboratory) within 48 hours.
• Keep frozen (-10 to -20 °C) if it is to be processed after the
first 48 hours or within 7 days.
• Keep frozen (-70 °C) if it is to be processed after a week. The
sample can be preserved for extended
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17. • Label each specimen container with the patient’s ID
number (e.g., medical record number), unique specimen ID
(e.g., laboratory requisition number), specimen type (e.g.,
serum) and the date the sample was collected.
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20. A. Lower respiratory tract
Bronchoalveolar lavage, Tracheal aspirate
Collect 2-3 mL into a sterile, leak-proof, screw-
collection cup or sterile dry container.
Sputum
Have the patient rinse the mouth with water and
expectorate deep cough sputum directly into a
proof, screw-cap sputum collection cup or sterile
container.
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21. B. Upper respiratory tract
Nasopharyngeal swab (NP) /oropharyngeal swab (OP)
Use only synthetic fiber swabs with plastic shafts.
Do not use calcium alginate swabs or swabs with
they may contain substances that inactivate some
inhibit PCR testing.
Place swabs immediately into sterile tubes containing
viral transport media.
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22. In general Centre of disease control and prevention (CDC) is now
recommending collecting only the NP swab.
If both swabs are used, NP and OP specimens should be combined
at collection into a single vial.
Nasopharyngeal swab: Insert a swab into the nostril parallel to the
palate. Leave the swab in place for a few seconds to absorb
secretions.
Oropharyngeal swab (e.g., throat swab): Swab the posterior
pharynx, avoiding the tongue.
Nasopharyngeal wash/aspirate or nasal aspirate
Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum
collection cup or sterile dry container.
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23. • For transport of samples for viral detection, use viral
transport medium (VTM) containing antifungal and antibiotic
supplements.
• Avoid repeated freezing and thawing of specimens.
• If VTM is not available sterile saline may be used in place of
VTM (in such case, duration of sample storage at 2-8 °C).
• Aside from specific collection materials, assure other
materials and equipment are available: e.g. transport
containers and specimen collection bags and packaging,
coolers and cold packs or dry ice, sterile blood-drawing
equipment (e.g. needles, syringes and tubes), labels and
permanent markers, PPE, materials for decontamination of
surfaces etc.
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24. A BSL2 containment level is required to handle suspected
samples.
• Consider all specimens as POTENTIALLY HAZARDOUS /
INFECTIOUS.
• Handle all specimens with gloves in a secure manner.
• Place each specimen into a separate container labelled with
the patient's name and identification number, the collection
site, the date of collection and the time of the collection.
• Do not contaminate the outside of the specimen container.
• Do not handle laboratory requisition forms with gloves.
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26. • The laboratory studies showed leucopenia with leukocyte
counts of 2.91 × 10^9 cells/L of which 70.0% were
neutrophils. Lymphopenia is present in most of the cases
(80%).
• LFTs- Elevated levels of ALT, AST and bilirubin can be
present.
• Elevated levels of Blood urea nitrogen and Increased
serum creatinine levels can be present.
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27. • Increase levels of C-reactive.
• High erythrocyte sedimentation rate and D-dimer were
also observed.
• Serum Procalcitonin is normal in COVID-19. Usually
procalcitonin is raised in bacterial infections. However if
COVID-19 with superadded bacterial infection can present
with increased levels of procalcitonin.
• In case of mortality, Elevated troponins and CK-MB are
seen.
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Chest X-ray

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CT findings

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USG Findings

31. • Serology testing, ELISA antibody test kits to detect the
presence of antibodies produced by the host immune
system against the virus.
• The CDC runs two ELISA tests against two different proteins
produced by the virus.
• If either test is positive, a microneutralization assay test is
performed to confirm the positive result.
• The microneutralization assay is highly specific, but
significantly more labour and time intensive.
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32. • Since antibodies continue to circulate even after the
infection is cleared, serology tests continue to be positive for
individuals who have been previously exposed and
developed an immune response, which means a positive test
may not indicate an active infection.
• As such, the CDC is using serology antibody testing for
surveillance and investigational purposes only while the
molecular test methodologies are used to diagnosis active
infections.
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33. • Virus isolation in cell culture and initial characterization of viral
agents recovered in cultures of SARS-CoV-2 specimens are NOT
recommended at this time, except in a Biosafety Level 3 (BSL-3)
laboratory using BSL-3 work practices.
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34. Role of pathologist
• In hematology
• In Autopsy
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35. Treatment
1. Intravenous fluids sparingly –IV NS
2. Antipyretics for fever – Tylenol
3. Remdesivir –Inhibits RNA dependent RNA polymerase
enzyme
4. Choloquine – Inhibits entry of virus into the cytoplasm
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5. Ritonavir – Proteinase inhibitor
6. Tocilizumab –Blocks interleukin-6
7. Cortico-steroids – To reduce inflammation
8. In severe Acute respiratory distress syndrome, Ventilation
has to be provided.

37. Precautions
• Self quarantine
• Wash your hands with soap
• Don’t touch your eyes, nose
and mouth
• Don’t travel
• Use masks : n-95 , surgical
mass
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38. WHO Guidelines for Precautions:-
• Wash your hands frequently
• Regularly and thoroughly clean your hands with an alcohol-
based hand rub or wash them with soap and water.
• Why? Washing your hands with soap and water or using
alcohol-based hand rub kills viruses that may be on your
hands.
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39. • Avoid touching eyes, nose and mouth
• Why? Hands touch many surfaces and can pick up viruses.
Once contaminated, hands can transfer the virus to your
eyes, nose or mouth.
• From there, the virus can enter your body and can make you
sick.
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40. • Maintain social distancing
• Maintain at least 1 metre (3 feet) distance between yourself
and anyone who is coughing or sneezing.
• Why? When someone coughs or sneezes they spray small
liquid droplets from their nose or mouth which may contain
virus. If you are too close, you can breathe in the droplets,
including the COVID-19 virus if the person coughing has the
disease.
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41. • Practice respiratory hygiene
• Make sure you, and the people around you, follow good
respiratory hygiene. This means covering your mouth and
nose with your bent elbow or tissue when you cough or
sneeze. Then dispose of the used tissue immediately.
• Why? Droplets spread virus. By following good respiratory
hygiene you protect the people around you from viruses
such as cold, flu and COVID-19.
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42. • If you have fever, cough and difficulty breathing, seek medical care
early
• Stay home if you feel unwell. If you have a fever, cough and difficulty
breathing, seek medical attention and call in advance. Follow the
directions of your local health authority.
• Why? National and local authorities will have the most up to date
information on the situation in your area. Calling in advance will
allow your health care provider to quickly direct you to the right
health facility. This will also protect you and help prevent spread of
viruses and other infections.
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43. • Stay informed and follow advice given by your healthcare
provider
• Stay informed on the latest developments about COVID-19.
Follow advice given by your healthcare provider, your
national and local public health authority or your employer
on how to protect yourself and others from COVID-19.
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44. • Protection measures for persons who are in or have
recently visited (past 14 days) areas where COVID-19 is
spreading
• Follow the guidance outlined above.
• Stay at home if you begin to feel unwell, even with mild
symptoms such as headache and slight runny nose, until you
recover.
• Why? Avoiding contact with others and visits to medical
facilities will allow these facilities to operate more effectively
and help protect you and others from possible COVID-19 and
other viruses.
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47. Recent Advances
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48. Current status in india
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50. Thank you
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