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The teams of the Infectious and Tropical Diseases Hospital Bichat AP-HP and the University Hospital of Bordeaux, in collaboration with researchers from University of Paris, Inserm IAME UMRS-1137 (University of Paris / INSERM / University Sorbonne Paris Nord), the Institut Pasteur, the Hospices Civils de Lyon, CNRS – UMR 5308, Ecole Normale Supérieure de Lyon and University Claude Bernard Lyon, published a study based on the monitoring of the first five patients diagnosed Covid-19, admitted to Bichat hospital and the University hospital of Bordeaux. Despite the very limited number of patients, the work carried out, which were the subject of a publication March 27, 2020  in The Lancet  Infectious Diseases , have identified three very different types of clinical presentations.

This work aimed to evaluate clinical disease models and viral load from different nasopharyngeal samples of blood, urine and feces that were obtained once a day for three days from admission to hospital, and once every two or three days until the patient is discharged. All samples were refrigerated and shipped in the National Center laboratory virus respiratory infections Reference (Institut Pasteur and Hospices Civils de Lyon), where RNA extraction, real-time RT-PCR were performed to quantifications and for the isolation and sequencing of the virus. These analyzes were conducted on 5 patients initially detected by the Pasteur Institute, three men (aged 31, 48 and 80) and two women (aged 30 years and 46 years)

This work has identified three very different types of clinical presentations:

– The first is a clinical presentation frustrating, very few symptoms with rapidly favorable spontaneous evolution despite the strong presence of SARS-CoV virus-2 in nasopharyngeal early in the disease.  

– The second type of presentation is biphasic with a reassuring initial phase and a secondary aggravation approximately 10 days after the onset of the disease despite a decrease in viral load during this period in nasopharyngeal samples.  

– The third type is a serious presentation outset rapidly evolving to multiple organ failure with persistent high viral load in the lower respiratory tract and upper and virus detection in plasma.

These three clinical-virological phenotypes appeared in profiles distinct patient enough, shape frustrated in both patients, the two-phase form in both young patients and the severe form immediately in the elderly. The clinical and virological confrontations do not seem correlated; spontaneous clearance of virus in 10 days for forms frustrated, worsening symptoms of secondary unrelated to the virus, prolonged persistence of viral shedding for severe forms of comorbid field.

“Despite the passage of time and events have passed since the first description of these cases, the classification of different clinical presentations seems to be confirmed through clinical experience of the epidemic phase. It seems interesting to better understand the natural history of the disease Covid-19 and contribute to the therapeutic management for each situation. It suggests that the vast majority of patients do not need treatment. It illustrates the need to rapidly identify patients that could worsen secondarily based on a particular field (the male gender seems to be confirmed as a risk factor of gravity) and early markers of more inflammatory than virological detection elsewhere. “says Professor Xavier Lescure first author of the study and Assistant Professor Yazdan Yazdanpanah, head of infectious diseases and tropical Bichat Hospital, and last author of the study initiated under the Reacting network, both members of Inserm team IAME UMRS 1137 (University of Paris / Inserm / Université Sorbonne Paris North).

If these works bring us many indications, no conclusions can be drawn directly from the work therapeutically. 

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