ABSTRACT
Context: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. A small proportion of COVID patients are positive for SARS-CoV-2 for long time. We report a COVID-19 patient with prolonged presence of SARS-CoV-2 RNA. Objective: In this study we evaluate the unexpected evolution of patients with CLL diagnosed with COVID-19. Design and Setting: We have a prospective study that included all CLL patients admitted in the Hematology Department of Colentina Clinical Hospital, during April-June 2020. Patients or other participants: The study group included 3 CLL patients. All patients were SARS-CoV-2 positive by molecular test. Results: 1st patient: A 53-year-old male diagnosed with COVID on 25th March, 2020, at the onset presented fever, headache, and associated anal abscess. The patient had a history of diabetes mellitus and CLL (starting 2014). The CLL patient was monitored as a “watch and wait” patient until 2019 when started on Ibrutinib (was stopped on 16th March, 2020). He received antiviral+hydroxychloroquine associated with antibiotics Piperacilin/Tazobactam and Linezolid with favourable evolution and resolution of anal abscess. During surgical monitoring (week 3), patient presented fever, chills, cough and dyspnea. CT scan revealed bilateral COVID pneumonia and associated Klebsiella pneumonie infection in sputum by Biofire exam. Antibiotics treatment (Vancomycin, Colimicin, and Meropenem), antifungal treatment (Caspofungin), and Tocilizumab 640 mg was started with favourable evolution but patient is still SARS-CoV-2-positive (50 days). The long-time of positive SARS-CoV-2 status although the patient received COVID treatment including Tocilizumab is not an usual evolution for COVID patient 2nd and 3rd patients watch and wait CLL patients with positive SARS-CoV-2 test and ongoing evolution during 2 weeks. Compared with the rest of patients, including AML or MPN patients (negativity of SARS-CoV-2 test was obtained in maximum 2 weeks), CLL patients had long evolution. Conclusions: These cases suggest that a small proportion of COVID patients like CLL patients may have prolonged positivity for SARS-CoV-2 RNA although the evolution is not severe.
ABSTRACT
Context: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. Severity of this disease is associated with comorbidities present (hypertension, obesity, pulmonary disease) or with age. Objective: In this study, we evaluate haematological and biochemistry parameters in order to obtain indications for unfavourable evolution of the patient. Design and Setting: We performed a prospective study that included all patients admitted in our hospital in Hematology, Pneumology, and ICU at Department Colentina Clinical Hospital during April and May 2020. Patients or other participants: The study group included 80 patients that was split into ICU and non-ICU patients. All patients were SARS-CoV-2-positive by molecular test. The distribution according to gender was: 47 male with median age: 73 (min 35, max 88) and 33 female with median age: 50 (min 17, max 84). Results: Age is an important risk factor for the severity, as the median age of patients admitted in ICU was 73 (min 43, max 88) compared with non-ICU patients 41 (min 17, max 64), p=0.00004. Comorbidities associated were important but were present in both groups. In ICU patients, we obtained lower level of lymphocytes compared with non ICU group median: 0.87× 103/L (min 0.09 × 103/L max 7.04 × 103/L) vs 2.17 × 103/L (min 0.19 × 103/L max 3.28 × 103/L), p=0.01. There are no significant differences between groups for the rest of haematological parameters. The biochemistry markers ferritin, AST, ALT, LDH, and D Dimers are important in evaluation of COVID-19 patients;there are statistical differences between ICU and non ICU patients (median value: LDH 405.5 UI/l vs 215 U/l, p=0.001;ferritin 1275 ng/ml vs. 161 ng/ml, p=0.002;D Dimers 2.61 mg/ml FEU vs 0.39 mg/ml FEU, p=0.002;AST 70.9 U/l vs. 19.9 U/l, p=0.0003;ALT 50.05 U/l vs. 18.5 U/l, p=0.009). The ICU patients with unfavourable evolution had a higher level of D-Dimers at the admission in hospital compared with ICU patients who was discharged from the hospital (3.42 mg/ml FEU vs 1.09 mg/ml FEU, p=0.01). We did not obtain statistical significance between ICU groups for all haematological and biochemistry parameters. Conclusions: We conclude that lymphocyte count, LDH, AST, ALT, and ferritin at the time of hospital admission is important to evaluate in COVID-19 patient in order to expect a severe evolution of the disease. D-Dimer should be an important parameter to evaluate for all COVID-19 patients. Anti-thrombotic therapy is important to be introduced in COVID-19 patients.