ABSTRACT
Covid-19 associated pulmonary aspergillosis (CAPA) is a new entity and is associated with high morbidity and mortality. Covid-19 is a pro-inflammatory and immunosuppressive disease, provoking fungal infections, especially by Aspergillus species. We describe the case of a critically ill Covid-19 female patient, who was diagnosed with CAPA infection and acute respiratory distress syndrome (ARDS). She was given intravenous Remdesivir. Her chest X-ray a few days after admission showed multiple cavities. Her condition initially improved but deteriorated again, with worsening hypoxia and pneumothorax and multiple cavitary lesions on HRCT of the chest. Despite optimal treatment, she could not recover. Interestingly, she had no predisposing risk factor for pulmonary aspergillosis, such as chronic lung disease, diabetes or use of immunosuppressants such as Tocilizumab. CAPA is an emerging entity with worsening hypoxia, and failure to improve can be an early sign. Early identification and treatment can improve survival and outcomes in Covid-19 patients.
Subject(s)
COVID-19 , Pneumonia , Pulmonary Aspergillosis , Humans , Female , COVID-19/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/diagnostic imaging , Administration, Intravenous , Hypoxia , Immunosuppressive Agents/therapeutic useABSTRACT
BACKGROUND: Coronavirus disease 19 (COVID-19) is a viral disease caused by SARS-CoV-2. There is an increased incidence of a thromboembolic phenomenon in patients with COVID-19 infection. Pulmonary embolism is the most common thrombotic presentation in COVID-19 patients. Extra-pulmonary thrombosis is an unusual thrombotic complication of COVID-19 disease. METHODS: This study was conducted at The Aga Khan University Hospital from June-July'2021. Patients clinical and laboratory findings, treatment, and outcomes were recorded. RESULTS: We report three cases with the diagnosis of COVID-19 pneumonia associated with extra-pulmonary thrombosis from June to July 2021. The mean age of the patients were 66.3 and two of them (66.6%) were male. The diagnosis of COVID-19 was confirmed by real-time reverse transcriptase-polymerase chain reaction analysis in all the three patients. Extra-pulmonary thrombosis was identified in the celiac artery and splenic veins in case 1, left common iliac artery in case 2, and left ventricular apical thrombus in case 3. All the patients were treated with anticoagulation. In total, two patients were discharged home after total recovery, while the third patient died. CONCLUSIONS: The take-home message is that COVID-19 infection is a pro-thrombotic condition that can provoke arterial and venous thrombosis. Extra-pulmonary thrombosis is increasingly identified with COVID-19 infection. It is important to remember that the patient might have no potential risk factor for thromboses, as COVID-19 infection per se is a risk to induce thrombosis.
Subject(s)
COVID-19 , Thrombosis , Venous Thrombosis , Humans , Male , Female , COVID-19/complications , SARS-CoV-2 , Anticoagulants/therapeutic use , Venous Thrombosis/etiology , Thrombosis/etiologyABSTRACT
Objective A hospital-based cross-sectional study on COVID-19 confirmed patients was conducted at the Aga Khan University Hospital, Karachi, Pakistan, from April to June 2021. Presence of thrombosis in these patients was compared with mortality. Platelet counts and D-dimer was also compared among survivor and non-survivor to identify the marker for severity of the disease. Results Sixty-six patients were enrolled in the study and the mean age of the patients was 62.3 years and 45 patients (68.2%) were male. Pulmonary embolism was identified in 32 patients (48.5%) while non-pulmonary thrombosis occurred in 5 of the admitted patients (7.6%). In our study, mortality occurred in 34 patients (51.5%). Pulmonary embolism was identified in 20 recovered patients (62.5%) and 10 patients died (p value 0.03). Four patients (80%) with non-pulmonary thrombosis were non-survivors (p value 0.05). Median platelets were 73 in non-survivors and 109.5 in survivors (p value < 0.01). Both the groups had a median D-dimer of 3.8 (p value 0.024). Conclusion Based on our study, we conclude that COVID-19 infection has the potential to cause hypercoagulable states. It increases the risk of thrombosis and with thrombosis it has a higher mortality rate. Thrombocytopenia is a biomarker with an adverse prognosis in these patients.