ABSTRACT
COVID-19 continues to spread across the world with more than 60 million confirmed cases in 220 countries. Since March 11, 2020 WHO announced the COVID-19 outbreak as a pandemic. Impacts caused by COVID-19 are not only on the health sector but also economic social and political sectors. In a diagnosing process the SARS-CoV-2 PCR results for swab specimen are a gold standard in determining confirmed COVID-19 cases. Previously 2 repeated results of negative SARS-CoV-2 PCR become criteria of being recovered from COVID-19. Therefore, based on the latest guidelines from the Indonesian Ministry of Health revised on July 13th, 2020 patients with no symptoms mild to moderate symptoms and severe symptoms are declared to be recovered if the patients meet the requirements of finished periods of isolation based on a doctor’s assessment. Confirmed cases with severe or critical symptoms are specially declared with one negative result of the PCR test plus three days without showing any symptoms. This case study discussed a 52-years-old woman diagnosed with COVID-19. PCR test for this patient had been conducted 11 times during 64 days of treatment and its results turned to be always positive failing to fulfil the discharge criteria. Therefore, it needs to determine causes of prolonged positive PCR results and impacts of clinical condition of the patients and prognosis of the patients.
ABSTRACT
BACKGROUND: Severe acute respiratory infection (SARI) accounts for a large burden of illness in Indonesia. However, epidemiology of SARI in tertiary hospitals in Indonesia is unknown. This study sought to assess the burden, clinical characteristics, and etiologies of SARI and concordance of clinical diagnosis with confirmed etiology. METHODS: Data and samples were collected from subjects presenting with SARI as part of the acute febrile Illness requiring hospitalization study (AFIRE). In tertiary hospitals, clinical diagnosis was ascertained from chart review. Samples were analyzed to determine the "true" etiology of SARI at hospitals and Indonesia Research Partnership on Infectious Diseases (INA-RESPOND) laboratory. Distribution and characteristics of SARI by true etiology and accuracy of clinical diagnosis were assessed. RESULTS: Four hundred and twenty of 1464 AFIRE subjects presented with SARI; etiology was identified in 242 (57.6%), including 121 (28.8%) viruses and bacteria associated with systemic infections, 70 (16.7%) respiratory bacteria and viruses other than influenza virus, and 51 (12.1%) influenza virus cases. None of these influenza patients were accurately diagnosed as having influenza during hospitalization. CONCLUSIONS: Influenza was misdiagnosed among all patients presenting with SARI to Indonesian tertiary hospitals in the AFIRE study. Diagnostic approaches and empiric management should be guided by known epidemiology. Public health strategies to address the high burden of influenza should include broad implementation of SARI screening, vaccination programs, clinician education and awareness campaigns, improved diagnostic capacity, and support for effective point-of-care tests.