ABSTRACT
Background: Growing evidence shows that viral co-infection is found repeatedly in patients with Coronavirus Disease-2019 (COVID-19). This is the first report of SARS-CoV-2 co-infection with viral respiratory pathogens in Indonesia. Methods: Over a one month period of April to May 2020, SARS-CoV-2 positive nasopharyngeal swabs in our COVID-19 referral laboratory in Yogyakarta, Indonesia, were tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR). Proportion of co-infection reported in percentage. Results: Fifty-nine samples were positive for other viral respiratory pathogens among a total of 125 samples. Influenza A virus was detected in 32 samples, Influenza B in 16 samples, Human metapneumovirus in 1 sample, and adenovirus in 10 samples. We did not detect any co-infection with respiratory syncytial virus. Nine (7.2%) patients had co-infection with more than two viruses. Conclusion: Viral co-infection with SARS-CoV-2 is common. These results will provide a helpful reference for diagnosis and clinical treatment of patients with COVID-19.
ABSTRACT
INTRODUCTION: and importance: A common gastrointestinal presentation of both COVID-19 and multisystem inflammatory syndrome in children (MIS-C) is acute abdominal pain, which sometimes mimics appendicitis. Literature describing children with COVID-19 infection and concurrent acute appendicitis is growing, and understanding these patients' clinical picture is necessary for their proper treatment. CASE PRESENTATION: We present a case series of six healthy children before they developed classic symptoms of appendicitis. At the same time, they were also found to have confirmed COVID-19. All patients had fever and right lower abdominal pain. Four of six children having Alvarado score above seven had surgical treatment, while the others only received systemic antibiotic and antiviral medication. Surgical results of two patients revealed perforated appendicitis. No mortality occurred among them. CLINICAL DISCUSSION: There is increasing recognition of gastrointestinal involvement in patients with COVID-19 and MIS-C. There are several postulates to explain appendicitis in COVID-19. First, inflammatory response is exaggerated in SARS-CoV-2 infected patients. Second, obstruction of the appendiceal lumen is caused by mesenteric adenopathy, which in turn, is caused by COVID-19 infection, not fecalith. Third, hyperinflammatory response in MIS-C triggers inflammation in appendix. CONCLUSION: Clinicians must recognize that abdominal pain with fever could be the presenting symptoms of COVID-19 with MIS-C. MIS-C, which has severe presentations with gastrointestinal manifestations and high mortality rate, should be considered as a differential diagnosis for a patient with appendicitis-like symptoms and a positive SARS-CoV-2 infection.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness. But there are few studies that explain the clinical features of COVID-19 patients with active primary tuberculosis. In a low-resource setting, it is difficult to distinguish the clinical characteristics of COVID-19 from other respiratory diseases. Here, we briefly report the first case of COVID-19 with active primary tuberculosis in our low-resource institution. CASE PRESENTATION: A fourty two year old diabetic Indonesian male was admitted to emergency department in November 2020 due to vertigo-like dizzines for one week, tension type headache, shivering, cough with sputum, abdominal pain, and night sweats. Xpert MTB-RIF Assay G4 detect Mycobacterium Tuberculosis Bacteria (MTB) without rifampicin resistance, but the Tubex test for antibody IgM anti-O9 was negative. Patient admitted to isolation ward for suspected COVID-19 with separate rooms due to tuberculosis, until 24 hours evaluation of nasopharyng and oropharyng swab test performed. On the second day, the evaluation swab test was positive for COVID-19. CLINICAL DISCUSSION: Limited or no protection against COVID-19 is one of the problems that leads to co-infection. Now, there is no recommendation treatment for COVID-19 sufferer with tuberculosis co-infection or vice versa. Ventilation support and intensive care for infectious patient must be accessible, yet still unavailable in our institution. CONCLUSION: A low resource setting has its own challenges in handling COVID-19. Further studies are needed to address the clinical characteristics, diagnosis and management in COVID-19 patients with active tuberculosis.