Severe COVID-19 in 2 Kidney Transplant Patients in Gabon.

BACKGROUND Kidney failure is a public health problem that may require transplantation for patient survival and for those at risk of developing infectious diseases such as COVID-19 due to severe immunosuppression. We report the case of 2 kidney transplant patients who contracted COVID-19. CASE REPORT Patient 1: A 60-year-old Gabonese man presented with 8 days of wet cough, fever, and myalgias associated secondarily with dyspnea, without anosmia or ageusia. His medical history included renal transplant for malignant nephro-angiosclerosis and high blood pressure. The oxygen saturation level subsequently fell to 89-90%. The diagnosis of acute hypoxic respiratory failure secondary to COVID-19 pneumonia with heart and acute renal failure on renal transplant was made based on clinical symptoms, lung imaging results, and a positive SARS-CoV-2 nasal swab PCR test. Patient 2: A 79-year-old Gabonese man presented with 10 days of dry cough associated with intermittent fevers not quantified, anorexia, and fatigue. The patient's medical history was high blood pressure, diabetes mellitus, and renal transplantation. Oxygen saturation level decreased to 85-89% in ambient air. Clinical signs and chest CT scan showed 70% lung lesions with large areas of ground-glass opacity with essentially peripheral distribution of both lungs associated with crazy paving, condensation, bronchiectasis, and arterial dilatation, suggesting severe COVID-19. CONCLUSIONS Those 2 presentations highlight the fact that a severe clinical form of COVID-19 associated with acute renal failure and kidney transplant can be fatal. Kidney transplantation is a risk factor for poor prognosis in patients with severe COVID-19 and greatly worsens the mortality rate of immunocompromised patients.

Biochemical and hematological factors associated with COVID-19 severity among Gabonese patients: A retrospective cohort study.

The COVID-19 disease presents a large range of clinical manifestations and includes asymptomatic, mild, and severe cases. The level of severity is related to parameters associated with immunity, genetics, and biochemistry. Africa shows one of the lowest COVID-19 fatality rates but very few data on the biochemical markers of COVID-19 in patients and the factors associated with disease severity are available for the continent. In Gabon, the COVID-19 fatality rate is only 0.63% but almost no data on biomarkers in COVID-19 patients have been published. Both the number of COVID-19 cases and the mortality rate reported in Africa in general, and in Gabon in particular, are lower than in non-African countries. As such, understanding the factors associated with disease severity in Gabonese patients is a crucial step to better understand the disease in the African context and prepare for future COVID-19 waves and other epidemics of emerging diseases. Here, we compared biochemical and hematological markers among 753 Gabonese COVID-19 patients with asymptomatic (184/753), mild/moderate (420/753), and severe/critical (149/753) forms of the disease using an Analysis of Variance (ANOVA) or a Kruskal-Wallis (KW) test. We modeled these parameters together with comorbidities, age, and sex to predict factors associated with disease severity by using a "binomial generalized linear model" utilizing the "package" stats of R software version 4.0.2. Our results showed that almost all the biochemical and hematological parameters (except creatinine, phosphorus, D-dimers, platelets, and monocytes) varied according to disease severity. However, age and the dysfunction of organs like the kidney, liver, and lung together with the decrease of electrolytes (chloride, potassium, and sodium) are the best predictors of disease severity in Gabonese patients.