ABSTRACT
Background: The Utility ofserum biomarker in the Diagnosis of COVID-19 cases has not been studied thoroughly. Aims and Objective: Tofind outthe diagnostic accuracy of serum ferritin, c-reactive protein, lactate dehydrogenase and d-dimer with RT-PCR positive moderate to severe covid-19 patients. Methods: This diagnostic accuracy study was conducted on suspected COVID-19 SARI patients and were divided into two groups based on the results of RT-PCR for COVID-19 and to minimise false-negative RT-PCR in the control group patientshaving HRCT-thorax CORADS-5 were excluded, and the accuracy of different serum biomarker in predicting cases withpositive RT-PCR was evaluated using the area under the ROC curve (AUC),In thisstudy, AUC 0.9 to 1 was defined as excellent accuracy, 0.8 to0.9 as very good, 0.7 to 0.8 as good, 0.6 to 0.7 as sufficient, 0.5to 0.6 as bad, and < 0.5 as poor(useless test). Results: 126 cases with the mean age of 47.2(range: 19- 84) years were studied (73% male). The result of RT-PCR for COVID-19 waspositive in 62(49.2%) cases. Patients with positive RT-PCR had significantly higher C-reactive protein (CRP) (p = <0.001),D-dimer (p=0.001), lactate dehydrogenase (LDH) (p = <0.001) and non-significantly Serum ferritin (p=0.188).AUC of CRP(AUC=0.832), LDH (AUC=0.809), D-Dimer (AUC=0.667) and serum ferritin(AUC=0.568). Conclusion: Our findings suggest that levelsof Serum Ferritin as bad,D-DIMER as sufficient,CRPand LDH as very good biomarker to predict the results of the COVID-19 test. CRP and LDH can help in the detection of COVID-19 patients.
ABSTRACT
Background: Fungal epidemic was announced amid COVID pandemic with several cases of COVID-associated Mucormycosis and Aspergillosis being reported however there is not sufficient data regarding mixed fungal infection. Case Study: A 54-year-old male patient diagnosed with severe COVID 19 pneumonia and diabetes 1-month back presented to OPD with C/O of chest pain and breathlessness for two days associated with haemoptysis, heaviness and congestion of right nostril but no fever. O/E patient was tachypnoeic, hypoxic and in shock, Neutrophil count 87%, RBS-530 mg/dl, urine ketone body was absent. Chest x-ray showed opacity over the left upper and mid-zone, HRCTthorax showed a bird-nest-sign noted in the left upper lobe S/O invasive fungal infection. MRI PNS showed mucosal thickening S/O sinusitis, Fungal infection. Sino-nasal mucosa KHO-mount and fungal culture showed mixed infection of Rhizopus species and aspergillus flavus. Right nasal HP study showed mixed invasive moulds infection. Initially, the patient was treated conservatively later on inj. amphotericin-B was started. The patient's condition worsened on day-18 and succumbed a day later. Discussion: Uncontrolled diabetes-mellitus, and corticosteroids leading to hyperglycaemia, extensive use of broad-spectrum antibiotics increases the risk of invasive Moulds. In our case study, patients suffered from COVIDpneumonitis and had uncontrolled diabetes leading to damage of airway epithelium inviting an invasion of tissues by moulds. Conclusion: Mixed fungal infections as COVID-19 sequelae may be an emerging issue and seen particularly in post- COVID patients with uncontrolled diabetes, and on steroids. The focus should be on prompt management: hit hard approach with both medical and surgical treatment.