ABSTRACT
Mortality rate among maintenance hemodialysis (HD) patients with COVID-19 is alarmingly high. In Fatmawati General Hospital, most of HD patients with COVID-19 presented with acute respiratory distress syndrome (ARDS). Hemoperfusion (HP) is a blood purification therapy used to remove cytokines and inflammatory mediators to prevent ARDS worsening and organ failure. We report 6 cases of COVID-19 in maintenance HD patients. HP and HD were performed in two consecutive days when patient developed early ARDS as indicated by inflammatory markers elevation. HP and HD were conducted by using resin-containing cartridge and high-flux dialyzer, respectively, for 4 hours. Improvements in CRP levels, PaO2/FiO2 ratios, and chest X-rays were observed after 2 sessions of HP in most of our patients. Based on our clinical experience, the timing of HP delivery is critical and should be undertaken in the early phase of ARDS, but larger studies are still needed.
Subject(s)
COVID-19 , Hemoperfusion , Respiratory Distress Syndrome , COVID-19/complications , COVID-19/therapy , Cytokines , Humans , Inflammation Mediators , Renal Dialysis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapyABSTRACT
RATIONALE: Bacterial and fungal infections in Coronavirus Disease-19 (COVID-19) patients have been inadequately investigated and reported thus far. The safety profile of tocilizumab (TCZ) administration in candidemia patient still debatable. PATIENT CONCERNS: A 54 year-old woman presenting with weakness on the left side of her body was diagnosed with COVID-19. After 7âdays of admission, her condition worsened and developed respiratory distress and was having respiratory distress despite standard treatment. DIAGNOSES: Acute respiratory distress syndrome (ARDS) in COVID 19 was diagnoses based on real time-PCR swab, deterioration of PaO2/FiO2 and increased of acute phase reactants. INTERVENTIONS: Anti Interleukin-6 (IL-6) was considered to tackle her inflammatory condition. Prior to TCZ administration, blood culture was performed and the result came with Candida tropicalis in the absence of bacterial growth. OUTCOMES: No major complications associated with intravenous antifungal or TCZ occurred. After 40âdays of hospitalization, the patient's clinical condition improved and was finally discharged. LESSONS: This case underscores the safety profile of giving TCZ in candidemia as a secondary infection in severe COVID-19 patient.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antifungal Agents/therapeutic use , COVID-19 Drug Treatment , COVID-19/complications , Candidemia/complications , Candidemia/drug therapy , Interleukin-6/antagonists & inhibitors , Antibodies, Monoclonal, Humanized/adverse effects , Candida tropicalis , Coinfection , Female , Humans , Micafungin/therapeutic use , Middle Aged , SARS-CoV-2ABSTRACT
Coronavirus disease 2019 (COVID-19) is a new infectious disease that spreads very rapidly and therefore, WHO has declared it as a global pandemic disease. The main clinical symptoms found in COVID-19 patients are cough and fever; however, in some cases, diarrhea can be one of the early symptoms. The present case report describes a patient who came with a complaint of diarrhea without fever and she was later confirmed to be positive for COVID-19 during hospitalization. The presence of unspecified initial symptoms calls for greater vigilance from health workers in establishing diagnosis patients with COVID-19.