ABSTRACT
Background/Objective Diabetic ketoacidosis (DKA) during pregnancy is an obstetric emergency associated with higher rate of maternofetal morbidity and mortality. Pregnancy itself is a ketosis-prone state and several unique mechanisms predispose to development of insulin resistance which can be further exacerbated by acute stressors such as infection. Thus, pregnant patients who additionally contract COVID-19 may be at an even higher risk of developing DKA. Case Report A 32-year-old patient, with no prior history of impaired glucose tolerance, presented at 27 weeks gestation with 3-day history of shortness of breath, congestion, loss of taste and smell, polyuria, and polydipsia. Biochemical evaluation was consistent with DKA. Subsequently she was diagnosed with acute SARS-CoV-2 infection. Treatment included intravenous hydration, electrolyte replacement and insulin infusion. Post-partum phenotypic evaluation confirmed autoimmune diabetes (positive GAD-65 and Zinc T8 antibodies) with residual beta cell function. Six months post-partum, glycemic control remains at goal with basal- bolus insulin regimen. Discussion This case describes the peculiar ability of SARS-CoV-2 infection to potentially rouse autoimmunity and how COVID-19 and DKA in pregnancy can be particularly challenging given the risk for significant maternal and fetal morbidity and mortality. Conclusion Prompt diagnosis and evaluation of DKA in pregnancy as well as higher level of suspicion is needed in the setting of SARS-CoV-2 infection. Additionally, this case depicts the need for close monitoring post-partum for patients at risk for autoimmune disease which may have been blunted in pregnancy. It describes the peculiar ability of SARS-CoV-2 infection to rouse autoimmunity and how COVID-19 and DKA in pregnancy can be particularly challenging given the risk for significant maternal and fetal morbidity and mortality.
ABSTRACT
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 19 (COVID-19), is a novel human Coronavirus that is responsible for about 300,000 deaths worldwide. To date, there is no confirmed treatment or vaccine prevention strategy against COVID-19. Due to the urgent need for effective treatment, drug repurposing is regarded as the immediate option. Potential drugs can often be identified via in silico drug screening experiments. Consequently, there has been an explosion of in silico experiments to find drug candidates or investigate anecdotal claims. One drug with several anecdotal accounts of benefit is Cefuroxime. The aim of this study was to identify and summarize in silico evidence for possible activity of Cefuroxime against SARS-CoV-2.To this end, we performed a scoping review of literature of in silico drug repurposing experiments for SARS-CoV-2 using PRISMA-ScR. We searched Medline, Embase, Scopus, Web of Knowledge, and Google Scholar for original studies published between 1st Feb, 2020 and 15th May, 2020 that screened drug libraries, and identified Cefuroxime as a top-ranked potential inhibitor drug against SARS-CoV-2 proteins. Six studies were identified. These studies reported Cefuroxime as a potential inhibitor of 3 key SARS-CoV-2 proteins; main protease, RNA dependent RNA polymerase, and ACE2-Spike complex. We provided a summary of the methodology and findings of the identified studies. Our scoping review identified significant in silico evidence that Cefuroxime may be a potential multi-target inhibitor of SARS-CoV-2. Further in vitro and in vivo studies are required to evaluate the potential of Cefuroxime for COVID-19.Communicated by Ramaswamy H. Sarma.