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1.
Frontiers in immunology ; 12, 2021.
Article in English | EuropePMC | ID: covidwho-1564399

ABSTRACT

Objective To evaluate clinical effectiveness of regdanvimab, a monoclonal antibody agent for treating coronavirus 2019 (COVID-19). Methods A retrospective cohort study was conducted at two general hospitals during the study period of December 2020 to May 2021. Mild COVID-19 patients with risk factors for disease progression admitted to the hospitals within seven days of symptom onset were enrolled and followed until discharge or referral. Multivariate analyses for disease progression were conducted in the total and propensity score (PS)-matched cohorts. Results A total of 778 mild COVID-19 patients were included and classified as the regdanvimab (n = 234) and supportive care (n = 544) groups. Significantly fewer patients required O2 supplementation via nasal prong in the regdanvimab group (8.1%) than in the supportive care group (18.4%, P < 0.001). The decreased risk for O2 support by regdanvimab treatment was noticed in the multivariate analysis of the total cohort (HR 0.570, 95% CI 0.343–0.946, P = 0.030), but it was not statistically significant in the PS-matched cohort (P = 0.057). Progression to severe disease was also significantly lower in the regdanvimab group (2.1%) than in the supportive care group (9.6%, P < 0.001). The significantly reduced risk for progression to severe disease by regdanvimab treatment was observed in the analysis of both the total cohort (HR 0.262, 95% CI 0.103–0.667, P = 0.005) and PS-matched cohort (HR 0.176, 95% CI 0.060–0.516, P = 0.002). Potential risk factors for progression were investigated in the supportive care group and SpO2 < 97% and CRP elevation >1.5 mg/dL were common risk factors for O2 support and progression to severe disease. Among the patients with any of these factors, regdanvimab treatment was associated with decreased risk for progression to severe disease with slightly lower HR (HR 0.202, 95% CI 0.062–0.657, P = 0.008) than that of the total cohort. Conclusion Regdanvimab treatment was associated with a decreased risk of progression to severe disease.

2.
Infect Chemother ; 53(2): 395-403, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1526888

ABSTRACT

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence.

4.
Front Immunol ; 12: 744206, 2021.
Article in English | MEDLINE | ID: covidwho-1459508

ABSTRACT

The effects of corticosteroid use on the reactogenicity and immunogenicity of ChAdOx1 nCoV-19 (ChAd) vaccine were evaluated. Healthcare workers (HCWs) who took low-dose corticosteroid agents around the time of the first dose of ChAd (ChAdPd group) were recruited and the reactogenicity and immunogenicity were compared with those of ChAd (ChAd group) and BNT162b2 vaccination (BNT group) of HCWs without corticosteroid exposure. The immunogenicity was measured three weeks after vaccination using quantitative anti-SARS-CoV-2 spike protein (S) antibody electrochemiluminescence immunoassay and interferon gamma (IFN-γ) release assay. A total of 67 HCWs comprising 24 ChAd, 29 BNT, and 14 ChAdPd was included. The median total corticosteroid dose of the ChAdPd group was 30 mg prednisolone equivalents (interquartile range (IQR) 20-71.3 mg). HCWs in the ChAdPd group experienced significantly milder reactogenicity (median total score 7.5, IQR 4.0-18.0) compared to those in the ChAd group (median 23.0, IQR 8.0-43.0, P=0.012) but similar to that in the BNT group (median 5.0, IQR 3.0-9.0, P=0.067). The S antibody concentration of the ChAdPd group (62.4 ± 70.0 U/mL) was higher than that of the ChAd group, though without statistical significance (3.45 ± 57.6 U/mL, P=0.192). The cellular immune response was most robust in the ChAdPd group, with significantly higher IFN-γ concentration (5.363 ± 4.276 IU/mL), compared to the ChAd (0.978 ± 1.181 IU/mL, P=0.002) and BNT (1.656 ± 1.925 IU/mL, P=0.009) groups. This finding suggest that short-term corticosteroid reduces reactogenicity of the first dose of ChAd without hindering immunogenicity.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19 Vaccines/immunology , COVID-19/immunology , SARS-CoV-2/physiology , Spike Glycoprotein, Coronavirus/metabolism , Adult , Antibodies, Viral/blood , Female , Health Personnel , Humans , Immunity, Cellular , Immunogenicity, Vaccine/drug effects , Interferon-gamma/metabolism , Male , Middle Aged , Spike Glycoprotein, Coronavirus/immunology , Time Factors , Vaccination
6.
J Clin Med ; 9(7)2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-1403634

ABSTRACT

OBJECTIVES: To investigate antibody production in asymptomatic and mild COVID-19 patients. METHODS: Sera from asymptomatic to severe COVID-19 patients were collected. Microneutralization (MN), fluorescence immunoassay (FIA), and enzyme-linked immunosorbent assay (ELISA) were performed. RESULTS: A total of 70 laboratory-confirmed COVID-19 patients were evaluated, including 15 asymptomatic/anosmia, 49 mild symptomatic, and 6 pneumonia patients. The production of the neutralizing antibody was observed in 100% of pneumonia, 93.9% of mild symptomatic, and 80.0% of asymptomatic/anosmia groups. All the patients in the pneumonia group showed high MN titer (≥1:80), while 36.7% of mild symptomatic and 20.0% of asymptomatic/anosmia groups showed high titer (p < 0.001). Anti-SARS-CoV-2 antibodies could be more sensitively detected by FIA IgG (98.8%) and ELISA (97.6%) in overall. For the FIA IgG test, all patients in the pneumonia group exhibited a high COI value (≥15.0), while 89.8% of mild symptomatic and 73.3% of asymptomatic/anosmia groups showed a high value (p = 0.049). For the ELISA test, all patients in the pneumonia group showed a high optical density (OD) ratio (≥3.0), while 65.3% of mild symptomatic and 53.3% of asymptomatic/anosmia groups showed a high ratio (p = 0.006). CONCLUSIONS: Most asymptomatic and mild COVID-19 patients produced the neutralizing antibody, although the titers were lower than pneumonia patients. ELISA and FIA sensitively detected anti-SARS-CoV-2 antibodies.

7.
Vaccines (Basel) ; 9(8)2021 Aug 21.
Article in English | MEDLINE | ID: covidwho-1367934

ABSTRACT

Mass vaccination campaigns are important to control the COVID-19 pandemic, however, adverse events (AEs) contribute to vaccine hesitancy. To investigate and compare early AEs between the BNT162b2 mRNA and AZD1222 adenovirus-vectored vaccines, recipients completed daily surveys about local and systemic reactions for 7 days after each dose, respectively. A total of 80 and 1440 healthcare workers received two doses of BNT162b2 and a first dose of AZD1222 vaccines. Any AEs were reported by 52.5% of recipients after the first dose of BNT162b2, by 76.2% after the second dose of BNT162b2, and by 90.9% after the first dose of AZD1222 (p < 0.001). Younger vaccinees had more AEs after the second dose of BNT162b2 and first dose of AZD1222. Sex based differences were only observed in the AZD1222 recipient group. No incidence of anaphylaxis or neurologic AEs were observed. In conclusion, early AEs were mostly mild to moderate in severity and generally transient in both BNT162b2 and AZD1222 groups. Sufficient explanation of the expected AEs of the vaccine would be helpful for wider vaccination.

8.
Infect Chemother ; 53(1): 166-219, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1365727

ABSTRACT

Despite the global effort to mitigate the spread, coronavirus disease 2019 (COVID-19) has become a pandemic that took more than 2 million lives. There are numerous ongoing clinical studies aiming to find treatment options and many are being published daily. Some effective treatment options, albeit of variable efficacy, have been discovered. Therefore, it is necessary to develop an evidence-based methodology, to continuously check for new evidence, and to update recommendations accordingly. Here we provide guidelines on pharmaceutical treatment for COVID-19 based on the latest evidence.

9.
J Korean Med Sci ; 36(27): e197, 2021 Jul 12.
Article in English | MEDLINE | ID: covidwho-1308264

ABSTRACT

We used the nationwide claims database to calculate the incidence of thrombotic events and predict their overall 2-week incidence. From 2006 to 2020, the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) tended to increase. Unlike intracranial venous thrombosis (ICVT) and intracranial thrombophlebitis (ICTP), which showed no age difference, other venous embolism, and thrombosis (OVET), DIC, DVT, and PE were significantly more common in over 65 years. The overall 2-week incidence of ICVT was 0.21/1,000,000 (95% confidence interval [CI], 0.11-0.32). ICTP, OVET, DIC, DVT and PE were expected to occur in 0.08 (95% CI, 0.02-0.14), 7.66 (95% CI, 6.08-9.23), 5.95 (95% CI, 4.88-7.03), 13.28 (95% CI, 11.92-14.64), 14.09 (95% CI, 12.80-15.37) per 1,000,000, respectively. To date, of 8,548,231 patients vaccinated with ChAdOx1 nCoV-19 in Korea, two had confirmed thrombosis with thrombocytopenia syndrome within 2 weeks. The observed incidence of ICVT after vaccination was 0.23/1,000,000.


Subject(s)
COVID-19 Vaccines/adverse effects , Disseminated Intravascular Coagulation/chemically induced , Pulmonary Embolism/chemically induced , Thromboembolism/chemically induced , Vaccination/adverse effects , Venous Thrombosis/chemically induced , Aged , Causality , Cerebrovascular Disorders/epidemiology , Disseminated Intravascular Coagulation/epidemiology , Female , Humans , Incidence , Intracranial Thrombosis/epidemiology , Male , Middle Aged , Models, Theoretical , Pulmonary Embolism/epidemiology , Republic of Korea/epidemiology , Thrombocytopenia/chemically induced , Thrombocytopenia/epidemiology , Thromboembolism/epidemiology , Venous Thrombosis/epidemiology
10.
Int J Environ Res Public Health ; 18(12)2021 06 16.
Article in English | MEDLINE | ID: covidwho-1273426

ABSTRACT

Asymptomatic/mildly symptomatic coronavirus disease 2019 (COVID-19) patients produce a considerable amount of virus and transmit severe acute respiratory syndrome virus 2 (SARS-CoV-2) through close contact. Preventing in-hospital transmission of SARS-CoV-2 is challenging, since symptom-based screening protocols may miss asymptomatic/mildly symptomatic patients. In particular, dental healthcare workers (HCWs) are at high risk of exposure, as face-to-face contact and exposure to oral secretions is unavoidable. We report exposure of HCWs during dental procedures on a mild symptomatic COVID-19 patient. A 32-year-old male visited a dental clinic at a tertiary care hospital. He experienced mild cough, which started three days before the dental visit, but did not report his symptom during the entrance screening. He underwent several dental procedures and imaging for orthognathic surgery without wearing a mask. Seven HCWs were closely exposed to the patient during dental procedures that could have generated droplets and aerosols. One HCW had close contact with the patient during radiologic exams, and seven HCWs had casual contact. All HCWs wore particulate filtering respirators with 94% filter capacity and gloves, but none wore eye protection or gowns. The next day, the patient experienced dysgeusia and was diagnosed with COVID-19 with high viral load. All HCWs who had close contact with the patient were quarantined for 14 days, and polymerase chain reaction and antibody tests for SARS-CoV-2 were negative. This exposure event suggests the protective effect of particulate filtering respirators in dental clinics. The recommendations of different levels of personal protective equipment (PPE) for dental HCWs according to the procedure types should be established according to the planned procedure, the risk of COVID-19 infection of the patient, and the outbreak situation of the community.


Subject(s)
COVID-19 , Dental Clinics , Adult , Health Personnel , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Personal Protective Equipment , SARS-CoV-2 , Ventilators, Mechanical
11.
J Korean Med Sci ; 36(23): e166, 2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1269968

ABSTRACT

BACKGROUND: This study presents a framework for determining the allocation and distribution of the limited amount of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: After analyzing the pandemic strategies of the major organizations and countries and with a literature review conducted by a core panel, a modified Delphi survey was administered to 13 experts in the fields of vaccination, infectious disease, and public health in the Republic of Korea. The following topics were discussed: 1) identifying the objectives of the vaccination strategy, 2) identifying allocation criteria, and 3) establishing a step-by-step vaccination framework and prioritization strategy based on the allocation criteria. Two rounds of surveys were conducted for each topic, with a structured questionnaire provided via e-mail in the first round. After analyzing the responses, a meeting with the experts was held to obtain consensus on how to prioritize the population groups. RESULTS: The first objective of the vaccination strategy was maintenance of the integrity of the healthcare system and critical infrastructure, followed by reduction of morbidity and mortality and reduction of community transmission. In the initial phase, older adult residents in care homes, high-risk health and social care workers, and personal support workers who work in direct contact with coronavirus disease 2019 (COVID-19) patients would be prioritized. Expansion of vaccine supply would allow immunization of older adults not included in phase 1, followed by healthcare workers not previously included and individuals with comorbidities. Further widespread vaccine supply would ensure availability to the extended adult age groups (50-64 years old), critical workers outside the health sector, residents who cannot socially distance, and, eventually, the remaining populations. CONCLUSION: This survey provides the much needed insight into the decision-making process for vaccine allocation at the national level. However, flexibility in adapting to strategies will be essential, as new information is constantly emerging.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , Delphi Technique , Resource Allocation , SARS-CoV-2 , Adolescent , Adult , Aged , Child , Child, Preschool , Decision Making , Health Personnel , Humans , Infant , Infant, Newborn , Middle Aged , Pandemics/prevention & control , Public Health , Republic of Korea/epidemiology , Surveys and Questionnaires , Vaccination , Young Adult
12.
J Korean Med Sci ; 36(14): e107, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1181338

ABSTRACT

Coronavirus disease 2019 vaccinations for healthcare workers (HCWs) have begun in South Korea. To investigate adverse events (AEs) of the first dose of each vaccine, any symptom was collected daily for seven days after vaccination in a tertiary hospital. We found that 1,301 of 1,403 ChAdOx1 nCoV-19 recipients and 38 of 80 BNT162b2 recipients reported AEs respectively (90.9% vs. 52.5%): injection-site pain (77.7% vs. 51.2%), myalgia (60.5% vs. 11.2%), fatigue (50.7% vs. 7.5%), headache (47.4% vs. 7.5%), and fever (36.1% vs. 5%; P < 0.001 for all). Young HCWs reported more AEs with ChAdOx1 nCoV-19 than with BNT162b2. No incidences of anaphylaxis were observed. Only one serious AE required hospitalization for serious vomiting, and completely recovered. In conclusion, reported AEs were more common in recipients with ChAdOx1 nCoV-19 than in those with BNT162b2. However, most of the reported AEs were mild to moderate in severity. Sufficient explanation and preparation for expected AEs required to promote widespread vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Health Personnel , Adult , Female , Hospitalization , Humans , Incidence , Male , Middle Aged , Republic of Korea/epidemiology , Tertiary Care Centers , Vaccination/adverse effects
13.
Infect Chemother ; 53(1): 151-154, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1175629
14.
J Microbiol Immunol Infect ; 54(5): 983-986, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1157512

ABSTRACT

In an investigation of six anti-SARS-CoV-2 antibody kits with different target antigen and methodology, each kit showed comparable performance. As false-positive reactions occurred independently with different kits, specificity increased to 100% when pairs of kits were used. With three-kit combination, both sensitivity (99.1%) and specificity (100%) increased.


Subject(s)
Antibodies, Viral/immunology , COVID-19 Serological Testing/methods , COVID-19/diagnosis , Reagent Kits, Diagnostic , SARS-CoV-2/isolation & purification , False Positive Reactions , Humans , Real-Time Polymerase Chain Reaction/methods , Sensitivity and Specificity
15.
J Korean Med Sci ; 36(11): e83, 2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1146214

ABSTRACT

BACKGROUND: Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. METHODS: A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. RESULTS: A total of 86 severe COVID-19 patients were evaluated including 48 remdesivir-treated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1-5 to 11-15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). CONCLUSION: The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , COVID-19/drug therapy , SARS-CoV-2 , Adenosine Monophosphate/therapeutic use , Aged , Aged, 80 and over , Alanine/therapeutic use , COVID-19/virology , Female , Humans , Male , Middle Aged , Real-Time Polymerase Chain Reaction , Respiration, Artificial , Retrospective Studies , Viral Load
16.
Korean J Intern Med ; 35(6): 1270-1278, 2020 11.
Article in English | MEDLINE | ID: covidwho-1067813

ABSTRACT

BACKGROUND/AIMS: This study aimed to collect information on the opinions of Korean infectious disease (ID) experts on coronavirus disease 2019 (COVID-19) and related issues in preparation for a future outbreak. METHODS: A survey was conducted over the course of 5 days (from April 21 to 25, 2020), targeting all adult ID specialists currently in the medical field in South Korea (n = 265). An online-based survey was forwarded via text message and e-mail. Only one response was accepted from each participant. RESULTS: Of these 265 ID specialists gotten to, 132 (49.8%) responded. The highest proportion of the respondents envisaged the current COVID-19 outbreak to end after December 2020 (47.7% for the domestic Korean outbreak and 70.5% for the global pandemic); moreover, 60.7% of them stated that a second nationwide wave is likely to occur between September and December 2020 in South Korea. N95 respirators were considered to be the most important item in hospitals in preparation for a second wave. The most important policy to be implemented at the national level was securing national hospitals designated for the treatment of ID (67.4%). CONCLUSION: ID experts in South Korea believe that the COVID-19 pandemic may not be easily controlled and that a second nationwide wave is likely to occur in South Korea. Our results indicate that Korean ID specialists believe that a high level of preparation is needed in various aspects, including the procurement of personal protective equipment, to respond efficiently to a second outbreak.


Subject(s)
Coronavirus Infections , Disaster Planning , Pandemics , Pneumonia, Viral , Adult , COVID-19 , Female , Humans , Infectious Disease Medicine , Male , Middle Aged , Republic of Korea , Surveys and Questionnaires
17.
Immunity ; 54(1): 44-52.e3, 2021 01 12.
Article in English | MEDLINE | ID: covidwho-1065202

ABSTRACT

Memory T cell responses have been demonstrated in COVID-19 convalescents, but ex vivo phenotypes of SARS-CoV-2-specific T cells have been unclear. We detected SARS-CoV-2-specific CD8+ T cells by MHC class I multimer staining and examined their phenotypes and functions in acute and convalescent COVID-19. Multimer+ cells exhibited early differentiated effector-memory phenotypes in the early convalescent phase. The frequency of stem-like memory cells was increased among multimer+ cells in the late convalescent phase. Cytokine secretion assays combined with MHC class I multimer staining revealed that the proportion of interferon-γ (IFN-γ)-producing cells was significantly lower among SARS-CoV-2-specific CD8+ T cells than those specific to influenza A virus. Importantly, the proportion of IFN-γ-producing cells was higher in PD-1+ cells than PD-1- cells among multimer+ cells, indicating that PD-1-expressing, SARS-CoV-2-specific CD8+ T cells are not exhausted, but functional. Our current findings provide information for understanding of SARS-CoV-2-specific CD8+ T cells elicited by infection or vaccination.


Subject(s)
CD8-Positive T-Lymphocytes/immunology , COVID-19/immunology , Programmed Cell Death 1 Receptor/metabolism , SARS-CoV-2/immunology , Acute-Phase Reaction/immunology , Acute-Phase Reaction/virology , COVID-19/pathology , COVID-19/virology , Convalescence , Epitopes, T-Lymphocyte , Histocompatibility Antigens Class I/immunology , Humans , Immunologic Memory , Immunophenotyping , Interferon-gamma/metabolism , Lymphocyte Activation , Viral Load
18.
Int J Environ Res Public Health ; 17(24)2020 12 20.
Article in English | MEDLINE | ID: covidwho-1006976

ABSTRACT

Nonpharmaceutical intervention has been one of the most important strategies to prevent the spread of the SARS-CoV-2 in the communities during the COVID-19 pandemic. Korea has a unique experience that we had the first large outbreak during the early pandemic and could flatten the epidemic curve without lockdown. In this study, the effective reproductive numbers were calculated for the entire nation and Seoul (the capital city) Metropolitan Area from February 16-15 July, where 60% of the population reside. We compared the changes in population mobility data and reproductive number trends according to the changes in the government's nonpharmaceutical intervention strategy. The total daily mobility decreased when Korea had the first wave of a large outbreak in February-March 2020, which was mainly caused by the decrease of daily noncommuting mobility. However, daily commuting mobility from 16 February to 30 June 2020 was maintained at a similar level since there was no national lockdown for workers who commute between home and work. During the first half-year of 2020, Korea could control the outbreak to a manageable level without a significant decrease in daily public mobility. However, it may be only possible when the public follows personal hygiene principles and social distancing without crisis fatigue or reduced compliance.


Subject(s)
Basic Reproduction Number , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Pandemics , Humans , Republic of Korea/epidemiology , Seoul
19.
Infect Chemother ; 52(3): 453-459, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-993752

ABSTRACT

Coronavirus disease 2019 (COVID-19) has spread widely across the world since January 2020. There are many challenges when caring for patients with COVID-19, one of which is infection prevention and control. In particular, in cases where surgery must absolutely be performed, special infection control may be required in order to perform surgery without spreading infection within the hospital. We aim to present potentially useful recommendations for non-deferrable surgery for COVID-19 patients based on in vivo and in vitro research and clinical experiences from many countries.

20.
Infect Chemother ; 52(3): 410-414, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-993751

ABSTRACT

Coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly all over the world, being a major threat to public health. Since clinical feature of COVID-19 has not been fully evaluated yet, empirical antibacterial agents are frequently combined for the treatment of COVID-19 in addition to antiviral agents, concerning co-existing bacterial pathogens. We experienced a case of severe thrombocytopenia with epistaxis and petechiae, while treating a COVID-19 patient with ceftriaxone, levofloxacin, and lopinavir/ritonavir. The platelet count decreased to 2,000/mm³ and recovered after discontinuation of the three suspected drugs. In treating a potentially fatal emerging infectious disease, empirical and/or experimental approach would be unavoidable. However, the present case suggests that the possibility of adverse effects caused by polypharmacy should also be carefully considered.

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