ABSTRACT
Background: Coronavirus disease (COVID-19) induces inflammation, coagulopathy following platelet and monocyte activation, and fibrinolysis, resulting in elevated D-dimer levels. Activated platelets and monocytes produce microvesicles (MVs). We analyzed the differences in platelet and monocyte MV counts in mild, moderate, and severe COVID-19, as well as their correlation with D-dimer levels. Methods: In this cross-sectional study, blood specimens were collected from 90 COVID-19 patients and analyzed for D-dimers using SYSMEX CS-2500. Platelet MVs (PMVs; PMVCD42b+ and PMVCD41a+), monocyte MVs (MMVs; MMVCD14+), and phosphatidylserine-binding annexin V (PS, AnnV+) were analyzed using a BD FACSCalibur instrument. Results: PMV and MMV counts were significantly increased in COVID-19 patients. AnnV+ PMVCD42b+ and AnnV+ PMVCD41a+ cell counts were higher in patients with severe COVID-19 than in those with moderate clinical symptoms. The median (range) of AnnV+ PMVCD42b+ (MV/µL) in mild, moderate, and severe COVID-19 was 1,118.3 (328.1-1,910.5), 937.4 (311.4-2,909.5), and 1,298.8 (458.2-9,703.5), respectively (P =0.009). The median (range) for AnnV+ PMVCD41a+ (MV/µL) in mild, moderate, and severe disease was 885.5 (346.3-1,682.7), 663.5 (233.8-2,081.5), and 1,146.3 (333.3-10,296.6), respectively (P =0.007). D-dimer levels (ng/mL) weak correlated with AnnV+ PMVCD41a+ (P =0.047, r=0.258). Conclusions: PMV PMVCD42b+ and PMVCD41a+ counts were significantly increased in patients with severe clinical symptoms, and PMVCD41a+ counts correlated with D-dimer levels. Therefore, MV counts can be used as a potential biomarker of COVID-19 severity.
Subject(s)
Biomarkers , Blood Platelets , COVID-19 , Cell-Derived Microparticles , Fibrin Fibrinogen Degradation Products , Monocytes , SARS-CoV-2 , Severity of Illness Index , Humans , COVID-19/blood , COVID-19/diagnosis , COVID-19/pathology , Cross-Sectional Studies , Monocytes/metabolism , Monocytes/cytology , Female , Male , Fibrin Fibrinogen Degradation Products/analysis , Fibrin Fibrinogen Degradation Products/metabolism , Middle Aged , Biomarkers/blood , Blood Platelets/metabolism , Blood Platelets/pathology , Blood Platelets/cytology , SARS-CoV-2/isolation & purification , Aged , Adult , Cell-Derived Microparticles/metabolism , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/blood , Pneumonia, Viral/virology , Coronavirus Infections/diagnosis , Coronavirus Infections/blood , Coronavirus Infections/virology , Betacoronavirus/isolation & purification , Aged, 80 and overABSTRACT
BACKGROUND: Extrapulmonary tuberculosis has increased in the last few decades, and establishing a diagnosis is still challenging. CASE PRESENTATION: A 15 years old Indonesian adolescent complained of a lump on the right lung. The patient and his mother had a history of pulmonary tuberculosis and received the anti-tuberculosis drug. Chest inspection showed a soft consistency mass, smooth surface, poorly defined borders, and size of 7 × 7 cm in the posterolateral dextra region. Radiological examination showed a mass of 2 × 2.5 × 5.3 cm in the right anterior mediastinum. FNAB lymph nodes showed granulomatous inflammation consistent with tuberculosis. The patient had a wide excision tumor, and a GeneXpert MTB/RIF examination of the tumor excision material showed that Mycobacterium tuberculosis was detected very low. The patient received an anti-tuberculosis drug and had a good prognosis. DISCUSSION: Patients with a family history of tuberculosis should be examined for tuberculosis. Although in a patient with lung carcinoma signs and symptoms, it does not rule out chest wall tuberculosis. CONCLUSION: Enforcement of the correct diagnosis can increase the prognosis of extrapulmonary tuberculosis.
