tetano
Editor, Senior Moderator
Recurrence of COVID‑19 after recovery: a case report from Italy
Daniela Loconsole1 ? Francesca Passerini2 ? Vincenzo Ostilio Palmieri2 ? Francesca Centrone1 ? Anna Sallustio3 ? Stefania Pugliese2 ? Lucia Donatella Grimaldi2 ? Piero Portincasa2 ? Maria Chironna1
Dear Editors,Since the diffusion of SARS-CoV-2 infection outside China, Italy became one of the world’s worst-affected country. By May 3, 2020, recorded cases in Italy were 210,717, with 28,884 deaths and 81,654 recovered cases.Here, we describe a case of reactivation of COVID-19 registered in Italy at the beginning of May 2020.On March 17, a 48-year-old man visited the Emergency Department, Policlinico Hospital of Bari, Puglia region (Italy), with fever, cough and shortness of breath, hyporexia for 6 days (Fig. 1). Physical examination revealed normal vital signs but because of 90% oxygen saturation on ambi-ent air, the patient was promptly treated with O2 6 lt/min (Venturi Mask 31%). The patient did not report any under-lying medical condition such as diabetes, hypertension, or cardiovascular disease. For the suspicion of COVID-19, he was immediately admitted to the “grey zone” of internal medicine, at the “Asclepios” COVID-Hospital, Policlinico. The chest X-ray showed a pneumonia (bilateral multiple thickenings with badly defined margins with consolidation aspects more evident on the right side). The real-time PCR on the nasopharyngeal swab collected on March 18 revealed the presence of SARS-CoV-2. The virus was detected by a real-time PCR assay targeting E-gene, RdRP-gene and N-gene, performed with the protocol previously reported by the WHO (https ://www.who.int/docs/defau lt-sourc e/coron aviru se/uscdc rt-pcr-panel -for-detec tion-instr uctions.pdf?sfvrs n=3aa07 934_2). Based on the criteria of Wang et al. (2020), the patient had a severe form of the disease due to the presence of fever, respiratory symptoms, radiological signs of pneumonia and PaO2/FiO2 < 300 mmHg [1]. He was treated with O2 at different volumes (up to 60% FiO2 VM), lopinavir/ritonavir (200/50 mg, 2 tablets ? 2/day), hydroxy-chloroquine (400 mg b.i.d on the first day, and 200 mg b.i.d afterwards), enoxaparin 6000 IU b.i.d., methylprednisolone (starting dose 40 mg b.i.d, lately tapered). At the checkup after 6 days, the chest X-ray showed a slight improvement involvement.After 14 days the patients became afebrile and his res-piratory symptoms disappeared. The chest X-ray showed only blurred areas of parenchymal thickening. Our hospital required two consecutive negative SARS-CoV-2 molecular tests, plus normal body temperature, resolution of respira-tory symptoms, with the improvement of lung imaging. The two nasopharyngeal swabs collected on March 30 and 31 were both negative for SARS-CoV-2 infection. The patient was therefore discharged and encouraged to maintain home quarantine for at least 14 days. The molecular test was also negative at his follow-up visit on April 15, suggesting that the patient was cured from COVID-19. In addition, two sero-logical assays (VivaDiag™, VivaChek Laboratories, INC, USA and Anti SARS-CoV-2 ELISA IgG Test, Euroimmun, Lubeck, Germany) revealed the presence of IgM and IgG anti-SARS-CoV-2. However, on April 30, he developed new symptoms, i.e., dyspnea and chest pain. He visited again the Emergency Department where he was re-admitted to the same ward with a suspicion of a pulmonary embolism that was confirmed by CT scan. The imaging showed the pres-ence of segmental and sub-segmental signs of arterial micro-embolism with some parcel area of ground glass. Because of his recent clinical history, a SARS-CoV-2 molecular test was performed and proved to be positive. Moreover, serological assay revealed the presence of only IgG anti-SARS-CoV-2. To date, the patient is well, on anticoagulant therapy and does not require O2 supplementation.
https://link.springer.com/content/p...xTv-a50w7ftalw-owSTA0GK9xpYBuBjdgjzhxtJ_xwDiM
Daniela Loconsole1 ? Francesca Passerini2 ? Vincenzo Ostilio Palmieri2 ? Francesca Centrone1 ? Anna Sallustio3 ? Stefania Pugliese2 ? Lucia Donatella Grimaldi2 ? Piero Portincasa2 ? Maria Chironna1
Dear Editors,Since the diffusion of SARS-CoV-2 infection outside China, Italy became one of the world’s worst-affected country. By May 3, 2020, recorded cases in Italy were 210,717, with 28,884 deaths and 81,654 recovered cases.Here, we describe a case of reactivation of COVID-19 registered in Italy at the beginning of May 2020.On March 17, a 48-year-old man visited the Emergency Department, Policlinico Hospital of Bari, Puglia region (Italy), with fever, cough and shortness of breath, hyporexia for 6 days (Fig. 1). Physical examination revealed normal vital signs but because of 90% oxygen saturation on ambi-ent air, the patient was promptly treated with O2 6 lt/min (Venturi Mask 31%). The patient did not report any under-lying medical condition such as diabetes, hypertension, or cardiovascular disease. For the suspicion of COVID-19, he was immediately admitted to the “grey zone” of internal medicine, at the “Asclepios” COVID-Hospital, Policlinico. The chest X-ray showed a pneumonia (bilateral multiple thickenings with badly defined margins with consolidation aspects more evident on the right side). The real-time PCR on the nasopharyngeal swab collected on March 18 revealed the presence of SARS-CoV-2. The virus was detected by a real-time PCR assay targeting E-gene, RdRP-gene and N-gene, performed with the protocol previously reported by the WHO (https ://www.who.int/docs/defau lt-sourc e/coron aviru se/uscdc rt-pcr-panel -for-detec tion-instr uctions.pdf?sfvrs n=3aa07 934_2). Based on the criteria of Wang et al. (2020), the patient had a severe form of the disease due to the presence of fever, respiratory symptoms, radiological signs of pneumonia and PaO2/FiO2 < 300 mmHg [1]. He was treated with O2 at different volumes (up to 60% FiO2 VM), lopinavir/ritonavir (200/50 mg, 2 tablets ? 2/day), hydroxy-chloroquine (400 mg b.i.d on the first day, and 200 mg b.i.d afterwards), enoxaparin 6000 IU b.i.d., methylprednisolone (starting dose 40 mg b.i.d, lately tapered). At the checkup after 6 days, the chest X-ray showed a slight improvement involvement.After 14 days the patients became afebrile and his res-piratory symptoms disappeared. The chest X-ray showed only blurred areas of parenchymal thickening. Our hospital required two consecutive negative SARS-CoV-2 molecular tests, plus normal body temperature, resolution of respira-tory symptoms, with the improvement of lung imaging. The two nasopharyngeal swabs collected on March 30 and 31 were both negative for SARS-CoV-2 infection. The patient was therefore discharged and encouraged to maintain home quarantine for at least 14 days. The molecular test was also negative at his follow-up visit on April 15, suggesting that the patient was cured from COVID-19. In addition, two sero-logical assays (VivaDiag™, VivaChek Laboratories, INC, USA and Anti SARS-CoV-2 ELISA IgG Test, Euroimmun, Lubeck, Germany) revealed the presence of IgM and IgG anti-SARS-CoV-2. However, on April 30, he developed new symptoms, i.e., dyspnea and chest pain. He visited again the Emergency Department where he was re-admitted to the same ward with a suspicion of a pulmonary embolism that was confirmed by CT scan. The imaging showed the pres-ence of segmental and sub-segmental signs of arterial micro-embolism with some parcel area of ground glass. Because of his recent clinical history, a SARS-CoV-2 molecular test was performed and proved to be positive. Moreover, serological assay revealed the presence of only IgG anti-SARS-CoV-2. To date, the patient is well, on anticoagulant therapy and does not require O2 supplementation.
https://link.springer.com/content/p...xTv-a50w7ftalw-owSTA0GK9xpYBuBjdgjzhxtJ_xwDiM
