Infecção por COVID-19 em Transplante de Coração: Relatos de Caso

Schtruk, Ligia Espinoso; Miranda, J Jaime; Salles, Vitor; Sales, Ana Camila Cavalcante; Lobbe, Luciana; Cavalcante, Vaisnava; Reis, Elisangela; Kugel, Sharon; Marques, Bruno Ribeiro; Carvalho, Gabrielle; Maia, Ruth; Reis, Filipe Oliveira dos; Rodrigues, D. B.

doi:10.36660/abc.20200554

Cited by 6 publications

(1 citation statement)

References 9 publications

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“…Of the thirty-three studies, eleven were retrospective case series [ 7 , 11 , 14 , 19 , 20 , 26 , 29 – 33 , 38 , 39 ], while twenty-two were case reports [ 8 – 10 , 12 , 13 , 15 – 18 , 21 – 25 , 27 , 28 , 34 – 37 ]. All were peer-reviewed.…”

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SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

et al. 2021

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Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

et al. 2021

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Immunosuppressants

2020

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Haematological disorders and COVID-19: 2 case reports In a case report, two men were described, of whom a 47-year-old man developed thrombocytopenia, leukopenia, lymphopenia and COVID-19 infection during immunosuppressive treatment with mycophenolate sodium and tacrolimus, and a 54-year-old man developed lymphopenia and COVID-19 infection during immunosuppressive treatment with mycophenolate mofetil and tacrolimus [routes and times to reaction onsets not stated]. This report describes a 47-year-old man (case 1): The man, who had with Chagas disease, had undergone heart transplantation on 08 August 2012. He had been receiving immunosuppressive treatment with mycophenolate sodium 1440 mg/day and tacrolimus 4 mg/day. On 12 April 2020, he developed fever, headache, myalgia, mild dyspnoea, dry cough, anosmia and diarrhoea. He was living in a community with confirmed cases of COVID-19. On 14 April 2020 (on day 3 of symptom onset), he sought emergency care. On physical examination, he was found to be feverish without haemodynamic instability. Arterial blood gases showed mild hypoxia. Investigations showed trombocytopenia, leukopenia and lymphopenia. Chest CT scan showed lung abnormalities. RT-PCR SARS-COV2 test for the collected nasopharyngeal secretion was found to be positive and he was diagnosed with COVID-19. He was hospitalised. His therapy with mycophenolate sodium was stopped due to thrombocytopenia, leukopenia and lymphopenia, while tacrolimus was maintained. Prophylactic anticoagulation with unspecified drug was also started. On day 6 of symptom onset, he remained clinically stable. He had fever with consolidation in the right haemithorax, and intensification of the ground glass opacification in the left haemithorax. A bacterial pneumonia was also considered; therefore, he was started on azithromycin and ceftriaxone. On day 6 of the hospitalisation, the serum tacrolimus level was 4.3 ng/dL, and the dose of tacrolimus was adjusted. His fever persisted. A CT scan showed disease progression, with impairment of <50% of the lung parenchyma. Off-label hydroxychloroquine was started for COVID-19. On the same day, leukopenia, lymphopenia and thrombocytopenia improved; hence, mycophenolate sodium was restarted. On day 12 of the hospitalisation, he was discharged with asymptomatic status. This report describes a 54-year-old-man (case 2): The man with dilated idiopathic cardiomyopathy, underwent heart transplantation on 03 August 2012. He had been receiving immunosuppressive treatment with tacrolimus 2 mg/day and mycophenolate mofetil 1000 mg/day. On 11 May 2020, he had fever, dry cough, lack of appetite and asthenia. His daughter had the same symptoms. On 13 May 2020 (day 3 of symptom onset), he sought emergency care. Physical examination showed no fever or haemodynamic instability. Investigations showed lymphopenia. Chest CT scan showed lung abnormalities. RT-PCR SARS-COV2 test for the collected nasopharyngeal secretion was found to be inconclusive. Based on clinical and radiological parameters, COVID-19 was considered,...

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Clinical manifestations and outcomes of coronavirus disease‐19 in heart transplant recipients: a multicentre case series with a systematic review and meta‐analysis

et al. 2021

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Summary Available data on clinical presentation and mortality of coronavirus disease‐2019 (COVID‐19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory‐confirmed COVID‐19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow‐up of 54 (19–80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C‐reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3‐centre HT recipient cohort was 56% higher in 2020 compared to the time‐matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta‐analysis including 4 studies, pre‐existing diabetes mellitus (OR 3.60, 95% CI 1.43–9.06, I 2 = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39–10.31, I 2 = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID‐19 in HT recipients.

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Infecção por COVID-19 em Transplante de Coração: Relatos de Caso

Cited by 6 publications

References 9 publications

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

Immunosuppressants

Clinical manifestations and outcomes of coronavirus disease‐19 in heart transplant recipients: a multicentre case series with a systematic review and meta‐analysis

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