A case of SARS-CoV-2 pneumonia with successful antiviral therapy in a 77-year-old man with a heart transplant

Mathies, Daniel; Rauschning, Dominic; Wagner, U; Mueller, Frank; Maibaum, Maja; Binnemann, Christin; Waldeck, Stephan; Thinnes, Katrin; Braun, Michael; Schmidbauer, Willi; Hagen, Ralf Matthias; Bickel, Christoph

doi:10.1111/ajt.15932

Cited by 30 publications

(39 citation statements)

References 19 publications

(18 reference statements)

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“…A quarter of these participants made the decision without the input of their neurologist. Although it is plausible that high efficacy therapies confer risk of worse outcomes in COVID-19, (Wijnands et al, 2018 Oct;Grebenciucova and Pruitt, 2017;Luna et al, 2020) not all data demonstrate as negative of a prognosis as first may have been feared (Meca-Lallana et al, 2020;Hsu et al, 2020;Mathies et al, 2020;Zhu et al, 2020;Novi et al, 2020). Some authors have posited that immunosuppression is protective due to the inflammatory nature of the SARS-CoV2 infection.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Vogel

Schmidt²,

Loud³

et al. 2020

Multiple Sclerosis and Related Disorders

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Background: People with multiple sclerosis (PwMS) experienced changes in health behaviors and access to MS care due to the COVID-19 pandemic. The USA has the highest recognized number of Covid19 infections globally. The extent of the impact of COVID-19 has not been well characterized in large samples of PwMS to date. The MS patient perspective on COVID-19 would complement the physician-reported cases of MS and COVID-19 in the literature. Methods: A cross-sectional survey of adult PwMS was performed online, using the U.S.-based patient-powered iConquerMS™ platform, in April 2020. Results: There were 1,145 respondents (response rate: 20%). 1,019 had a diagnosis of MS and responded completely (average age: 54.2 years, range: 20-81; 79% female; 64% relapsing remitting, 22% secondary progressive, 12% primary progressive; 88% in the USA). 748 (73%) used a DMT in the last year, primarily higherefficacy therapies: ocrelizumab (n=238), dimethyl fumarate (n=85), fingolimod (n=80). The most frequent comorbidities were depression (41%), hypertension (26%), and asthma (12%). Women were more worried than men about COVID-19 (p=0.001); non-white-identifying PwMS believed it was a greater danger to their health than white-identifying PwMS (p=0.002). Through the continuum of symptoms to care, 61% of PwMS (n=617) reported symptoms associated with COVID-19, 39% (n=395) knew someone exposed to COVID-19, 4% (n=38) were aware of a personal COVID-19 exposure, 13% (n=128) wanted testing for COVID-19 but could not access it, and 4% (n=43) were tested. Specific to their MS care, 64% (n=650) canceled a medical visit, 22% (n=222) canceled a neurologist visit, 11% (n=112) canceled an MRI, 21% (n=212) canceled a laboratory test, and 10% (n=98) changed their DMT in some way due to COVID19 including 65 delaying at least one dose. 37% (n=382) had a telehealth visit due to COVID-19. 37% of PwMS (n=374) experienced employment changes, most commonly working from home (n=194) and having work hours reduced (n=65) while 32 lost their jobs. Of the 7 cases who tested positive for COVID-19 (<1% of participants) (5 female; age range: 29-64 years), DMTs included dimethyl fumarate (n=2), ocrelizumab (n=1), rituximab (n=1), and a clinical trial drug (n=1). Conclusions: A majority of people with MS reported interruptions to their MS care along the MS care pathway alongside limited access to COVID-19 testing. Postponements and delays in care were common with 10% of participants reporting a change in their DMT administration. Less than 1% of this self-referred convenience online cohort had a positive test for COVID-19 although more than half reported symptoms that are associated with COVID-19. Organization, 2020) By mid-April, SARS-CoV-2 was detected in 185 countries, had infected at least 19 million people worldwide, and linked to >700,000 deaths. (Johns Hopkins University, 2020) Multiple sclerosis (MS) affects more than three-quarters of a million adults in the U.S.A. People with MS (PwMS) on higher efficacy disease modifying therapies (DMTs) may be at an incr...

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Vogel

Schmidt²,

Loud³

et al. 2020

Multiple Sclerosis and Related Disorders

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“…Among those, heart transplant recipients have a particular high prevalence of comorbidities that have been established as risk factors for severe disease. Despite the widespread concern about the potential for high prevalence and severity of COVID-19 among heart transplant recipients, reliable data on heart transplant recipients with COVID-19 are missing so far aside from case reports and case series [13,[15][16][17][18]. As transplant centers all over the world prepare for a rising incidence of the disease, knowledge about the clinical course, differences in disease susceptibility, clinical presentation and severity, and transplant-specific management of both antiviral therapy and immunosuppressant management are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 among heart transplant recipients in Germany: a multicenter survey

et al. 2020

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Aims Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nationwide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. Methods and results A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T-and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). Conclusion Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.

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“…Since these initial reports, other papers describing the clinical course of COVID-19 in HTR have been published from Germany and the United states. They also featured HTR who were remote from transplant and were mostly receiving relatively low-dose maintenance immunosuppression [2,4,5,7]. Recently, Latif et al described a single-center case series of 28 HTR with con rmed diagnosis of COVID-19 in the United states.…”

Section: Discussionmentioning

confidence: 99%

“…In the current context of coronavirus disease 2019 (COVID- 19), the management of patients with endstage heart failure on the transplant waiting-list is challenging. To date, only few case reports or small case series of COVID-19 in heart transplant recipients (HTR) have been described in China, Spain, Germany, and the United States, with mainly HTR who were remote from transplant [1][2][3][4][5][6][7]. Herein, we report on two HTR who developed and ultimately died from severe COVID-19, a few days after their urgent transplant procedure (TP).…”

Section: Introductionmentioning

confidence: 94%

Clinical course and challenging management of early COVID-19 infection after heart transplantation: Case report of two patients

Tchana‐Sato

Ancion

Tridetti

et al. 2020

Preprint

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Background: There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients and especially in heart transplant recipients with only few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state. Case presentation: This report describes the clinical course and the challenging management of early COVID-19 infection in two heart transplants recipients who were tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease, and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil. Conclusions: These two cases illustrate the severity and the poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory and the issue of asymptomatic carrier need to be addressed.

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A case of SARS-CoV-2 pneumonia with successful antiviral therapy in a 77-year-old man with a heart transplant

Cited by 30 publications

References 19 publications

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

COVID-19 among heart transplant recipients in Germany: a multicenter survey

Clinical course and challenging management of early COVID-19 infection after heart transplantation: Case report of two patients

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