A Physician Suffering from COVID-19 with Multiple Co-Morbidities Have Delayed Viral Clearance: A Case Report from Bangladesh

Abstract

Background: Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in mild to moderate COVID-19 patients. As it is highly contagious, health care workers including physicians are high risk of being infected in hospital care. Case Report: A 37 years old Bangladeshi physician working in a paediatric unit of a medical college hospital with multiple co-morbidities, hypertension, diagnosed axial spondyloarthropathy (ankylosing spondylitis) taking disease modifying anti rheumatic drugs-DMARDs (Salfasalazine) from 2016 till now, chronic persistent bronchial asthma on medication developed sore throat, increasing breathlessness and cough admitted to his own hospital on 22 April, 2020. He had a history of contact with a relapse nephrotic syndrome (glomerulonephritis) patient admitted with severe respiratory distress later confirmed as COVID-19 following RT PCR test on 14 April, 2020. After 3 days of contact with the patient, the physician also developed the symptoms mentioned above. The RT PCR test result of the physician came positive on 18 April, 2020. The physician primarily taken only azithromycin 500 mg once daily along with other regular drugs. On 5, 12 and 18 May, 2020, his sample was taken for re-test and came positive subsequently. After that he started Ivermectin (0.15 mg/kg) once daily for 3 days and doxycycline 100 mg BD for 7 days. He gave samples again on 27 and 29 May, 2020 which were came negative after 39 days. On full recovery he was discharged from hospital on day 40. We choose the patient because presence of co-morbidities may be associated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.

Persistent Dyspnea after Recovery from COVID-19: Two Case Reports from Bangladesh

“…Most of them mentioned that persistent viremia or delayed viral clearance may be due to weak immunity of the host or absence of innate immunity response to produce antibody [14][15] . Some have mentioned relapse or re-infection as a possibility and some have mentioned mental factors such as post-traumatic stress as a contributing factor [16][17] . Besides, the symptoms after discharge may also be the sequalae of organ damage in the acute phase.…”

A case report of clinical outcome of a COVID-19 patient presented by acute ischemic stroke

“…COVID-19 infection associated with presence of vascular risk factors such as hypertension, ischemic heart disease, diabetes mellitus and chronic kidney disease [9]. It has been observed that SARS-CoV-2 virus can cause a cytokine storm through ACE-2 receptor binding leading to a hypercoagulable state and increased incidence of vascular thrombosis in patients suffering from COVID-19 [10].…”