PDF(Sci-hub)
Abstract：
BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that was first discovered in December 2019 in Wuhan, China. With the growing numbers of community spread cases worldwide, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic on March 11, 2020. Like influenza viruses, SARS-CoV-2 is thought to be mainly transmitted by droplets and direct contact, and COVID-19 has a similar disease presentation to influenza. Here we present a case of influenza A and COVID-19 co-infection in a 60-year-old man with end-stage renal disease (ESRD) on hemodialysis.
METHODS: A 60-year-old man with ESRD on hemodialysis presented for worsening cough, shortness of breath, and diarrhea. The patient first developed a mild fever (37.8 °C) during hemodialysis 3 days prior to presentation and has been experiencing worsening flu-like symptoms, including fever of up to 38.6 °C, non-productive cough, generalized abdominal pain, nausea, vomiting, and liquid green diarrhea. He lives alone at home with no known sick contacts and denies any recent travel or visits to healthcare facilities other than the local dialysis center. Rapid flu test was positive for influenza A. Procalcitonin was elevated at 5.21 ng/mL with a normal white blood cell (WBC) count. Computed tomography (CT) chest demonstrated multifocal areas of consolidation and extensive mediastinal and hilar adenopathy concerning for pneumonia. He was admitted to the biocontainment unit of Nebraska Medicine for concerns of possible COVID-19 and was started on oseltamivir for influenza and vancomycin/cefepime for the probable bacterial cause of his pneumonia and diarrhea. Gastrointestinal (GI) pathogen panel and Clostridioides difficile toxin assay were negative. On the second day of admission, initial nasopharyngeal swab came back positive for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The patient received supportive care and resumed bedside hemodialysis in strict isolation, and eventually fully recovered from COVID-19.
CONCLUSIONS: We presented a case of co-infection of influenza and SARS-CoV-2 in a hemodialysis patient. The possibility of SARS-CoV-2 co-infection should not be overlooked even when other viruses including influenza can explain the clinical symptoms, especially in high-risk patients.
METHODS: A 60-year-old man with ESRD on hemodialysis presented for worsening cough, shortness of breath, and diarrhea. The patient first developed a mild fever (37.8 °C) during hemodialysis 3 days prior to presentation and has been experiencing worsening flu-like symptoms, including fever of up to 38.6 °C, non-productive cough, generalized abdominal pain, nausea, vomiting, and liquid green diarrhea. He lives alone at home with no known sick contacts and denies any recent travel or visits to healthcare facilities other than the local dialysis center. Rapid flu test was positive for influenza A. Procalcitonin was elevated at 5.21 ng/mL with a normal white blood cell (WBC) count. Computed tomography (CT) chest demonstrated multifocal areas of consolidation and extensive mediastinal and hilar adenopathy concerning for pneumonia. He was admitted to the biocontainment unit of Nebraska Medicine for concerns of possible COVID-19 and was started on oseltamivir for influenza and vancomycin/cefepime for the probable bacterial cause of his pneumonia and diarrhea. Gastrointestinal (GI) pathogen panel and Clostridioides difficile toxin assay were negative. On the second day of admission, initial nasopharyngeal swab came back positive for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The patient received supportive care and resumed bedside hemodialysis in strict isolation, and eventually fully recovered from COVID-19.
CONCLUSIONS: We presented a case of co-infection of influenza and SARS-CoV-2 in a hemodialysis patient. The possibility of SARS-CoV-2 co-infection should not be overlooked even when other viruses including influenza can explain the clinical symptoms, especially in high-risk patients.
摘要：
背景：2019年冠状病毒病（COVID-19）是由严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）引起的，2019年12月在武汉首次发现的新型冠状病毒，中国。随着全球社区传播病例的增加，世界卫生组织（WHO）于2020年3月11日宣布COVID-19疫情为大流行。像流感病毒一样，SARS-CoV-2被认为主要通过液滴和直接接触传播，COVID-19与流感有类似的疾病表现。在这里，我们介绍了一名患有终末期肾病（ESRD）的60岁男性血液透析患者的甲型流感和COVID-19共感染病例。
方法：一名60岁的ESRD患者因咳嗽恶化而接受血液透析，呼吸急促,和腹泻。患者在就诊前3天在血液透析期间首次出现轻度发烧（37.8°C），并且一直在经历恶化的流感样症状，包括高达38.6°C的发烧，非生产性咳嗽,全身腹痛,恶心,呕吐,和液绿色腹泻。他独自一人住在家里，没有已知的病人接触，并且否认最近有任何旅行或访问当地透析中心以外的医疗机构。快速流感试验对甲型流感呈阳性。降钙素原升高至5.21ng/mL，白细胞（WBC）计数正常。计算机断层扫描（CT）胸部显示多灶性合并区域以及广泛的纵隔和肺门腺病，涉及肺炎。他因担心可能的COVID-19而被送往内布拉斯加州医学院的生物收容部门，并开始服用奥司他韦治疗流感，万古霉素/头孢吡肟治疗可能的肺炎和腹泻的细菌原因。胃肠道（GI）病原体组和艰难梭菌毒素测定均为阴性。入学的第二天，通过实时逆转录酶聚合酶链反应（RT-PCR），初始鼻咽拭子对SARS-CoV-2呈阳性。患者接受支持性护理，并在严格隔离的情况下恢复床边血液透析，并最终从COVID-19中完全康复。
结论：我们介绍了一例血液透析患者合并感染SARS-CoV-2的病例。即使包括流感在内的其他病毒可以解释临床症状，也不应忽视SARS-CoV-2合并感染的可能性。尤其是高危患者。
方法：一名60岁的ESRD患者因咳嗽恶化而接受血液透析，呼吸急促,和腹泻。患者在就诊前3天在血液透析期间首次出现轻度发烧（37.8°C），并且一直在经历恶化的流感样症状，包括高达38.6°C的发烧，非生产性咳嗽,全身腹痛,恶心,呕吐,和液绿色腹泻。他独自一人住在家里，没有已知的病人接触，并且否认最近有任何旅行或访问当地透析中心以外的医疗机构。快速流感试验对甲型流感呈阳性。降钙素原升高至5.21ng/mL，白细胞（WBC）计数正常。计算机断层扫描（CT）胸部显示多灶性合并区域以及广泛的纵隔和肺门腺病，涉及肺炎。他因担心可能的COVID-19而被送往内布拉斯加州医学院的生物收容部门，并开始服用奥司他韦治疗流感，万古霉素/头孢吡肟治疗可能的肺炎和腹泻的细菌原因。胃肠道（GI）病原体组和艰难梭菌毒素测定均为阴性。入学的第二天，通过实时逆转录酶聚合酶链反应（RT-PCR），初始鼻咽拭子对SARS-CoV-2呈阳性。患者接受支持性护理，并在严格隔离的情况下恢复床边血液透析，并最终从COVID-19中完全康复。
结论：我们介绍了一例血液透析患者合并感染SARS-CoV-2的病例。即使包括流感在内的其他病毒可以解释临床症状，也不应忽视SARS-CoV-2合并感染的可能性。尤其是高危患者。
