背景:发展为严重甚至致命的冠状病毒病2019(COVID-19)的风险随着高龄和慢性疾病等各种因素而增加,尤其是那些用免疫抑制药物治疗的。已提出肺外标本中的病毒核糖核酸(RNA)和病毒载量检测来指示疾病的严重程度。
方法:在这里,我们描述了一例83岁的高加索男性患者的致命COVID-19病例,该病例具有各种潜在的合并症,包括心血管和自身免疫性疾病,以及淋巴瘤治疗引起的免疫抑制。一被录取,患者经放射学诊断为重症COVID-19.病人发热并出现腹泻,持续呼吸困难,呼吸急促,血氧饱和度低,用高浓度氧气补充和抗菌治疗。总体而言,患者接受了19天的COVID-19治疗。入院时进行血液检查,第五,第十,13,第19天。此外,鼻咽拭子,血,尿液,在第14天收集患者的粪便样本,用于病毒学和免疫学研究。在从该患者收集的所有样本中均可检测到严重急性呼吸系统综合症冠状病毒2(SARS-CoV-2),包括血浆和外周血单核细胞(PBMC),病毒载量非常高。然而,既不是病毒特异性IgA,IgM,也检测到IgG抗体。
结论:各种心血管疾病,自身免疫,和肿瘤疾病,高龄,和高水平的炎症标志物使患者易患严重的COVID-19,并确定了该疾病的致命结局。我们认为,鼻咽拭子和粪便样本中的SARS-CoV-2阳性和极高的病毒载量是COVID-19严重程度的结果,由于高龄,病毒无法清除和免疫反应减弱,合并症,以及非霍奇金淋巴瘤的存在和免疫抑制治疗,强调此类患者中COVID-19的风险。
BACKGROUND: The risk of developing severe and even fatal coronavirus disease 2019 (COVID-19) increases with various factors such as advanced age and chronic diseases, especially those treated with immunosuppressive drugs. Viral ribonucleic acid (RNA) and viral load detection in extra-pulmonary specimens have been proposed to indicate disease severity.
METHODS: Here we describe a fatal COVID-19
case of an 83-year-old Caucasian male patient with various underlying comorbidities, including cardiovascular and autoimmune disorders, as well as immunosuppression due to lymphoma treatment. Upon admission, the patient was radiologically diagnosed with severe COVID-19. The patient was febrile and presented with diarrhea, continued dyspnea, tachypnea, and low blood oxygen saturation, treated with high-concentration oxygen supplementation and antibacterial therapy. Overall the patient was treated for COVID-19 for 19 days. Blood tests were performed upon admission, on the fifth, 10th, 13th, and 19th day. In addition, nasopharyngeal swab, blood, urine, and fecal samples were collected from the patient on the 14th day for virological and immunological investigations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in all samples collected from this patient, including blood plasma and peripheral blood mononuclear cells (
PBMC), with very high viral loads. However, neither virus-specific IgA, IgM, nor IgG antibodies were detectable.
CONCLUSIONS: The various cardiovascular, autoimmune, and oncological disorders, advanced age, and the high levels of inflammatory markers predisposed the patient to severe COVID-19 and determined the fatal outcome of the disease. We believe that the multiple specimen SARS-CoV-2 positivity and extremely high viral loads in nasopharyngeal swab and fecal samples to be the result of COVID-19 severity, the inability of viral clearance and weakened immune response due to advanced age, comorbidities, and the presence of non-Hodgkin\'s lymphoma and the immunosuppressive treatment for it, highlighting the risks of COVID-19 in such patients.