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

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 pa-tients. 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 hos-pital with multiple co-morbidities, hypertension, diagnosed axial spondy-loarthropathy (ankylosing spondylitis) taking disease modifying anti rheu-matic drugs— DMARDs (Salfasalazine) from 2016 till now, chronic persis-tent 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 (glomerulone-phritis) 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 Iver-mectin (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 nega-tive 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 asso-ciated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.

COVID-19 Disease Complicated with Severe Pneumonia in a Patient with End Stage Renal Disease (ESRD): A Case Report from Bangladesh

Background: Since 2019, the pandemic of Coronavirus disease 2019 (COVID-19) has spread very rapidly in China and Worldwide. COVID-19 is a highly contagious, infectious and rapidly spreading viral disease with an alarming case fatality rate up to 5%. Case Report: In this article, we report a case of 60 years old non diabetic, hypertensive woman infected with COVID-19 who has end stage renal disease (ESRD) on hemodialysis for last 18 months. COVID-19 patients with ESRD need isolation dialysis but most of them cannot be handled properly due to limited hemodialysis machine. With these unavailability and risk, we continue the treatment along with hemodialysis for controlling uraemia and fluid balance. With all effort this patient ended with an uneventful course with clinical improvement, improvement of all laboratory parameters and resolution of radiological findings but follow up RT-PCR cannot done due to changing guideline of discharge criteria of COVID-19 patient in Bangladesh. He positively responded to meropenem, clarithromycin, favipiravir, thromboprophylaxis with enoxaparin along with supplemental oxygen therapy. After that she was discharged with an advice of 14 days home isolation with regular hemodialysis and a follow up visit after 14 days in the outpatient department. Conclusion: An ESRD patient on regular hemodialysis suffering from severe pneumonia has high risk of mortality. Combined effort from the health care workers are needed to decrease the mortality of COVID-19 infected ESRD patients.