Çınar Güle, Sarıcaoğlu Cahit, İnan Bahadır, Dinçer İrem, Çakıcı Mehmet, Sayın Tamer, Azap Alpay, Akar Ahmet Rüçhan
Department of Infectious Diseases and clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey.
Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Oct 21;28(4):674-679. doi: 10.5606/tgkdc.dergisi.2020.20291. eCollection 2020 Oct.
Any highly infectious and rapidly spreading disease is a primary concern for immunocompromised solid organ transplant recipients. The number of data about the spectrum of clinical illness, the treatment modalities, and the outcomes of COVID-19 in this vulnerable population is scant and still remains empirical. Herein, we report the first COVID-19 case of a heart transplant recipient in Turkey who presented with fever, postnasal discharge, and myalgias for two days. The possibility of lung involvement was ruled out by thoracic computed tomography. Despite stable vital signs, we reduced the intensity of immunosuppressive therapy and maintained home self-isolation promptly. We also commenced a five-day course of hydroxychloroquine 200 mg q12h initially. After confirmation of real-time reverse-transcriptase-polymerasechain- reaction testing of the nasopharyngeal swab positive for COVID-19, the patient was hospitalized. After a loading dose of favipiravir 1,600 mg b.i.d., the patient received a five-day course of favipiravir 600 mg q12h. He was discharged with cure after 23 days of hospital isolation and treatment. In conclusion, treatment process can be affected by the daily electrocardiography, hand-held portable echocardiography, myocardial injury markers, and pulse oximeter for selfmonitoring in the follow-up of previous heart transplant recipients suffering from COVID-19. The lack of treatment protocols in the solid organ transplant recipients with COVID-19 infection and the controversies about the protective effect of immunosuppression invite a global and update discussion.
任何具有高度传染性且传播迅速的疾病都是免疫功能低下的实体器官移植受者的主要担忧。关于这一脆弱人群中 COVID-19 的临床疾病谱、治疗方式和结局的数据很少,仍然基于经验。在此,我们报告了土耳其首例心脏移植受者的 COVID-19 病例,该患者出现发热、鼻后滴漏和肌痛两天。胸部计算机断层扫描排除了肺部受累的可能性。尽管生命体征稳定,我们还是立即降低了免疫抑制治疗的强度并保持居家自我隔离。我们还最初开始了为期五天的羟氯喹治疗,剂量为 200 毫克,每 12 小时一次。在鼻咽拭子实时逆转录聚合酶链反应检测确诊为 COVID-19 阳性后,患者住院治疗。在给予法匹拉韦 1600 毫克每日两次的负荷剂量后,患者接受了为期五天的法匹拉韦治疗,剂量为 600 毫克,每 12 小时一次。经过 23 天的医院隔离和治疗后,患者治愈出院。总之,对于先前患有 COVID-19 的心脏移植受者,在随访过程中,每日心电图、手持式便携式超声心动图、心肌损伤标志物和脉搏血氧仪进行自我监测可能会影响治疗过程。COVID-19 感染的实体器官移植受者缺乏治疗方案以及免疫抑制的保护作用存在争议,这引发了全球范围的讨论并需要更新。