The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19: a case report

Liba Sokolovska; Anna Terentjeva-Decuka; Maksims Cistjakovs; Zaiga Nora-Krukle; Sabine Gravelsina; Anda Vilmane; Katrine Vecvagare; Modra Murovska

doi:10.1186/s13256-022-03706-y

The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19: a case report

Liba Sokolovska (Corresponding Author), Anna Terentjeva-Decuka, Maksims Cistjakovs, Zaiga Nora-Krukle, Sabine Gravelsina, Anda Vilmane, Katrine Vecvagare, Modra Murovska

Institute of Microbiology and Virology

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

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Abstract

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.

CASE PRESENTATION: 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.

Original language	English
Article number	484
Journal	Journal of Medical Case Reports
Volume	16
Issue number	1
DOIs	https://doi.org/10.1186/s13256-022-03706-y
Publication status	Published - 22 Dec 2022

Keywords*

Humans
Male
Aged, 80 and over
COVID-19
SARS-CoV-2
Leukocytes, Mononuclear
COVID-19 Testing
Lung
Antibodies, Viral
RNA, Viral

Field of Science*

3.1 Basic medicine
3.2 Clinical medicine

Publication Type*

1.1. Scientific article indexed in Web of Science and/or Scopus database

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s13256-022-03706-yLicence: CC BY

The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19Final published version, 1.29 MBLicence: CC BY

Cite this

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title = "The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19: a case report",

abstract = "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.CASE PRESENTATION: 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.",

keywords = "Humans, Male, Aged, 80 and over, COVID-19, SARS-CoV-2, Leukocytes, Mononuclear, COVID-19 Testing, Lung, Antibodies, Viral, RNA, Viral",

author = "Liba Sokolovska and Anna Terentjeva-Decuka and Maksims Cistjakovs and Zaiga Nora-Krukle and Sabine Gravelsina and Anda Vilmane and Katrine Vecvagare and Modra Murovska",

note = "Funding Information: This case was investigated as a part of a research project called {"}Clinical, biochemical, immunogenetic paradigms of Covid-19 infection and their correlation with socio-demographic, etiological, pathogenetic, diagnostic, therapeutically and prognostically important factors to be included in guidelines{"} (VPP-COVID-2020/1-0023) funded by the National Research Program {"}COVID-19 Mitigation{"}. The sample collection was funded by the Boris and Ināra Teterev Foundation. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

day = "22",

doi = "10.1186/s13256-022-03706-y",

language = "English",

volume = "16",

journal = "Journal of Medical Case Reports",

issn = "1752-1947",

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number = "1",

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TY - JOUR

T1 - The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19

T2 - a case report

AU - Sokolovska, Liba

AU - Terentjeva-Decuka, Anna

AU - Cistjakovs, Maksims

AU - Nora-Krukle, Zaiga

AU - Gravelsina, Sabine

AU - Vilmane, Anda

AU - Vecvagare, Katrine

AU - Murovska, Modra

N1 - Funding Information: This case was investigated as a part of a research project called "Clinical, biochemical, immunogenetic paradigms of Covid-19 infection and their correlation with socio-demographic, etiological, pathogenetic, diagnostic, therapeutically and prognostically important factors to be included in guidelines" (VPP-COVID-2020/1-0023) funded by the National Research Program "COVID-19 Mitigation". The sample collection was funded by the Boris and Ināra Teterev Foundation. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12/22

Y1 - 2022/12/22

N2 - 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.CASE PRESENTATION: 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.

AB - 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.CASE PRESENTATION: 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.

KW - Humans

KW - Male

KW - Aged, 80 and over

KW - COVID-19

KW - SARS-CoV-2

KW - Leukocytes, Mononuclear

KW - COVID-19 Testing

KW - Lung

KW - Antibodies, Viral

KW - RNA, Viral

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DO - 10.1186/s13256-022-03706-y

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JO - Journal of Medical Case Reports

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ER -

The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19: a case report

Abstract

Keywords*

Field of Science*

Publication Type*

UN SDGs

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Clinical, biochemical, immunogenetic paradigms of Covid-19 infection and their correlation with socio-demographic, etiological, pathogenetic, diagnostic, therapeutically and prognostically important factors to be included in guidelines

Cite this

The presence of SARS-CoV-2 in multiple clinical specimens of a fatal case of COVID-19: a case report

Abstract

Keywords*

Field of Science*

Publication Type*

UN SDGs

Access to Document

Other files and links

Fingerprint

Projects

Clinical, biochemical, immunogenetic paradigms of Covid-19 infection and their correlation with socio-demographic, etiological, pathogenetic, diagnostic, therapeutically and prognostically important factors to be included in guidelines

Cite this