3 Case presentation
Concerning C/T adherence, C/T ingestion was possible every day in all patients.
Case 1
Patient: A woman in her nineties.
Complaint: Fever.
Medical history: Intestinal obstruction and dementia/hearing loss.
Infectious disease/allergy: Absent.
Present illness: In a nursing-care facility to which she had been admitted, it was clarified that a resident had novel coronavirus infection on X month 8th, 2020. Fever was noted on X month 10th and PCR testing was conducted on the same day. A positive reaction was detected and she was admitted to our hospital on X month 11th.
Physical examination on admission: The height, body weight, and body mass index (BMI) were 150 cm, 40 kg, and 17.78, respectively. The blood pressure, pulse rate, and body temperature were 121/59 mmHg, 71/min, and 36.8°C (after the oral administration of Acetaminophen), respectively.
Laboratory data on admission: Chest X-ray did not demonstrate pneumonia. The TB, AST, ALT, ALP, LDH, γ-GTP, ChE, TP, Alb, Cr, BUN, and CRP levels were 0.26 mg/dL, 20 IU/L, 10 IU/L, 230 IU/L, 218 IU/L, 16 IU/L, 256 IU/L, 6.9 g/dL, 3.6 g/dL, 0.79 mg/dL, 13.3 mg/dL, and 0.30 mg/dL, respectively. The HbA1c value, WBC, RBC, Hb level, Ht value, PLT count, PT-INR, D-dimer level, and ferritin level were 5.6%, 4,000/µL (Neut/Lymp=1.19), 438 x 104/µL, 12.9 g/dL, 39.4%, 26.5 x 104/µL, 0.92, 3.3 µg/mL, and 169.3 ng/mL, respectively.
Course after admission: Slight fever (37.0 to 37.9°C) persisted, but fever (>38°C) was sometimes observed. The CRP level ranged from 4 to 5 mg/dL. The general condition was maintained, and the patient was discharged on May 21st. No antiviral drug, such as Favipiravir, was used (admission period: 41 days).
C/T administration and PCR testing results
One pack/day of C/T was administered from X+1 month 15th, and this was continued until X+1 month 21st. In this patient, negative and positive reactions on PCR testing were repeatedly detected 4 times, but negative reactions on two consecutive sessions of PCR testing were obtained 5 and 6 days after the start of C/T administration (Figure a).
Case 2
Patient: A woman in her nineties.
Complaint: Fever.
Medical history: Dementia.
Infectious disease/allergy: Absent.
Present illness: In a nursing-care facility to which she had been admitted, it was clarified that a resident had novel coronavirus infection on X month 8th, 2020. Fever was noted on X month 10th and PCR testing was conducted on the same day. A positive reaction was detected and she was admitted to our hospital on X month 11th.
Physical examination on admission: The height, body weight, and BMI were 136 cm, 37.8 kg, and 20.44, respectively. The SpO2 was 96% (room air). The blood pressure, pulse rate, and body temperature were 156/87 mmHg, 69/min, and 36.8°C, respectively.
Laboratory data on admission: Chest X-ray did not demonstrate pneumonia. The TB, AST, ALT, ALP, LDH, γ-GTP, ChE, TP, Alb, Cr, BUN, and CRP levels were 0.35 mg/dL, 36 IU/L, 22 IU/L, 260 IU/L, 181 IU/L, 24 IU/L, 227 IU/L, 6.0 g/dL, 3.6 g/dL, 0.47 mg/dL, 12.0 mg/dL, and 0.32 mg/dL, respectively. The HbA1c value, WBC, RBC, Hb level, Ht value, PLT count, PT-INR, D-dimer level, and ferritin level were 5.4%, 4,600/µL (Neut/Lymp=1.63), 410 x 104/µL, 12.8 g/dL, 38.7%, 18.3 x 104/µL, 0.92, 0.9 µg/mL, and 91.6 ng/mL, respectively.
Course after admission: As fever persisted, the administration of Ceftriaxon at 2 g was started on X month 13th. On X month 14th, the body temperature, respiratory rate, and SpO2 were 38.1°C, 22 times/min, and 93% (room air), respectively. Chest X-ray did not demonstrate pneumonia. Subsequently, fever transiently reduced, but it recurred on X month 18th. Antibiotic therapy was continued and pyretolysis was achieved on X month 20th. The subsequent condition was stable and the patient was discharged on X+1 month 30th (admission period: 50 days).
No antiviral drug, such as Favipiravir, was used.
C/T administration and PCR testing results
One pack/day of C/T was administered from X+1 month 15th. Even after the start of C/T administration, positive reactions on PCR testing persisted, and the dose was increased to 2 packs from X+1 month 26th. After 3 days, a negative reaction was obtained for the first time. In addition, two consecutive sessions of PCR testing yielded negative reactions (Figure b).
Case 3
Patient: A woman in her forties.
Complaint: Dysgeusia.
Medical history: Not contributory.
Infectious disease/allergy: Absent.
Present illness: Malaise developed on X month 21st, 2020. Headache, nasal obstruction, mild cough, and slight fever were noted from X month 24th. Dysgeusia was observed on X month 27th. PCR testing yielded a positive reaction and the patient was admitted on X month 28th.
Physical examination on admission: The height, body weight, and BMI were 156 cm, 46 kg, and 18.90, respectively. The SpO2 was 98% (room air). Headache, cough, nasal obstruction, and mild dysgeusia were present. Slight malaise was noted. The blood pressure, pulse rate, and body temperature were 122/78 mmHg, 71/min, and 37.5°C, respectively.
Laboratory data on admission: Chest X-ray did not demonstrate pneumonia. The TB, AST, ALT, ALP, LDH, γ-GTP, ChE, TP, Alb, Cr, BUN, and CRP levels were 0.33 mg/dL, 16 IU/L, 10 IU/L, 125 IU/L, 135 IU/L, 10 IU/L, 230 IU/L, 6.3 g/dL, 3.5 g/dL, 0.45 mg/dL, 7.8 mg/dL, and 0.10 mg/dL, respectively. The WBC, RBC, Hb level, Ht value, PLT count, PT-INR, D-dimer level, and ferritin level were 2,700/µL (Neut/Lymp=0.88), 403 x 104/µL, 10.9 g/dL, 32.3%, 18.6 x 104/µL, 0.91, 0.8 µg/mL, and 21.5 ng/mL, respectively.
Course after admission: Headache, slight fever, nasal obstruction, cough, and dysgeusia persisted, but the oral administration of Acetaminophen reduced headache. Pyretolysis was achieved on X+1 month 3rd. Headache subsided on X+1 month 4th and taste was normalized. Subsequently, mild nasal obstruction and cough gradually reduced, and the patient was discharged on X+1 month 21st (admission period: 24 days).
No antiviral drug, such as Favipiravir, was used.
C/T administration and PCR testing results
One pack/day of C/T was administered from X+1 month 15th and this was continued until X+1 month 21st. The results of PCR testing were negative 5 and 6 days after the start of C/T administration (Figure c).
Case 4
Patient: A man in his forties.
Complaint: Dysgeusia.
Medical history: Fracture of the right lower thigh (20 years previously).
Infectious disease/allergy: Absent.
Smoking: Twenty cigarettes x 15 years. Smoking cessation was achieved in the latter half of his thirties.
Present illness: Fever (38°C) and cough developed on X+1 month 5th, 2020. Malaise was noted on X+1 month 6th. Dysgeusia was observed on X+1 month 7th. PCR testing was conducted. On the same day, a positive reaction was detected and the patient was admitted.
Physical examination on admission: The height, body weight, and BMI were 168 cm, 64 kg, and 22.68, respectively. The SpO2 was 96% (room air). Nasal discharge and mild cough were present. Slight malaise was noted. Dysgeusia and dysosmia were noted. The blood pressure, pulse rate, and body temperature were 128/92 mmHg, 94/min, and 38.3°C, respectively.
Laboratory data on admission: Chest X-ray did not demonstrate pneumonia. The TB, AST, ALT, ALP, LDH, γ-GTP, ChE, TP, Alb, Cr, BUN, CRP, and Zn levels were 0.38 mg/dL, 25 IU/L, 24 IU/L, 128 IU/L, 201 IU/L, 38 IU/L, 395 IU/L, 6.4 g/dL, 3.7 g/dL, 0.83 mg/dL, 8.8 mg/dL, 1.18 mg/dL, and 51 µg/dL, respectively. The WBC, RBC, Hb level, Ht value, PLT count, PT-INR, D-dimer level, and ferritin level were 3,500/µL (Neut/Lymp=3.31), 475 x 104/µL, 14.2 g/dL, 41.9%, 14.6 x 104/µL, 1.03, 1.0 µg/mL, and 175.9 ng/mL, respectively.
Course after admission: The general condition was stable, but fever, nasal discharge, cough, and malaise persisted. Dysgeusia reduced from X+1 month 10th. Pyretolysis was achieved on X+1 month 13th. Blood testing revealed slight increases in the CRP, ferritin, and D-dimer levels (1.27 mg/dL, 278.7 ng/mL, and 3.0 µg/mL, respectively), in addition to a decrease in the Zn level (62 µg/dL) on X+1 month 14th. Chest X-ray revealed a slight peripheral shadow in the right lower lung field. Subsequently, mild cough was present, but the course was favorable. The patient was discharged on X+1 month 27th (admission period: 21 days).
No antiviral drug, such as Favipiravir, was used.
C/T administration and PCR testing results
One pack/day of C/T was administered from X+1 month 15th and this was continued until X+1 month 27th. PCR testing yielded a positive reaction 4 days after the start of C/T administration, but negative reactions were obtained 11 and 12 days after its initiation (Figure d).