|Year : 2022 | Volume
| Issue : 2 | Page : 169-171
Covid – 19 infection and treatment: Still an unfolding clinical scenario
Basil N Okeahialam
Department of Medicine, Cardiology Sub-Unit 1, Jos University Teaching Hospital, Jos, Nigeria
|Date of Submission||20-Jun-2022|
|Date of Acceptance||24-Nov-2022|
|Date of Web Publication||11-Jan-2023|
Basil N Okeahialam
Department of Medicine, Cardiology Sub-Unit 1, Jos University Teaching Hospital, Jos
Source of Support: None, Conflict of Interest: None
COVID-19 infection was declared a pandemic by the World Health Organization due to its widespread nature and devastating effect on health, demography, and economics all over the world. The disease has evolved fast, changing treatment paradigms as its pathophysiology became clearer. Lately, a vaccine was introduced, and its effects and efficacy have come to be a thing of challenge as experience continues to be gained. In this case report, the author shares his experience of unfolding scenarios with treatment of the disease in his clinical environment.
Keywords: Adverse effects, COVID-19, drugs, treatment choices, vaccination
|How to cite this article:|
Okeahialam BN. Covid – 19 infection and treatment: Still an unfolding clinical scenario. Santosh Univ J Health Sci 2022;8:169-71
|How to cite this URL:|
Okeahialam BN. Covid – 19 infection and treatment: Still an unfolding clinical scenario. Santosh Univ J Health Sci [serial online] 2022 [cited 2023 Jan 28];8:169-71. Available from: http://www.sujhs.org/text.asp?2022/8/2/169/367563
| Introduction|| |
COVID-19 infection came upon mankind in 2019. Initially, not much was known about its evolution making initial treatment rather supportive. As knowledge about the disease improved, treatment paradigms changed. Later, a vaccine was approved which was met initially with skepticism and later hesitancy, arising from conspiracy theories and reports of reinfection and thromboembolic phenomena. Several drug targets have been touted. A potential benefit of serine protease inhibitors has been speculated but experiences though encouraging are still anecdotal.
The following cases are being reported to share the experience with clinicians as more is still unfolding in this area of clinical enterprise.
| Case Reports|| |
A 41-year-old female consulted the author early in October 2021 with fever, weakness, cough, and other flu-like symptoms. Having tested positive to COVID-19 in 2020 when she had similar symptoms, she put herself back of the cocktail of drugs availed her then namely: azithromycin, chloroquine, cetirizine, dexamethasone, and ibuprofen. She discontinued them after 3 days due to tinnitus and reduced hearing followed quickly by vertigo. On evaluation in another facility for these, her blood pressure which had been normal was noted to be elevated. This prompted her presentation to the author.
On examination, she looked acutely ill. All systems were normal except the cardiovascular system that revealed a tachycardia of 108/min and hypertension of 210/110 mmHg. An ongoing COVID-19 infection with side effect to chloroquine was suspected. She was given nattokinase 670 before breakfast and 1340 FU before dinner, cinnarizine 25 mg b. d., lisinopril 5 mg, and nebivolol/hydrochlorothiazide 5/12.5, and advised to go for screening and self-isolation. On review after 2 weeks, she was now feeling well. She only self-isolated and had not gone for screening as advised. Blood pressure had started coming down and stood at 190/96 mmHg with a pulse of 92/min. Metabolic profile was normal except for hypercholesterolemia. Initial treatment was sustained with addition of atorvastatin 40 mg daily.
A 40-year-old female presented in October 2021 with a history of gestational diabetes mellitus with each of her earlier pregnancies, which would usually clear after delivery while on dietary modification. After the delivery of her second baby early in 2021, she developed postpartum depression and new-onset hypertension and was put on antidepressants with lifestyle modification only for her mild hypertension. In April 2021, she had her first shot of AstraZeneca COVID-19 vaccine. Her diabetes that was hitherto controlled on diet only, now needed oral hypoglycemic agents, namely, metformin at 1 g 12 hourly. After the second dose, her blood pressure rose higher, and she developed palpitations with sensation of weight on her chest prompting her presentation to the author.
On examination, she was overweight. Cardiovascular system examination revealed a tachycardia of 104/min and blood pressure of 140/106 mmHg. On abdominal examination, the only significant finding was a tipped liver. Vaccine-induced hypertension and worsened diabetes mellitus were suspected. She was maintained on her metformin at the same dose but had bisoprolol and nattokinase introduced. She was asked to run some tests and return in a fortnight.
When she returned for her review, her full blood count was normal except for a reduced packed cell volume of 35%. Liver function test was borderline with marginally raised alkaline phosphatase, alanine, and aspartate transaminase. Cardiac enzymes were essentially normal. Only lactate dehydrogenase and total creatinine phosphokinase were marginally raised. Electrocardiography showed voltage criteria for left ventricular hypertrophy only with no ischemic features. She was feeling a lot better. She no longer had palpitations, and chest discomfort had become milder. Her blood pressure was down to 108/69 mmHg and pulse rate was 81/min. Her oral hypoglycemic agent was adjusted slightly given the glycosylated hemoglobin result of 6.8%. Nattokinase and bisoprolol were continued and a hematinic was introduced.
| Discussion|| |
More is becoming manifest with the COVID-19 infection with the passage of time and close observation of patients. Some of these are changing the treatment paradigm. For instance, it was the discovery that thrombotic clots plugged and blocked the lung alveolar capillaries in those dying from the disease that changed treatment emphasis from ventilators and supplemental oxygen to anticoagulants and thrombolytic agents.
Two cases are herein reported: the first developing new-onset hypertension and vertigo. She had been confirmed a case of COVID-19 1 year previously and responded to treatment. When one year later she presented in a similar manner, she put herself on the same treatment availed her the first time. She, however, developed tinnitus, reduced hearing, and vertigo. Although probably related to chloroquine, it must be mentioned that audiovestibular disorders have been reported with COVID-19 infection, specifically sensorineural hearing loss occurring singly or with tinnitus and vertigo. Curiously, she developed severe hypertension and tachycardia. New-onset hypertension in the circumstance could be ascribed to dexamethasone use or psychological stress, but reports exist of new-onset hypertension as a sequela of COVID-19 infection. It is speculated that the binding of the virus to the angiotensin-converting enzyme-2 receptor inhibits the degradation of angiotensin II, thus fueling the elevation of blood pressure.
In the second case, the patient after receiving the AstraZeneca vaccine being deployed in Nigeria had her diabetes worsened. After the second shot, she developed symptoms of acute coronary syndrome. Exacerbation of hyperglycemia in patients with type 2 diabetes mellitus after COVID-19 vaccination has been reported in India, but not in our environment to the best of the author's knowledge. One of the cases reported in the Indian paper, apart from hyperglycemia, recorded elevated blood pressure. Although the mechanism is not clear, it has been speculated to result from damage albeit transient of the pancreatic beta-cells. As posited by Pal et al., there is a likelihood that vaccination to COVID-19 may cause a sudden increase in glycemic level. In the opinions of the author, this would be more likely in patients with background dysglycemia as the patient reported herein. Although rare and transient, vaccination against COVID-19 has been reported to cause spontaneous abortion in pregnancy and thrombotic events.
A point of interest cutting across both cases is improvement in general status with NattoEnzym brand of nattokinase (DHG PHARMA, DHG PHARMACEUTICAL JOINT STOCK COMPANY, 288 Bis Nguyen Van Cu Street, An Hoa Ward, North Kieu District, Can Tho City, Vietnam), a serine protease inhibitor. As posited by the author in an earlier publication, serine protease inhibitors may have a beneficial role in COVID-19 infection. The report by Jena lends support to this.
COVID-19 disease could perturb the cardiometabolic status of patients by causing new-onset hypertension or diabetes mellitus. If present before the infection, these could get worse. Its treatment in rare cases could cause symptoms which can otherwise result primarily from the infection. . Vaccinations are beneficial and effective, but in rare instances could cause transient cardiometabolic adverse effects. These make pharmacovigilance and continuing postmarketing surveillance compelling. As COVID-19 disease and its treatment evolve, all caregivers should look out for clues that could impact one way or the other on treatment and outcome of the disease.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jena NR. Drug targets, mechanisms of drug action and therapeutics against SARS-CoV-2. Chem Phy Impact 2021;2:2021.
Okeahialam BN. Serine protease inhibitors could be of benefit in the treatment of COVID-19 disease. Ther Adv Infect Dis 2021;8:20499361211032048.
Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al.
Pulmonary thrombosis in Covid-19: Before, during and after hospital admission. J Thromb Thrombolysis 2021;51:978-84.
Fancello V, Hatzopoulos S, Corazzi V, Bianchini C, Skarżyńska MB, Pelucchi S, et al.
SARS-CoV-2 (COVID-19) and audio-vestibular disorders. Int J Immunopathol Pharmacol 2021;35:20587384211027373.
Mishra A, Ghosh A, Dutta K, Tyagi K, Misra A. Exacerbation of hyperglycemia in patients with type 2 diabetes after vaccination for COVID19: Report of three cases. Diabetes Metab Syndr 2021;15:102151.
Chen G, Li X, Gong Z, Xia H, Wang Y, Wang X, et al.
Hypertension as a sequela in patients of SARS-CoV-2 infection. PLoS One 2021;16:e0250815.
Misra A, Ghosh A, Gupta R. Heterogeneity in presentation of hyperglycaemia during COVID-19 pandemic: A proposed classification. Diabetes Metab Syndr 2021;15:403-6.
Pal R, Bhadada SK, Misra A. COVID-19 vaccination in patients with diabetes mellitus: Current concepts, uncertainties and challenges. Diabetes Metab Syndr 2021;15:505-8.
Kharbanda EO, Haapala J, DeSilva M, Vazquez-Benitez G, Vesco KK, Naleway AL, et al.
Spontaneous abortion following COVID-19 vaccination during pregnancy. JAMA 2021;326:1629-31.
Tobaiqy M, Elkout H, MacLure K. Analysis of thrombotic adverse reactions of COVID-19 astrazeneca vaccine reported to eudravigilance database. Vaccines (Basel) 2021;9:393.