Case series in Indonesia: B.1.617.2 (delta) variant of SARS-CoV-2 infection after a second dose of vaccine.

BACKGROUND: The B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered in Maharashtra in late 2020 and has rapidly expanded across India and worldwide. It took only 2 mo for this variant to spread in Indonesia, making the country the new epicenter of the delta variant as of July 2021. Despite efforts made by accelerating massive rollouts of current vaccines to protect against infection, cases of fully-vaccinated people infected with the delta variant have been reported. AIM: To describe the demographic statistics and clinical presentation of the delta variant infection after the second dose of vaccine in Indonesia. METHODS: A retrospective, single-centre case series of the general consecutive population that worked or studied at Faculty of Medicine, Universitas Indonesia with confirmed Delta Variant Infection after a second dose of vaccine from 24 June and 25 June 2021. Cases were collected retrospectively based on a combination of author recall, reverse transcription-polymerase chain reaction (RT-PCR), and whole genome sequencing results from the Clinical Microbiology Laboratory, Faculty of Medicine, Universitas Indonesia. RESULTS: Between 24 June and 25 June 2021, 15 subjects were confirmed with the B.1.617.2 (delta) variant infection after a second dose of the vaccine. Fourteen subjects were vaccinated with CoronaVac (Sinovac) and one subject with ChAdOx1 nCoV-19 (Oxford-AstraZeneca). All of the subjects remained in home isolation, with fever being the most common symptom at the onset of illness (n = 10, 66.67%). The mean duration of symptoms was 7.73 d (± 5.444). The mean time that elapsed from the first positive swab to a negative RT-PCR test for SARS-CoV-2 was 17.93 d (± 6.3464). The median time that elapsed from the second dose of vaccine to the first positive swab was 87 d (interquartile range: 86-128). CONCLUSION: Although this case shows that after two doses of vaccine, subjects are still susceptible to the delta variant infection, currently available vaccines remain the most effective protection. They reduce clinical manifestations of COVID-19, decrease recovery time from the first positive swab to negative swab, and lower the probability of hospitalization and mortality rate compared to unvaccinated individuals.

Tocilizumab as a Treatment for 'Cytokine Storm Syndrome' in COVID-19: A Case Report.

Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects.

In-hospital mortality of pulmonary tuberculosis with acute respiratory failure and related clinical risk factors.

BACKGROUND/OBJECTIVE: Data on acute respiratory failure (ARF) in pulmonary tuberculosis (PTB) patients is limited. This study aims to investigate in-hospital mortality, its clinical risk factors and the accuracy of the existing scoring system in predicting in-hospital mortality. METHODS: An observational prospective cohort study involving PTB patients with ARF in tertiary hospital, between January 2017 and December 2018, was conducted. The in-hospital mortality was predicted using the National Early Warning Score 2 (NEWS2), quick Sequential Organ Failure Assessment (qSOFA) and CRB-65. Regression models were run to analyze the clinical risk factors for in-hospital Mortality. Sensitivity and specificity of scoring systems were calculated using a Wilson score interval. RESULTS: A total of 111 subjects were included. Most of subjects were hypoxemic type respiratory failure (68.5%), advanced lesions (62.2%), new cases (70.3%) and pneumonia co-infection (72.1%) patients. Invasive mechanical ventilation was utilized for 29.73% of cases. There were 53 (47.75%) in-hospital mortality cases and its risk factors were intensive phase treatment (3.34 OR; CI95% 1.27-8.78), P/F ratio < 100 (OR 4.30; CI 95% 1.75-10.59) and renal insufficiency (4.09 OR; CI95% 1.46-11.49). The sensitivity and specificity of NEWS2 ≥ 6, qSOFA ≥ 2 and CRB-65 ≥ 2 were 62.26% and 67.24%; 60.38% and 72.41%; 41.51% and 84.48% respectively. CONCLUSIONS: Most of PTB with ARF were new cases, advanced lesion and hypoxemic type respiratory failure. Intensive phase treatment, severe hypoxemia and renal insufficiency are independent predictors of in-hospital mortality in PTB patients with ARF. NEWS2, qSOFA and CRB-65 scores were poor to predict the in-hospital mortality.