Medical Case Reports

COVID-19 has posed numerous challenges since its emergence, and one area of concern has been the phenomenon of frequent reinfections.  In a recent study, based on UK's national COVID-19 Infection Survey, seven participants experienced COVID-19 reinfection five times.  Among these participants, identified as white females aged 21–50 years, three reported having a long-term health condition, and two were healthcare workers. The study also analyzed the variants, symptoms, and cycle threshold (Ct) values associated with these reinfections (see table) The study revealed that while reinfections increased after the emergence of Omicron variants, they were generally less severe than initial infections, associated with lower viral load and fewer reported symptoms compared to first infections. Several factors were identified as influencing the risk of reinfection. Age played a significant role, with individuals aged 30–45 years being at higher risk ( likely due to increased exposure )....

The respiratory viruses are out there.  Wastewater viral activity levels for COVID-19 , as reported by the Centers for Disease Control and Prevention, have reached the highest point since the Omicron surge in 2022. The levels are also high in Canada . The three primary respiratory illnesses continue to circulate at very high levels. But despite the triple threat of  SARS-Cov-2, respiratory syncytial virus ( RSV ) and the flu , there is a notable lack of community attention.   JN.1 (Pirola,  BA.2.86 ,  with additional L455S mutation, descending from a  de-escalated  variant of concern BA.2), initially detected on August 25 2023, has evolved from a variant under monitoring to a  variant of interest. Variants like Acrux (XBB.2.3, that began to spread worldwide soon after WHO declared the end of the pandemic) are  no longer relevant , but a few now less prevalent variants such as  Centaurus  (BA.2.75) and XBB, a hybrid of Centaurus wit...

As the world gradually moves forward from the darkest days of the COVID-19 pandemic, we are reminded that the battle is not yet over.  Otari Gogiberidze (July 14, 1971 - September 8, 2023), a renowned plastic surgeon, faced the grim reality of COVID-19 in February 2023. Little did he know that the virus would cast a long shadow over his life. Battling for months with heart complications stemming from long COVID, his fight came to an end on September 8, 2023, when he succumbed to cardiac arrest at the age of 52. Maria das Dores Braga Nunes  (4 April 1941 – 8 September 2023) was a distinguished Brazilian lawyer and politician. Throughout her career, she was associated with various political parties, and she served as a member of the Chamber of Deputies from 1995 to 1999. Additionally, she held the position of mayor in Gurupi. Tragically, on September 8, 2023, at the age of 82, Maria das Dores Braga Nunes lost her life to COVID-19 in Palmas, Tocantins. Her battle with the ...

In the early stages of the COVID-19 pandemic, reactivation and reinfection were considered rare. However, as the pandemic progressed, records for the length of infection and number of reinfections began to break. By October 2020, there were five cases of reinfection  with more severe second cases. By the end of 2021, prolonged positive tests were observed, such as a man in Bristol who remained SARS-CoV-2  positive for 290 days . A case report published in May 2023 (aren't academic reports obsolete by the time they are finally published?) asked " Is it possible to get Covid infection 3 times? " in the title. Now this question is rhetorical. In a recent  Malawi study , the risk of reinfection was highest in the immediate 3 to 6 months following the initial infection and declined substantially after that, and age demonstrated a significant association with reinfection. In  Southern Brazil , comparative genomic and phylogenetic analysis confirmed that the fourt...

A 35-year-old woman with history of cardiovascular disease presented with shortness of breath, lightheadedness, fatigue, chest pain, and premature ventricular contractions (pericarditis) 3 weeks after her second COVID-19 vaccine.  Some long-COVID–like symptoms  subsided following treatment except for chest pain and fatigue .  3 weeks later, the patient tested positive for SARS-CoV-2 .  Shortly after infection, the patient presented again with chest pain when moving or breathing, joint pain, and dermatitis, symptoms that persisted for 6 months.   Antinuclear antibody (ANA) Immunofluorescence assay screening was positive for autoimmune antibodies. This is in line with our findings about higher probability of breakthrough infections among those with long-COVID-like reactions to COVID-19 vaccines and genetic origins of some adverse reactions.  The patient has a family history of diabetes, high blood pressure, and cardiac cirrhosis. Genetic anal...

A 37-year-old South Asian woman  with a 7-year history of rheumatoid arthritis (on bi-weekly tocilizumab injections) tested SARS-CoV-2 positive 9 month after receiving her vaccination (JNJ-78436735). She experienced persistent headache and fatigue for >6 weeks after infection and continued to test intermittently antigen+ for 14 weeks post-infection despite no overt exposure to SARS-CoV-2 infected individuals. She lived alone, did not leave her residence without a surgical-grade N95 mask, and never removed the mask in public. She was subsequently prescribed a 5-day course of nirmeltravir/ritonavir 300/100 mg twice daily. Initially, all PASC symptoms resolved, and the patient tested antigen negative 3 weeks after completion of nirmeltravir/ritonavir, but the symptoms and antigen positivity subsequently reappeared at 4 weeks (see figure). Assessment of adaptive immune responses demonstrated that nirmatrelvir/ritonavir and tocilizumab treatment decreased antiviral and autoreactive T...

55-year-old male with no previous mental illness background presented with full-blown manic symptoms following a severe course of COVID-19 infections that required admission. The patient presented with behavioral disturbance after a diagnosis of COVID-19. He exhibited symptoms including irritability, verbal and physical aggressiveness, increased goal-directed activity, elated and expansive mood, increased energy, grandiosity and inflated self-esteem, and decreased need for sleep. With the diagnosis of bipolar I disorder, current manic episode, severe, with psychotic feature, and first manic episode due to COVID-19 infection, he was admitted to the psychiatry emergency ward. By day 21, after treatment, he was discharged from the hospital with full improvement.  This case presents an Ethiopian Perspective . Similar cases were described for a 44-year old Polish man with no psychiatric history and another healthy  51-year old Chinese male .  A study of more than 11 million ...

A new study from Mount Sinai  followed 453 COVID-19 patients with  post-acute sequelae of COVID ( PASC). 324 (72%) of them were vaccinated in the following 6 months. Unadjusted analyses did not show significant changes in anosmia, respiratory symptoms, depression, anxiety, PTSD, or quality of life ( p  > 0.05 for all comparisons) among vaccinated vs. unvaccinated patients. Similar results were found in propensity-adjusted comparisons and in secondary analyses based on the number of vaccine doses received. An older not-yet-peer-reviewed study  found that those who were vaccinated before catching COVID had only a 13% lower risk than unvaccinated patients of having PASC symptoms (mostly lung-related) six months later .  According to the lead author of this study, reliance on vaccination as a sole mitigation strategy is wholly inadequate. Here are a few case reports about Long COVID in the vaccinated individuals.   CASE REPORTS A previously healthy 47-...

A previously healthy 47 year-old woman was evaluated at our post-COVID clinic for 7 months of PASC symptoms. She developed acute COVID-19 infection in the summer of 2021 and had received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine 6 months prior to the onset of her infection. Her acute symptoms included cough, sore throat, altered smell and taste, headache, fever, chills, body aches, chest pressure, and fatigue, which were managed with home care. COVID-19 infection was confirmed by PCR test. Most acute symptoms resolved after 48 hours, but over the next several months she continued to suffer severe fatigue, cognitive difficulties, post-exertional malaise, insomnia, tachycardia, chest pressure, and body aches resulting in significant functional debilitation and a leave of absence from work. She also experienced headaches and hair loss, both of which self-resolved. 6-months post-infection, the patient was potentially exposed to COVID-19 again and developed new symptoms of headac...

 A 54-year-old  woman  received second dose of an mRNA vaccine on June 28th and her third booster dose on December 22, 2021 She tested positive for COVID-19 on January 2nd 2022 followed by two negative tests by January 6th.  However, she was still sick in February and March suffering from  “debilitating fatigue and heart problems.”  When spoking with News.com on April 15,  she reported being bedridden for two weeks in January. Thereafter she developed bladder inflammation. She revealed that she has pericarditis, which makes it hard for her to walk or even get out of bed. She also reported severe chest pains that landed her in the hospital because she thought she was having a heart attack. She can no longer exercise or take walks with friends. REFERENCES Long Covid: Tracey Spicer has debilitating long COVID, 'Shadow of my former self' | Exclusive (9news.com.au) Tracey Spicer details horror effects of long Covid after contracting virus in January (dailym...

Despite multiple publications, feverishly sprouting Long Covid clinics and  $1.15 billion in federal funding  for the National Institutes of Health to support research, there still remains a lack of comprehensive understanding and  no guidelines regarding the management of this  lingering condition. Patients with certain genetics - like inborn errors of the TLR3- and IRF7-dependent production and amplification of type I IFNs - are prone to both life-threatening COVID-19 pneumonia  and adverse reactions to some vaccines - like yellow fever virus live attenuated vaccine , due to the production of autoantibodies.  This case report describes COVID-19 infection and vaccination adverse effects in a 31-year old woman with genetic condition  Incontinentia pigmenti (IP) . This  Canadian (Caucasian) woman had a severe case of COVID-19 and was hospitalized for oxygen therapy, intravenous antibiotics, and corticosteroids.  On Day 1, she had fatigue and a...