contadores web
Skip to main navigation menu Skip to main content Skip to site footer

Case report, or case study

Vol. 23 No. 3 (2021)

A centenarian institutionalized patient who recovered from COVID-19 and developed immunity: a case study

DOI
https://doi.org/10.22267/rus.212303.244
Submitted
January 30, 2021
Published
2021-09-01

Abstract

Introduction: SARS-CoV-2 virus, and the disease it causes (COVID-19), severely affects older adults (OA), especially those with multimorbidity and frailty. This is due to physiological mechanisms such as immunosenescence or poor control of inflammatory activity in this population. Studies of the diagnoses and treatments in these patients are scarce and many of them have low levels of evidence. Objective: To describe the clinical and paraclinical characteristics of a frail institutionalized centenarian female patient with multimorbidity who survived COVID-19 infection, developed immunity, and was treated in an acute geriatric unit. Case presentation: Institutionalized centenarian patient with multimorbidity and frailty who fulfilled the criteria for severe COVID-19 disease, was managed early, recovered, and eventually developed immunity. Conclusion: early diagnosis, early management and a comprehensive and interdisciplinary geriatric approach are essential for a favorable outcome in OA patients at high risk of COVID-19 disease progression.

References

  1. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020;80(4):388-93. DOI: 10.1016/j.jinf.2020.02.016.
  2. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol. 2020;92(6):548-51. DOI: 10.1002/jmv.25722.
  3. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA - J Am Med Assoc. 2020;323(18):1775-6. DOI: 10.1001/jama.2020.4683.
  4. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92(4):441-7. DOI: 10.1002/jmv.25689.
  5. Coronavirus.jhu.edu. Coronavirus Resource Center resource center. Citado 2021 Jul 3. Disponible en: https://coronavirus.jhu.edu/
  6. WHO.int. Coronavirus Disease (COVID-19) Situation Reports. Citado 2021 Jul 3. Disponible en https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
  7. Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. DOI: 10.1056/NEJMoa2002032.
  8. The OpenSAFELY Collaborative, Williamson E, Walker AJ, Bhaskaran K, Bacon S, Bates C, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv. 2020 [citado en: 21 Sep 2020]. DOI: 10.1101/2020.05.06.20092999.
  9. Santesmasses D, Castro JP, Zenin A, Shindyapina A, Gerashchenko M, Zhang B, et al. COVID-19 is an emergent disease of aging. medRxiv. 2020. DOI: 10.1101/2020.04.15.20060095.
  10. Mueller AL, McNamara MS, Sinclair DA. Why does COVID-19 disproportionately affect older people? Aging. 2020;12(10):9959-81. DOI: 10.18632/aging.103344.
  11. Franceschi C, Bonafè M, Valensin S, Olivieri F, De Luca M, Ottaviani E, et al. Inflamm-aging. An evolutionary perspective on immunosenescence. Annals of the New York Academy of Sciences. 2000;908(1):244-54. DOI: 10.1111/j.1749-6632.2000.tb06651.x.
  12. Ongrádi J, Kövesdi V. Factors that may impact on immunosenescence: An appraisal. Immun Ageing. 2010;7(1):7. DOI: 10.1186/1742-4933-7-7.
  13. Ocampo M. Estrés y enfermedades del adulto mayor. In: Herrera JA. Psiconeuroinmunología para la práctica clínica. 1ª ed. Santiago de Cali: Programa editorial Universidad del Valle; 2009. Capítulo 11. p. 109-128. Disponible en: https://bibliotecadigital.univalle.edu.co/bitstream/handle/10893/10384/Psiconeuroinmunologia.pdf?sequence=5
  14. Smith SM, Wallace E, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;2016(3). DOI: 10.1002/14651858.CD006560.pub3.
  15. Guo T, Shen Q, Guo W, He W, Li J, Zhang Y, et al. Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study. Gerontology. 2020;66(5):467-75. DOI: 10.1159/000508734.
  16. Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, et al. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Heal. 2020;5(8):e444-51. DOI: 10.1016/S2468-2667(20)30146-8.
  17. CDC.gov. Coronavirus Disease 2019 (COVID-19). Citado 2020 Sep 3. Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/index.html
  18. Garnier‐Crussard A, Forestier E, Gilbert T, Krolak‐Salmon P. Novel Coronavirus (COVID‐19) Epidemic: What Are the Risks for Older Patients? J Am Geriatr Soc. 2020;68(5):939-40. DOI: 10.1111/jgs.16407.
  19. WHO.int. Clinical management of COVID-19. Citado 2020 Sep 29. Disponible en: https://www.who.int/publications/i/item/clinical-management-of-covid-19
  20. Bandaranayake T, Shaw AC. Host Resistance and Immune Aging. Clin Geriatr Med. 2016;32(3):415-32. DOI: 10.1016/j.cger.2016.02.007.
  21. WSJ.com. Coronavirus Outbreaks Spreading in Nursing Homes. Citado 2020 Sep 30. Disponible en: https://www.wsj.com/articles/coronavirus-outbreaks-spreading-in-nursing-homes-11584628291
  22. Bernal Torres W, Pérez Marmolejo DA, Gómez Gonzales B, Castro-Flóres X, Aristizabal-Gómez L, Ocampo Chaparro JM, et al. Ruta de manejo del adulto mayor con sospecha de infección por SARS CoV-2/COVID-19 en centros de protección de larga estancia para dultos mayores en el departamento del Valle del Cauca - Colombia. Rev ACGG. 2020;34(1):51-66. Disponible en: https://acgg.org.co/wp-content/uploads/Art4_Revista_Gerontologia_Vol34_Final.pdf
  23. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011;10(4):430-9. DOI: 10.1016/j.arr.2011.03.003.
  24. 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-94. DOI: 10.1111/jgs.15767.
  25. Vora A, Arora VK, Behera D, Tripathy S. White paper on Ivermectin as a potential therapy for COVID-19. Indian J Tuberc. 2020;67(3):448-51. DOI: 10.1016/j.ijtb.2020.07.031.
  26. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020;178:104787. DOI: 10.1016/j.antiviral.2020.104787.
  27. www.accessdata.fda.gov. FDA-Approved Drugs. Citado 2020 Sep 30. Disponible en: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=050742
  28. Horby P, Lim WS, Emberson J, Mafham M, Bell J, Linsell L, et al. Effect of Dexamethasone in Hospitalized Patients with COVID-19-Preliminary Report. medRxiv. 2020. DOI: 10.1101/2020.06.22.20137273.
  29. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: A meta-analysis. JAMA - J Am Med Assoc. 2020;324(13):1330-41. DOI: 10.1001/jama.2020.17023.
  30. Rossignol J-F. Nitazoxanide: A first-in-class broad-spectrum antiviral agent. Antiviral Res. 2014;110:94-103. DOI: 10.1016/j.antiviral.2014.07.014.
  31. Rossignol J-F. Nitazoxanide, a new drug candidate for the treatment of Midle East respiratory syndrome coronavirus. J Infect Public Health. 2016;9(3):227-30. DOI: 10.1016/j.jiph.2016.04.001.
  32. Hong SK, Kim HJ, Song CS, Choi IS, Lee JB, Park SY. Nitazoxanide suppresses IL-6 production in LPS-stimulated mouse macrophages and TG-injected mice. Int Immunopharmacol. 2012;13(1):23-7. DOI: 10.1016/j.intimp.2012.03.002.
  33. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-71. DOI: 10.1038/s41422-020-0282-0.
  34. Fox LM, Saravolatz LD. Nitazoxanide: A new thiazolide antiparasitic agent. Clin Infect Dis. 2005;40(8):1173-80. DOI: 10.1086/428839.
  35. Kow CS, Hasan SS. Meta-analysis of Effect of Statins in Patients with COVID-19. Am J Cardiol. 2020;134:153-5. DOI: 10.1016/j.amjcard.2020.08.004.
  36. Li Y-H, Wang Q-X, Zhou J-W, Chu X-M, Man Y-L, Liu P, et al. Effects of rosuvastatin on expression of angiotensin-converting enzyme 2 after vascular balloon injury in rats. J Geriatr Cardiol. 2013;10(2):151-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23888175/
  37. Rogers AJ, Guan J, Trtchounian A, Hunninghake GM, Kaimal R, Desai M, et al. Association of Elevated Plasma Interleukin-18 Level With Increased Mortality in a Clinical Trial of Statin Treatment for Acute Respiratory Distress Syndrome. Crit Care Med. 2019;47(8):1089-96. DOI: 10.1097/CCM.0000000000003816.
  38. Huang A, Garcia-Carreras B, Hitchings M, Yang B, Katzelnick L, Rattigan S, et al. A systematic review of antibody mediated immunity to coronaviruses: antibody kinetics, correlates of protection, and association of antibody responses with severity of disease. medRxiv. 2020. DOI: 10.1101/2020.04.14.20065771.

Downloads

Download data is not yet available.

Most read articles by the same author(s)