Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR

Abstract

Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

Keywords: COVID-19; Coronavirus; Pneumonia; Real-Time Reverse-Transcriptase Polymerase Chain Reaction; Tertiary Infection; Viral Load.

Fig. 1. Radiologic findings of the patient.

(A) Chest X-ray of illness day 3, hospital day 1. (B) Chest X-ray of illness day 9, hospital day 7. (C) Chest X-ray of illness day 15, hospital day 13. (D) HRCT scan of illness day 9, hospital day 7. (E) HRCT scan of illness day 15, hospital day 13. AP(P) = Anteroposterior (Portable X-ray), HRCT = high-resolution computed tomography.

Fig. 2. Clinical course, treatment and viral load of the patient.

RdRP = RNA-dependent RNA polymerase, Posi = positive, Nega = negative, UD = undeteced, Ct = cycle threshold.