A family cluster of diagnosed coronavirus disease 2019 (COVID-19) kidney transplant recipient in Thailand

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes an ongoing outbreak of respiratory illness called coronavirus disease 2019 (COVID-19). The clinical course could be ranging from mild to severe illness especially the individuals with an immunocompromised condition such as solid organ transplant recipients.

Method: We described a family cluster of COVID-19 patients who were admitted during 3rd April 2020 to 30th April 2020. COVID-19 was confirmed by a presence of SARS-CoV-2 ribonucleic acid in the respiratory specimens detected by a qualitative, real-time reverse transcription-polymerase chain reaction. The study focused on the clinical course and management of our cases.

Results: A family cluster of four laboratory-confirmed COVID-19 patients, one of those carried an underlying kidney transplant (KT) receiving immunosuppressants. Clinical presentation and severity of our case series are variable depending on each individual immune status. By far, a KT recipient seems to develop more severity despite antiviral therapy, cessation of immunosuppressant, and aggressive intensive care support.

Conclusion: Our case series plausibly affirmed a person-to-person transmission and potentially severe disease in the transplant population. Clinicians who are encountering with transplant recipients should be aware of possible transmission among family members.

Keywords: COVID-19; family cluster; pneumonia; post kidney transplant; transmission.

Figure 1

Timeline of exposure history of a family cluster of COVID‐19. COVID‐19, coronavirus disease 2019; PCR, polymerase chain reaction

Figure 2

Chest X‐ray of an index case (Case 1) on the day of admission revealed new small patchy opacities in left lower lung field

Figure 3

Chest X‐ray of Case 3 on day 9 after onset of illness. Patchy opacities in peripheral and basal both lungs, which was consistent with clinical acute respiratory distress syndrome. Finally, the infiltrations were all resolved at the time of recovery on day 25 after onset of illness

Figure 4

Chest X‐ray from Case 4. On days 14 after the onset of illness. Progressive of multiple small patchy opacities in peripheral and basal both lungs consistent with severe pneumonia. All the lesions were resolved on day 29 of the illness

Figure 5

Temporal change in laboratory markers during the course of an illness in a kidney transplant recipient (Case 4) who were diagnosed with severe COVID‐19 pneumonia A, Dynamic change of lymphocyte count. Data showed progressive decline of lymphocyte count in the second week of illness these suggested as severe illness and lymphocyte count progressively increase at the recovery phase. B and C, Dynamic change of serum creatinine and CRP. Data showed increase level of serum creatinine and CRP in the second week of illness and decrease to normal at the recovery phase. COVID‐19, coronavirus disease 2019; CRP, C‐reactive protein

Figure 6

Timeline of the diagnosis and management of a kidney transplant recipient diagnosed with severe COVID‐19 pneumonia (Case 4). COVID‐19, coronavirus disease 2019; PCR, polymerase chain reaction; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2