Ost-COVID-19 Syndrome - case report

Abstract

Background: Coronaviruses are enveloped RNA viruses that are widely distributed among humans and other mammals and birds causing respiratory, enteric, liver, and neurological diseases. At the end of December 2019, a group of patients with pneumonia of unknown etiology were registered, where a new virus called SARS-CoV-2 was later presented, and the disease it causes, COVID-19. The main clinical manifestations of this virus are fever, dry cough, dyspnea and acute respiratory stress. Many subjects have mild symptoms, such as headache, non-productive cough, fatigue, myalgia, and anosmia. The recovery time from this disease and the reasons why the sequelae it leaves vary so much between patients is still unknown. Symptoms and clinical manifestations after SARS-CoV-2 / COVID-19 infection have appeared in many survivors and are similar to those of fatigue after Severe Acute Respiratory Syndrome. The most commonly reported symptoms are fatigue, anxiety, joint pain, ongoing headache, chest pain, dementia, depression, and dyspnea. The NICE guideline defines post-COVID-19 syndrome as the set of signs and symptoms that develop during or after an infection compatible with COVID-19 that continues for more than 12 weeks and is not explained by an alternative diagnosis. Post-COVID-19 syndrome has the characteristic that its symptoms cause a disability, which is why it generates a great impact on the individual, the care, and rehabilitation units. Purpose: The objective of this report is to present a clinical case of a patient with the post-COVID-19 syndrome and its management. Materials and methods: This is a 57-year-old female patient, with a previous history that in June 2021 began with a clinical picture consisting of asthenia, adynamia, anosmia, ageusia, headache, myoarthralgia, nausea, cough chest and lumbar pain, for which the PCR test for SARS-CoV-2 was performed, which was positive, his clinical picture worsened at home, for which he consulted an emergency service in the city of Palmira, Valle del Cauca (Colombia). Subsequently, they conclude through paraclinical SARS-CoV-2 infection plus bacterial pneumonia due to Klebsiella pneumoniae, for which she is transferred to the hospitalization room and treatment with antibiotics is started, however, At the beginning of July, the patient maintained hemodynamic and ventilatory stability, without cardiovascular support, but still with minimal ventilatory support, with oximetry goals, so it was decided to start the gradual withdrawal of sedatives in favor of spontaneous modes of mechanical ventilation. On July 6, the patient tolerates extubation with the transition to non-invasive mechanical ventilation and a decision was made to transfer to hospitalization. Then, on July 15, a patient was seen in acceptable general conditions, with support even by nasal cannula, on physical examination with attenuated vesicular murmur with declining rales, for which it was decided to discharge. Results: Currently, the patient manifests 15 symptoms 4 months after her discharge from the clinic. Conclusions: The post-COVID-19 patient must have an individual and comprehensive rehabilitation, which takes into account their needs, since this syndrome varies from person to person, it must be an early rehabilitation so as not to decrease the functionality of the patient, and does not deteriorate their physical or mental health. The great challenge identified in the midst of the pandemic is that work must be done to build an improved and strengthened health system, where true integration and coordination between levels of care, primary care, and hospital care is achieved.