Renal Transplants COVID-19 Infection with Different Presentations, Clinical Courses and Outcomes

Abstract

We report five cases with different clinical presentations of COVID-19 infection in renal transplant patients. Initially a typical clinical presentation, in the form of CNS manifestations (amnesia, behavior change followed by left sided paresis) for the 1 st case, GIT manifestations for the 2 nd case and chest and cardiac manifestations for the 3 rd case were presented. The other two cases similarly presented with chest manifestations but with different clinical courses. Our patients had a favorable outcome, which may provide a reference value for treating COVID-19 patients. Keyword: Clinical manifestation, COVID19 virus infection, Renal transplant recipient. INTRODUCTION Respiratory droplets are considered the main mode of transmission of COVID-19 between people. COVID-19 entry to lung through binding of its S proteins to the angiotensin-converting enzyme 2 (ACE2) receptor, followed by the development of symptoms, that are ranging from coughing, fever to pneumonia 1 . Although respiratory manifestation is the most prominent symptoms of COVID-19, neurological manifestations of the virus is also reported in literature. Neurological manifestations have an incidence in 36% of the patients 2 . Non-specific mild neurological symptoms including headache, dizziness, myalgia and/or fatigue, anorexia, anosmia, and ageusia 3 , are noticed in hospitalized COVID-19 patients. Moresevere presentations of COVID-19 include acute stroke of varying arterial and venous mechanisms 4 , confusion or/ and impaired consciousness 5 , Guillain-Barre syndrome 6 , meningoencephalitis 7 , hemorrhagic posterior reversible encephalopathy syndrome 8 , and acute necrotizing encephalopathy, affecting the brain stem and basal ganglia 9 . The proinflammatory and prothrombotic cascade as a result of cytokine storm 10 , reflect other neurological manifestations because of the affection of brain vasculature and the blood brain barrier, from toxic-metabolic sequel of multi-organ dysfunction that was seen in critical illness of COVID19. COVID19 gastrointestinal symptoms, is atypical and not a common presentation of this viral infection. COVID 19 in kidney transplant recipients (KTRs) have varying clinical manifestations and severity, ranging from mild or asymptomatic infections to multiorgan failure resulting in death 11 . Clinical presentation of renal transplant like those of nontransplanted patients with the most frequently reported symptoms are fever (85%), dry cough (70%), myalgia (60%), and dyspnea (57%) 12 .The onset of symptoms has a wide range, from 1 day to 3 weeks before the diagnosis. The severity of the infection can be aggravated with reinfection and immunological impairment leading to the development of confections with bacteria, fungus, and opportunistic pathogens. Those patients can shed virus for longer period and have increased viral load 13 , in comparison to general populations. Statement of Ethics: Consent from the presented cases were taken and ethics approval from National Institute of Urology and Nephrology was taken.We presented a retrospective observational case series study related to new COVID19 infection in kidney transplant population.