Infectious Diseases I

Patient Cases

home with severe fatigue, shortness of breath, and rigors. T.Y. has a heart rate of 120 beats/minute, mean

arterial pressure 70 mm Hg, respiratory rate 24 breaths/minute, temperature 102.7°F (39.3°C), and arte-

rial oxygen saturation (SaO2) of 85% on room air. Because it is in the middle of influenza season (high

prevalence of influenza A and B), a nasal swab is done and sent for rapid diagnostic testing for suspected

influenza infection. Shortly thereafter, T.Y. is intubated for severe respiratory failure and admitted to the

MICU. In addition to antibiotic therapy for CAP, which would best be considered next?

hypoxemic respiratory failure requiring mechanical ventilation. G.L. is hypotensive, requiring norepineph-

rine after fluid resuscitation, and has acute kidney injury. She is awaiting a renal consult for continuous

renal replacement therapy. A rapid diagnostic test of a nasal washing suggests influenza B, consistent with

this year’s local influenza epidemiology. A nasogastric feeding tube is placed when she is admitted to the

ICU. Which would be most appropriate to treat G.L.’s severe influenza?

In late December 2019, a novel coronavirus strain causing pneumonia in a human was first identified

in Wuhan, China. This virus, first labeled 2019-nCoV, is now called novel severe acute respiratory

syndrome coronavirus 2 (SARS-CoV-2).

over 6.8 million associated deaths. More than 103 million cases and over 1 million deaths have been

attributed to SARS-CoV-2 in the United States (https://coronavirus.jhu.edu/map.html).

Illness related to SARS-CoV-2 is called coronavirus disease 2019 (COVID-19). COVID-19 was

categorized as a worldwide pandemic on March 11, 2020.

COVID-19 is characterized by a broad spectrum of illnesses, from mild upper respiratory symptoms to

life-threatening respiratory failure, sepsis, and/or multiorgan failure.

Before vaccination and other SARS-CoV-2-directed therapeutics, about 80% of patients with COVID-19

present with mild illness, and 15%–20% present with more severe illness requiring hospitalization.

Between 2% and 10% of patients with COVID-19 require ICU admission, accounting for 30%–40% of

patients hospitalized with COVID-19.