Features of the new coronavirus COVID-19 infection in identical twins

Abstract

The problem of the clinical course and principles of treatment of the new coronovirus infection Covid-19 has been the most discussed for two years. The disease can occur as an asymptomatic carriage, latent course, and severe forms with damage to the lungs, cardiovascular, circulatory and nervous systems, urogenital and gastrointestinal tracts. Numerous studies of Covid-19 have made it possible to study in detail the pathogenesis and apply effective methods of treatment using monoclonal antibodies to cytokines and their receptors, Janus-kinase inhibitors, convalescent plasma, etc. At the same time, reliable prognostic criteria that determine the characteristics of the course and the outcome of the disease has not been established. The features of the clinical course of a new coronavirus infection in patients with rare comorbid pathology (genetic diseases, a history of organ and tissue transplantation, paraneoplastic processes) are also of scientific and practical interest. With this in mind, the article presents clinical cases of a new coronavirus infection Covid-19 in identical twins.Patients A. and С., 39 years old, were admitted to the Regional Clinical Infectious Diseases Hospital with complaints of fever up to 37.5-37.80C, dry cough, shortness of breath at rest, weakness. Both patients fell ill at the same time, on the fourth day after contact with their father, who was diagnosed with Covid-19 coronavirus infection, confirmed by a PCR test. Upon admission, the patients were clinically diagnosed with Covid-19 coronavirus infection, a confirmed moderate form. Bilateral polysegmental pneumonia of moderate severity. Respiratory failure I degree.Despite the same history data, the course of Covid-19 coronavirus infection in identical twins was significantly different. Patient A. had lymphocytosis up to 46% in the blood, ESR acceleration up to 12 mm/h, CRP increase up to 5 mg/ml, ferritin up to 333 ng/ml, interleukin-6 up to 7.5 pg/ml, D-dimer up to 560 ng/ml. Unlike patient A., his twin brother (patient C.) had lymphopenia up to 16%, accelerated ESR up to 20 mm/h, a significant increase in CRP up to 10 mg/mg, interleukin-6 up to 9.5 pg/ml , D-dimer - up to 750 ng/ml Patient A.'s condition remained stable. Against the background of the ongoing treatment, already on the fourth day of treatment, a pronounced positive trend was noted, on the 13th day of treatment, the patient was discharged from the hospital in a satisfactory condition under the supervision of a doctor at the place of residence.The condition of the patient С. on the 3rd day of hospitalization deteriorated sharply. Considering the decrease in SpO2 level to 88%, the lesion of the lung parenchyma is more than 70%, the council of doctors decided to conduct non-invasive oxygen therapy, the patient, in addition to the treatment, was prescribed antibacterial drugs, a drug of monoclonal antibodies to interleukin-6 and a selective reversible an inhibitor of Janus-kinases 1 and 2. On the 16th day of treatment, a CT scan of the chest organs was performed in dynamics, where a decrease in lung damage was noted, and a positive trend was also noted in laboratory parameters. Subjectively, the patient showed an improvement in well-being. During the next two days, the patient's condition with pronounced positive dynamics on the 19th day of hospital stay, the patient was discharged for rehabilitation at the place of residence.Thus, significant differences in the severity of the course of a new coronavirus infection in identical twins with the same history, the absence of aggravating comorbid conditions, are most likely due to the initial dose of the viral load, which was an important factor determining the development and course of infection.