COVID-19 Reinfection in 60-Year-Old Man with Diabetes Mellitus, East Nusa Tenggara, Indonesia

Abstract

Coronavirus Disease 2019 (COVID-19) is an infectious disease which is caused by a new strain of coronavirus. Older individuals and people with comorbidities have a higher risk to develop more severe illness. COVID-19 survivors will have active immunity in conjunction with increase of SARS-CoV-2 antibody (Ab) titer 2-weeks after the symptoms onset and will be lasted until 12-weeks. Therefore, it will give protection against reinfection of COVID-19. This study reports a case of COVID-19 rapid reinfection in sixty-year-old man with diabetes mellitus. Case illustration: a sixty-year-old man presented to the emergency department with fever accompanied by cough, runny nose, malaise, and metallic taste since one day before admission to hospital. There was a history of uncontrolled diabetes mellitus (DM) and COVID-19 infection 35-days before hospital admission without any symptoms. The current physical examinations demonstrated a mild dyspnea with oxygen saturation 97%, and diffuse rhonchi at the right area of chest auscultation. Chest X-ray discovered a multiple consolidation of the right lung, with suspicion of viral pneumonia. Fasting blood glucose (FBG) was 205 mg/dl, and 2-hour postprandial glucose was 508 mg/dl. The polymerase chain reaction (PCR) of SARS-CoV-2 via nasopharyngeal swab was taken and the result was positive. COVID-19 Ab titers IgM and IgG were 0.18 U/ml and 0.43 U/ml (<0.8 U/ml → non-reactive), respectively. The patient was diagnosed with COVID-19 reinfection and DM. The patient was treated with convalescent plasma, antivirus, antibiotics, insulin, steroid, anticoagulant, and other symptomatic medications. As the results, a well improvement of his clinical condition and the increase of Ab COVID-19 IgM and IgG evaluation test after convalescent plasma administration, 0.28 AU/ml and 17.67 AU/ml, respectively, were recorded. Summary: Researches revealed that DM might cause the specific immunity system dysfunction and the low production of antibody. This study found that poor blood-glucose control with a low Ab of SARS-CoV-2 production might induce this patient to have a COVID-19 reinfection. Advance immunological study about the correlation between DM and COVID-19 is very essential in the management of COVID-19 patients with DM.