Case Report for Two Hemodialysed Patients Diagnosed for COVID-19 at the Donka National Hemodialysis Center

In December 2019, coronavirus disease (COVID-19) due to infection with the novel SARS-CoV-2 virus began to break out. Hemodialysis patients are at high risk because of the co-morbidities. We report the clinical and biological characteristics of two patients who developed COVID-19 infection in our dialysis center in Donka National Hospital. None of the patients had contact with an infected person. The age was 38 and 54 years. The symptoms common to both patients were: fatigue, diarrhea, fever. Lymphopenia was present in both patients. None of them had a chest X-ray or chest scan because they were positive for the test before admission.


Introduction
In December 2019, coronavirus disease (COVID-19) due to infection with the novel SARS-CoV-2 virus began to break out [1]. Research on the origin of SARS-CoV-2 focused on the bat [2]. There is no antiviral medication at this time that has proven effective against this infection or a vaccine. In life-threatening situations, some patients require respiratory assistance. There is limited data to date on COVID-19 infection in hemodialysis patients in reporting this case, the patients are informed and we have consent from the 2 patients. We report our experience of two hemodialysed patients who are positive for COVID-19.

Report on the 2 Cases
Out of a total of 193 hemodialysis patients, 2 were diagnosed with COVID-19 infection, the test by reverse transcriptase PCR for SARS-CoV-2 (rRT-PCR) returned positive. The characteristics of these 2 patients are presented in Table 1.
The age was 38 and 54 years, both are men. None of the 2 patients had any notion of direct contact with an infected person, no family member was infected.
Common symptoms of infection were: diarrhea (1/2), followed by fever (2/2), fatigue (2/2) dyspnea (2/2) and abdominal pain (2/2). Only one patient had a dry cough. One patient complained of a dry throat, none of them had rhinorrhea, they had severe asthenia and myalgia, and they did not have respiratory distress.
All 2 patients had lymphopenia (<1.0 × 10 9 /L). All 2 patients were hospitalized in a reanimation COVID in Donka National Hospital and subjected to hydroxychloroquine 200 mg (1 tablet 3 times a day); Erythromycin 500 mg 1 tablet the first day then 1/2 tablet from 2 nd to 5 th day; KALETRA (lopinavir 200 mg/Ritonavir 50 mg) one tablet once a day; dexamethasone injectable 20 mg from 1 st day to 5 th day then 10 mg/day from 6 th to 10 th day and 4 mg/day from 11 th to 14 th day; cefotaxime 1 g 2 times a day intravenously; Enoxaparin 8000 IU/J; vitamin C 1000 mg/J, Zinc 2 tablet per day. They were declared cured for COVID-19 after 25 days of hospitalization by the same test. At the end of this study, the patient's age of 54 years developed acute respiratory syndrome because of the sequelae of COVID in his lung. Now he is following in respiratory disease department.

Discussion
We described 2 patients in our dialysis center who were diagnosed with COVID-19, representing a frequency of 1.03% at this time. The 2 patients presented with lymphopenia to the blood count, they could not do the chest X-ray and the chest CT because the test being positive and the two patients did not present a pulmonary sign at the arrival. We did not systematically screen all patients and caregivers due to the lack of screening kites. We monitored the temperature for all the staff. Immune cells have been shown to play a large role in the recovery from SARS-CoV infection [4]. Because the uremic state is associated with a dysregulation of the lymphocyte and granulocytic function, therefore a drop in the immune system could reduce the response to SARS-CoV infection [4]. Dialysis center needs a special attention given the number of people on hemodialysis and who represent a population at high risk. In our case, we do not have a large spread of the virus in our center because we implemented preventive measures very early. We recommend all patients and medical staff to wear face mask before entrance and exit the center.  We have prohibited regrouping at the center without distancing. During dialysis session, we recommended the wearing of personal protective equipment (PPE). After the hemodialysis session, the machine and the room are disinfected with a hydrochloric solution, then all the medical equipment.
In a retrospective study of 1099 patients with acute respiratory distress due to COVID-19, fever and cough were the dominant symptoms whereas vomiting and diarrhea were rare [5]. Wang

Conclusion
We have described the case of 2 patients who developed COVID-19. In addition Open Journal of Nephrology to fever and fatigue, diarrhea was very common in the 2 patients, and further investigation would be necessary to fully understand the clinical aspect of COVID-19 in dialysis patients and optimal treatment of COVID-19 in dialysis patients.