Case Report - Volume 1 Issue 1
Loratadine syrup is successfully used to fix COVID-19 induced respiratory distress and chest pain
Balisa Mosisa Ejeta*
Pharmaceutics Unit, Department of Pharmacy, College of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.
Received Date : Oct 11, 2021
Accepted Date : Nov 17, 2021
Published Date: Nov 24, 2021
Copyright :© Balisa Mosisa Ejeta 2021.
*Corresponding Author : Balisa Mosisa Ejeta, Pharmaceutics Unit, Department of Pharmacy, College of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.
Email: balisamosisa@yahoo.com
Abstract
COVID-19 disease is a highly transmissible viral infection caused by the SARS-CoV-2 coronavirus. This virus can cause lung damage, acute respiratory distress syndrome and death. In this case, How Covid-19 in a pregnant patient which didn’t respond well to Vancomyci + Caftazidime + Dexamethasone + Heparin for 7 days was finally responded to Loratadine syrup, and the patient was cured is going to be presented.
Introduction
COVID-19 disease is a highly transmissible viral infection caused by the SARS-CoV-2 coronavirus. This virus is closely related to the SARS-CoV and MERS-CoV coronaviruses. All three viruses can cause lung damage, acute respiratory distress syndrome and death [1]. Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus , that was first recognized in Wuhan, China, in December 2019. Genetic sequencing of the virus suggests that it is a betacoronavirus closely linked to the SARS virus. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit [2]. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, multiorgan failure, including acute kidney injury and cardiac injury [3]. Older age and co-morbid disease have been reported as risk factors for death, and 2 Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance recent multivariable analysis confirmed older age, higher Sequential Organ Failure Assessment (SOFA) score and d-dimer > 1 µg/L on admission were associated with higher mortality. This study also observed a median duration of viral RNA detection of 20.0 days (IQR 17.0–24.0) in survivors, but COVID-19 virus was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days [4,5]. Pregnant and recently pregnant women with suspected or confirmed COVID-19 should be treated with supportive and management therapiesmtaking into account the immunologic and physiologic adaptations during and after pregnancy [6].
Patient description
The patient was my close relative. I was her care giver. I am not her physician. I admitted her to Minilik Specialized Hospital in February, 2021. She was pregnant woman of 25th weeks of gestational age. Her age was 34.
Case history
Before being admitted to Minilik Hospital, she had been in private clinic misdiagnosed as ‘typhoid and typhus’, and treated with ceftriaxone and diclofenac for one week. She was referred to Minilik Hospital following no sign of relief by being suspected of Covid-19.
Physical examination, pathological tests and other investigations results
After being tested of Covid-19, she was found Covid-19 positive. Her fetus was alive. Electrocardiography shows heart congestion. Liver and kidney function test shows presence of high indicator enzymes. Her oxygen concentration was dropped to 64. She speaks barely. There is high degree of dyspinia.
Treatments provided, results and Discussion
She was admitted to emergency ward following severe respiratory distress and chest pain. Oxygen was served for her by mechanical ventilation. The following medications were given for her for 7 days continuously: Vancomycin + Ceftazidime + Dexamethasone + Heparin with Normal Saline. After three days stay in emergency room, she got relief. Her oxygen concentration was restored to 91. Then, mechanical ventilator was removed from her. However, other treatments were not interrupted for 7 days. Having been improved by all investigations, she was discharged on the 8th day of her admission to the hospital. She was well at the time.
Unfortunately, after all these treatments, the disease relapsed after one day in home. She barely speaks. Almost she can’t breathe. Her chest pain and respiratory distress relapsed to the intensity of more severe that the previous time. Now, I didn’t want to lose hope, also I didn’t took her to the hospital again. I went to pharmacy and bought Loratadine syrup and provided her 10ml once a day. The respiratory distress and dry coughing started reducing. On the second day of dosing, she started speaking and slow walking and eating small foods. On the third days of dosing, she started some of normal activities. Her health was almost restoring. On the fourth day dosing, she become almost cured. Then, she returned to her daily activities which was Children Care at a School in Addis Ababa. Now, she had peacefully delivered one beautiful baby girl who suffered Covid-19 with her.
Figure 1: Loratadine Syrup which was given for the patient for 6 days.
Although this study is descriptive, our results bear some similarities with other studies [10,11]. Mast cells seem to play an important role in the inflammatory responses by releasing granules of histamine, in addition to synthesizing and secrete inflammatory lipid mediators and pro-inflammatory cytokines TNF-α and IL-6 [9]. The use of antihistamines may help to minimize the histamine-mediated cytokine storm [8].
There is also evidence that treatment with histamine receptor antagonists might help reduce symptom intensity of long-COVID. Moreover, the study provides information about long-term (more than 400 days) abnormalities in T cell landscape in long-COVID, which are considerably different from that observed in asymptomatic infections [7].
Conclusion
One of the Antihistamin-1, Loratadine syrup at dose of 10ml perday for 6 days has saved the life of one pregnant woman from severe Covid-19 disease at the 25 weeks of gestational age. However, she has been treated with strong antibiotics before that, even though the disease relapsed after those treatment dosages. Finally, she was responded well to Loratadine syrup.
Patient Consent: Patient was given her consent for publication of this case.
Recommendation: Loratadine syrup is highly recommended in addition to other treatment schedules for better outcome for COvid-19 disease.
References
- Shereen M.A., Khan S., Kazmi A., Bashir N., Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J. Adv. Res. 2020; 24:91–98. Doi: 10.1016/j.jare.2020.03.005.
- Team NCPERE. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) – China. China CDC Weekly. 2020; 2(8):113-22.
- Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020. Epub 2020/02/28. Doi: 10.1016/S2213-2600(20)30079-5. PMID: 32105632.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective study. Lancet, 2020. Doi: 1016/S0140-6736(20)30566-3.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. Epub 2020/01/28. Doi: 10.1016/S0140- 6736(20)30183-5. PubMed PMID: 31986264.
- WHO, 2020. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected Interim guidance, 13 March 2020.
- Glynne P. 2021. Long-COVID following mild SARS CoV-2 infection: characteristic T cell alterations and response to antihistamines. medRxiv. https://www.medrxiv.org/content/10.1101/2021.06.06.21258272v1.
- Hogan R.B. Dual-histamine receptor blockade with cetirizine - famotidine reduces pulmonary symptoms in COVID-19 patients. Pulm. Pharmacol. Therapeut. 2020; 63 Doi: 10.1016/j.pupt.2020.101942.
- Chang H.W. A common signaling pathway leading to degranulation in mast cells and its regulation by CCR1-ligand. Allergy Eur. J. Allergy Clin. Immunol. 2020; 75:1371–1381. Doi: 10.1111/all.14186.
- Gautret P. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int. J. Antimicrob. Agents. 2020; 56:1059. Doi: 10.1016/j.ijantimicag.2020.105949.
- Schwartz R.A., Suskind R.M. Azithromycin and COVID-19: prompt early use at first signs of this infection in adults and children, an approach worthy of consideration. Dermatol. Ther. 2020; 33:2–4. Doi: 10.1111/dth.13785.
- Mondejar-Lopez P. Impact of SARS-CoV-2 infection in patients with cystic fibrosis in Spain: incidence and results of the national CF-COVID19-Spain survey. Respir. Med. 2020; 170 Doi: 10.1016/j.rmed.2020.106062.
