key: cord-0725981-233zksmc authors: Minkobame, Ulysse; Mveang Nzoghe, Amandine; Maloupazoa Siawaya, Anicet C.; Alame‐Emane, Amel K.; Ndong Sima, Carene A. A.; Mvoundza Ndjindji, Ofilia; Zang Eyi, Carinne; Ndong Mintsa, Armel; Padzys, Guy‐Stephane; Meye, Jean‐François; Djoba Siawaya, Joel F. title: Case series of SARS‐COV‐2 infection in pregnant African women: focus on biological features date: 2021-03-26 journal: J Med Virol DOI: 10.1002/jmv.26927 sha: 97015b7c32fd85ae95276a87853b212d808cebf5 doc_id: 725981 cord_uid: 233zksmc COVID-19 pandemic is ongoing with devastating consequences. Here we investigated SARS-COV-2 infected pregnant African women and described their clinical and laboratory features. Inflammatory factors including complement C3c, Procalcitonin (PCT) and C-reactive protein (CRP) were elevated in SARS-CoV-2 infected pregnant women. Also, SARS-CoV-2 infected pregnant women are characterized by a stressed hepatobiliary function. The case concomitantly infected with SARS-COV-2 and Plasmodium falciparum had pancytopenia a condition characterized by the fall in the number of erythrocytes, leukocytes and thrombocytes. This article is protected by copyright. All rights reserved. ). The first patient (case no. 1) was a 38-year-old multiparous woman, 31 weeks pregnant with triplets, who consulted for pelvic abdominal pain. She had no history of medical condition or surgery. Her last prenatal check-up was normal and without intercurrent illness. The two ultrasounds, done at Weeks 15 and 23 of her pregnancy, showed perfectly healthy triplet pregnancy. The initial medical examination showed a low blood pressure (100/80 mmHg) and irregular uterine contractions, with a Baumgarten score of 4. The patient was, therefore, hospitalized for observation and underwent oxygen therapy and both a tocolytic treatment with Nicardipine (10 mg/ml) and a fetal pulmonary maturation treatment (dexamethasone 12 mg). After 48 h, the patient developed a fatty cough accompanied by rhinorrhea and myalgia. The pleuropulmonary examination revealed pulmonary condensation syndrome. On the basis of the epidemiological context, the patient nasopharyngeal samples were tested for SARS-COV-2 using real-time polymerase chain reaction (RT-PCR) and yielded a positive result. The blood count did not reveal any abnormalities. C-reactive protein (CRP) concentration was 28 mg/L, which is well above the normal range. C3c was above the normal range at 2 g/L (normal range: 0.8-1.6 g/L). Procalcitonin (PCT) concentration was 1 ng/ml, two-fold above the sepsis threshold (of 0.5 ng/ml). In addition, soluble FMS-like tyrosine kinase 1 (sFlt-a) to placenta growth factor (PlGF) ratio was 27.5 with a negative predictive value of 99.3%, which indicated that the risk of preeclampsia could be ruled out within the week of measurement of the variables. Case 1 was transferred to the COVID-19 management and treatment center, where she was put on the anti-COVID-19 treatment protocol, which consisted of oxygen therapy, hydroxychloroquine (200 mg two times a day for 10 days), azithromycin (500 mg on Day 1 and 250 mg/day for 4 days), vitamin C (500 mg/day for 10 days), and zinc tablets (15 mg/day for 10 days). The mother was declared cured 10 days following the 10 days of treatment. Due to persisting abdominal pain, infants were delivered during an urgent cesarean. The three infants were alive and healthy. The mother died 2 months later from unknown causes. The second patient (case no. 2) was a 20-year-old, who presented mild flu-like symptoms throughout her last days of pregnancy and tested negative for SARS-COV-2. Childbirth happened without any major difficulties. Two weeks after birth, the patient returned with cough, fever, headache, thoracic pain, stage 2 dyspnea (with 80% oxygen saturation), and signs of viral pneumonia were observed through a chest computed tomography (CT) scan. The blood pressure was normal. Blood work showed mild erythrocytopenia, anemia (7.9 g/dl) with a 24% hematocrit and mild lymphopenia. The PCT level was extremely high at 41.1 ng/ml. CRP concentration was also very high (207 mg/ml). The patient was put on oxygen therapy and the SARS-COV-2 retest by RT-PCR came back positive. The chest CT scan showed a 70% lung invasion. The patient was transferred to the COVID-19 management and treatment center, where she was put on respiratory assistance, but died before the initiation of an anti-COVID-19 treatment protocol. The cause of death was acute respiratory failure associated with a pulmonary. The third patient (case no. 3) was a 20-year-old, 20 weeks into her first pregnancy, and consulted for persisting cough, high fever, fatigue, and dyspnea. Complementary infections screening showed that the patient was coinfected with SARS-CoV-2 and malaria (parasitemia: 7700 parasites/µl). The patient presented signs of pancytopenia (characterized by a leukopenia associated with neutropenia) and highly elevated biochemical markers such as amylase She gave birth at her 40th week of pregnancy. In SARS-COV-2 infection, the associated antenatal inflammation is clearly the main factor that may create an adverse environment for the mother and the fetus. 5 cut-off identified as independent predictors of COVID-19 severity and adverse outcome by Luo et al. 12 We also observed a stressed hepatobiliary function in two of the mothers. All cases had their level of PCT above the normal range (≤0.15 ng/ml). Moreover, the two cases who had their PCT levels above the sepsis threshold died weeks after giving birth. For pregnant women who had COVID-19, the risk of adverse events persists after birth. Coronavirus disease 2019 (COVID-19) 13 However, we believe that mothers should be closely observed and followed for weeks or even months after birth. Although only four cases were described in this study, the clin- We thank all study participants and the Gabonese Government for funding the study. The study was funded through the CHU-Mère-Enfant laboratory services quota income. The funding covered sample, data collection, and analysis. The authors declare that there is no conflict of interests. The board of Libreville Mother and Child University Hospital approved the study and written informed consent was obtained from patients. All materials described in the manuscript will be freely available ondemand to any scientist wishing to use them. 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