The presentation and diagnosis of the first known community transmitted case of SARS-CoV-2 in the Republic of Ireland

Faller, Eamonn; Lapthorne, S.; Barry, R.; Shamile, F.; Salleh, F.; Doyle, D.; O'Halloran, D.; Prentice, Michael B.

The presentation and diagnosis of the first known community transmitted case of SARS-CoV-2 in the Republic of Ireland

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The-Presentation-Diagnosis-of-The-First-Known-Community-Transmitted-Case-of-SARS-CoV-2-in-the-Republic-of-Ireland.pdf(458.62 KB)

Published Version

Date

2020

Authors

Faller, Eamonn

Lapthorne, S.

Barry, R.

Shamile, F.

Salleh, F.

Doyle, D.

O'Halloran, D.

Prentice, Michael B.

Publisher

Irish Medical Organisation

Abstract

Introduction: This case series describes the diagnosis of the first case of community transmission of SARS-CoV-2 in the Republic of Ireland. Cases: Case 1: A 25 year old male presented with dyspnoea, cough and high fevers for 4 days. He was commenced on broad spectrum antimicrobials and oxygen therapy. His respiratory function deteriorated in spite of these measures and he required mechanical ventilation. CT showed left upper lobe consolidation as well as multifocal ground-glass opacification. Case 2: A 43 year-old male presented with headache and was found incidentally to have pneumonia. He was recently diagnosed with pituitary apoplexy secondary to an adenoma with resultant pituitary insufficiency but MRI brain was stable. His respiratory function deteriorated in spite of antibiotics and he required mechanical ventilation. CT showed likely atypical infection with resultant ARDS. Outcome: Both underwent nasopharyngeal RT-PCR testing for SARS-CoV-2. Patient 2 was positive. Patient 1 was extubated and made a good recovery. Patient 2 was transferred to another centre for ECMO therapy. He died 27 days after transfer. Conclusion: Given the atypical presentations in generally otherwise young and healthy individuals, the decision was made outside of national guidance to perform testing for SARS-CoV-2. This diagnosis had far-reaching implications for the SARSCoV-2 pandemic within Ireland.

Keywords

SARS-CoV-2 , Community transmission , Republic of Ireland

Citation

Faller, E., Lapthorne, S., Barry, R., Shamile, F., Salleh, F., Doyle, D., O’Halloran, D., Prentice, M. and Sadlier, C. (2020) ‘The presentation and diagnosis of the first known community transmitted case of SARS-CoV-2 in the Republic of Ireland', Irish Medical Journal, 113(5), P78 (5pp). Available at: http://www.imj.ie/wp-content/uploads/2020/07/The-Presentation-Diagnosis-of-The-First-Known-Community-Transmitted-Case-of-SARS-CoV-2-in-the-Republic-of-Ireland.pdf (Accessed: 30 November 2020)