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Volume 26, Number 11—November 2020
Research Letter

Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan

Ayako Okuhama, Masahiro IshikaneComments to Author , Daisuke Katagiri, Kohei Kanda, Takato Nakamoto, Noriko Kinoshita, Naoto Nunose, Takashi Fukaya, Isao Kondo, Harutaka Katano, Tadaki Suzuki, Norio Ohmagari, and Fumihiko Hinoshita
Author affiliations: National Center for Global Health and Medicine, Tokyo, Japan (A. Okuhama, M. Ishikane, D. Katagiri, K. Kanda, T. Nakamoto, N. Kinoshita, N. Nunose, T. Fukaya, I. Kondo, N. Ohmagari, F. Hinoshita); National Institute of Infectious Diseases, Tokyo (H. Katano, T. Suzuki)

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Table

Clinical course and quantitative reverse transcription PCR results for severe acute respiratory syndrome coronavirus 2 RNA in patient receiving hemodialysis, Japan*

Day after symptom onset
Hospitalization,
d
Temperature, °C
Event
CRP, mg/dL
Dialysis
Specimens tested for SARS-CoV-2 by qRT-PCR‡
Medication†
Nasal swab
Blood
Effluent, time collected
AZM
Hydroxy
1 h
2 h
1 37.3
2 37.2
3 37.3
4 37.3 Clinic 18.8 (NA‡)
5 37.7
6 39.0
7 1 38.8 Chest CT N N 8.8
8 2 38.4 Y Y 9.0 Y 29.6 (1,080.6)§ ND§ 38.3 (157.91) ND
9 3 38.7 Y Y
10 4 38.7 Y Y 14.0
11 5 37.4 Chest CT N Y 15.0 Y
12 6 37.0 N Y
13 7 37.2 N Y
14 8 37.0 N Y
15 9 36.9 N Y 14.4 Lixelle-DHP
16 10 37.0 N N 34.3 (NA‡)
17 11 36.9 N N Lixelle-DHP ND
18 12 36.9 N N 13.7 ND
19 13 36.8 N N
20 14 36.6 N N
21 15 36.7 N N 5.9 Lixelle-DHP
22 16 36.7 Chest CT, discharge N N

*AZM, azithromycin; CRP, C-reactive protein; CT, computed tomography; Hydroxy, hydroxychloroquine; Lixelle-DHP, direct hemoperfusion using a β2 microglobulin adsorbent column; NA, not available; ND, not detected; qRT-PCR, quantitative reverse transcription-PCR; –, not done.
†We prescribed azithromycin, 500 mg 2 times/d from day 1 to 3 because it was 1 of the potentially effective treatment regimens at the time. We also prescribed hydroxychloroquine 200 mg 2 times/d and initially planned to use it for 10 d in total, but the patient’s liver function tests (LFTs) became elevated during the course. We suspected side effects of hydroxychloroquine and stopped it on day 9. His LFTs returned to normal afterwards.
‡Results for SARS-CoV-2 shown as cycle threshold values (Viral load, copies/μL). Viral loads were not available because PCR was performed at an outside commercial laboratory where they did not report these results. The same PCR method was used (4) at both National Institute of Infectious Diseases (NIID), Japan, and the outside laboratory. HD effluent was collected at 1 hr and 2 hr into hemodialysis.
§PCR test was performed at NIID, Japan where they report viral loads.

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References
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  3. US Centers for Disease Control and Prevention. Interim guidance for infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in outpatient hemodialysis facilities 2020 Apr 21 [cited 2020 Apr 22]. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/dialysis.html
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  7. Wang  W, Xu  Y, Gao  R, Lu  R, Han  K, Wu  G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323:18434. DOIPubMed
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  10. US Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep. 2001;50(RR-5):143 .PubMed

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