![]() The patient has remained well, and the child was born healthy by normal spontaneous vaginal delivery.ĬOVID-19 has had devastating effects on the medical system and led to widespread changes in the practice of medicine. After discussion, the patient and her physicians chose not to treat for anaplasmosis because she was clinically improving. Several weeks later, studies revealed anaplasma IgM 1:256 and IgG 1:1,280. Platelets were 140,000 (previously 336,000), aspartate aminotransferase was 95, and alanine aminotransferase was 81. Serologic results for Lyme were positive for 41-kD, 39-kD, and 23-kD bands with no IgG bands. phagocytophilum was positive, as was a second test on July 8. On June 30, she saw her internist and underwent laboratory testing for tickborne illnesses she was treated empirically with amoxicillin because of her risks for Lyme disease. She contacted her obstetrician and was told she had a presumptive diagnosis of COVID-19. She continued to improve until June 23, when she experienced recurrent fever up to 38.9☌, chills, and lethargy. Repeat PCR testing for SARS-CoV-2 on June 15 was negative. She was prescribed oseltamivir by her obstetrician on June 11. She continued to have extreme fatigue, myalgia, and low-grade fever. On June 10, she tested negative for SARS-CoV-2 by PCR. ![]() She had no cough, shortness of breath, or sore throat. On June 9, she experienced severe headaches and the next day had low-grade fever, chills, and body aches. On June 3, she removed a tick from her neck. In the second case, a 31-year-old woman who was 6 months pregnant left New York at the end of May 2020 to rent a house in Ulster County, New York. He was treated with doxycycline for 10 days and recovered. Further testing on July 6 revealed serologic results for Lyme similar to results from June 25 and Anaplasma phagocytophilum titers of IgM 1:320 and IgG 1:1260. Fever up to 38☌ recurred on June 22 and lasted until June 29 he also experienced persistent fatigue and myalgia. On June 25, ELISA for Lyme disease was positive, and reflex to Western blot revealed IgM 41-kD, 39-kD, and 23-kD bands but no IgG bands. He tested negative for SARS-CoV-2 on June 19 and June 25 by PCR. He was seen on June 19 laboratory results were unremarkable, but lymphopenia was detected. He experienced fever, body aches, and fatigue during June 10–13 that resolved but left him fatigued and weak. In the first case, a 35-year-old man left New York, New York, USA, to go hiking in Maryland during June 5–June 7, 2020. We describe 2 cases that illustrate this point. This mindset has had unintended consequences, including delaying of evaluations for other infectious diseases, potentially leading to adverse outcomes. As fear of COVID-19 has spread, diagnosing COVID-19 in febrile persons has been prioritized, and patients may be presumed to have COVID-19 pending results of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronavirus disease (COVID-19) took the United States by force during the first quarter of 2020, affecting the economy, societal norms, and the delivery of medical care ( 1, 2).
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