scholarly journals 110: ACUTE FULMINANT MYOCARDITIS ASSOCIATED WITH COVID-19 MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS

2021 ◽  
Vol 50 (1) ◽  
pp. 38-38
Author(s):  
Taranika Sarkar ◽  
Angela Li ◽  
Rajiv Jauhar ◽  
Suresh Jain
Keyword(s):  
Fulminant Myocarditis ◽  
Inflammatory Syndrome

scholarly journals FULMINANT MYOCARDITIS AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN, IN THE LIGHT OF CORONA VIRUS

2021 ◽  
Vol 77 (18) ◽  
pp. 1964
Author(s):  
Vijay Pratap Singh ◽  
Mousa Thalji ◽  
Swaiman Singh ◽  
Hamza Hafeez ◽  
Amandeep Sekhon ◽  
...  
Keyword(s):  
Fulminant Myocarditis ◽  
Corona Virus ◽  
Inflammatory Syndrome

scholarly journals Severe Multi-inflammatory syndrome in children amidst tropical fevers– an overlapping spectrum, its clinical and laboratory attributes from a tertiary care centre in India.

2021 ◽  
Author(s):  
Arpita Chattopadhyay ◽  
Karnika Saigal Kalra ◽  
Diganta Saikia ◽  
Varshanjali Yadav ◽  
Juhi Chouksey ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Case Series ◽  
World Health ◽  
Fulminant Myocarditis ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Prospective Case Series ◽  
Inflammatory Syndrome

Abstract Objective: We aim to describe our experience in terms of clinical and laboratory attributes in children with Multi – inflammatory syndrome in children temporally related to COVID-19 (MISC) presenting amidst other prevalent tropical infections.Design: Prospective case series.Setting: A tertiary care hospital pediatric intensive care unit (PICU).Patients: Seventeen children with severe MIS-C managed in PICU.Methods: We did a prospective case series of children (aged ≤ 12 years), admitted to PICU betweenMay 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analysed routinely collected demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors.Results: 17 critically ill children with no previous comorbidities fulfilled the WHO/CDC classification of MIS-C. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammation markers were highly raised - median C- reactive protein (mg/L) showed serial reduction in levels - from (median/IQR) 210 (132.6, 246.9) at admission to PICU to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n=12) was 690 (203, 1324), serum LDH (IU/L) (n=12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n=7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Although neutrophilia was seen in 16 patients [Mean (SD) - 14,952.9/μl (7175.2)], lymphopenia was uncommon and seen in only 4/17, median (IQR) [3000/μl (2245, 4508)]. 12 patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six patients expired.Conclusions: With our case series we wish to highlight the pattern of clinical and laboratory features in a cohort of severe MISC who were positive for SARSCOV2 antibody. We suggest refining the spectra of phenotypes of MIS-C for tropical countries keeping other exanthematous infections that present with fulminant myocarditis and refractory shock in perspective.

scholarly journals Evidence of SARS-CoV-2-Specific T-Cell-Mediated Myocarditis in a MIS-A Case

2021 ◽  
Vol 12 ◽  
Author(s):  
Kevin M. Vannella ◽  
Cihan Oguz ◽  
Sydney R. Stein ◽  
Stefania Pittaluga ◽  
Esra Dikoglu ◽  
...  
Keyword(s):  
T Cell ◽  
High Frequency ◽  
Tissue Repair ◽  
Cytotoxic T Cells ◽  
Molecular Targets ◽  
Myocardial Necrosis ◽  
Cell Receptor ◽  
Fulminant Myocarditis ◽  
Cell Clones ◽  
Inflammatory Syndrome

A 26-year-old otherwise healthy man died of fulminant myocarditis. Nasopharyngeal specimens collected premortem tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Histopathological evaluation of the heart showed myocardial necrosis surrounded by cytotoxic T-cells and tissue-repair macrophages. Myocardial T-cell receptor (TCR) sequencing revealed hyper-dominant clones with highly similar sequences to TCRs that are specific for SARS-CoV-2 epitopes. SARS-CoV-2 RNA was detected in the gut, supporting a diagnosis of multisystem inflammatory syndrome in adults (MIS-A). Molecular targets of MIS-associated inflammation are not known. Our data indicate that SARS-CoV-2 antigens selected high-frequency T-cell clones that mediated fatal myocarditis.

scholarly journals Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253625
Author(s):  
Shazia S. Mohsin ◽  
Qalab Abbas ◽  
Devyani Chowdhary ◽  
Farah Khalid ◽  
Abdul Sattar Sheikh ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Viral Myocarditis ◽  
Intravenous Immunoglobulins ◽  
Left Ventricular ◽  
World Health ◽  
Fulminant Myocarditis ◽  
Severe Left Ventricular Dysfunction ◽  
Inflammatory Syndrome

Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes.

scholarly journals Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael I. Gurin ◽  
Yue J. Lin ◽  
Samuel Bernard ◽  
Randal I. Goldberg ◽  
Navneet Narula ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiogenic Shock ◽  
Endomyocardial Biopsy ◽  
Myocardial Injury ◽  
Fulminant Myocarditis ◽  
Hemodynamic Compromise ◽  
Biventricular Function ◽  
Histologic Pattern ◽  
Biventricular Failure ◽  
Inflammatory Syndrome

Abstract Background With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. Case presentation A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. Conclusions MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient’s biventricular function recovered with IVIg and steroids.

A new multisystem inflammatory syndrome temporally associated with SARS-CoV-2 in a 6-year-old boy

2020 ◽  
Vol 16 (3) ◽  
pp. 295-300
Author(s):  
Agnieszka Pawłowska-Kamieniak ◽  
◽  
Milena Wronecka ◽  
Natalia Panasiuk ◽  
Karolina Kasiak ◽  
...  
Keyword(s):  
Child Health ◽  
Physical Examination ◽  
Medical History ◽  
Royal College ◽  
New Disease ◽  
Imaging Findings ◽  
Inflammatory Syndrome ◽  
And Child Health

In December 2019, China reported cases of infections caused by a new zoonotic coronavirus, which gradually developed into a pandemic. The disease was initially believed to be mild in children. In April 2020, a possible relationship between a new paediatric multisystem inflammatory syndrome and SARS-CoV-2 was found. In May, the Royal College of Paediatrics and Child Health published the criteria for the diagnosis of this new disease. We present a case of a 6-year-old boy retrospectively diagnosed with SARS-CoV-2-related multisystem inflammatory syndrome based on medical history, physical examination, laboratory and imaging findings, as well as the available literature.

Clinical and Morphological Features of Myocardial Damage and the Course of Fulminant Myocarditis on the Background of СOVID-19, Diagnosis and Treatment Tactics

2020 ◽  
Vol 75 (5S) ◽  
pp. 414-425
Author(s):  
Olga S. Oynotkinova ◽  
Evgenii L. Nikonov ◽  
Oleg V. Zayratyants ◽  
Elena V. Rzhevskaya ◽  
Evgenii V. Krukov ◽  
...  
Keyword(s):  
Myocardial Dysfunction ◽  
Myocardial Damage ◽  
Heart Rhythm ◽  
Microvascular Dysfunction ◽  
Symptomatic Treatment ◽  
Clinical Situation ◽  
Diagnosis And Treatment ◽  
Screening Tests ◽  
Fulminant Myocarditis ◽  
Heart Rhythm Disorders

In a review article based on my own clinical experience of managing patients with acute myocardial injury and fulminant myocarditis, taking into account expert recommendations on the clinical treatment of myocardial damage associated with novel coronavirus infection a National clinical geriatric medical research center, division of cardiovascular diseases, the Chinese geriatrics society, Department of cardiology, Beijing Medical Association and European clinics discusses the pathogenesis, diagnosis and treatment of myocardial damage and FM patients, infected with SARS-CoV-2 in the context of the COVID-19 pandemic. Clinical features and diagnostic criteria are presented, including screening tests of markers of myocardial damage in the form of a highly sensitive troponin test, a natriuretic peptide. The article discusses in detail the pathogenesis and mechanisms of myocardial damage, including immune mechanisms, cytokine storm, systemic inflammation with macro- and microvascular dysfunction and the development of myocardial dysfunction with acute heart failure, hypotension, cardiogenic shock and/or life-threatening heart rhythm disorders caused by hypoxia and metabolic disorders at the cellular level. Features of the clinical course of fulminant myocarditis in infected patients (SARS-CoV-2) in the conditions of the COVID-19 pandemic are presented. For the first time, a detailed histo-morphological analysis of pathological myocardial injuries and complications is presented on the basis of unique autopsy material on post-mortem diagnostics of various pathoanatomic autopsies of those who died from COVID-19 in Moscow. Based on the clinical, functional and morphological material, the Protocol of etiopathogenetic treatment is presented. The basis of standard therapy is considered antiviral drugs, immunoglobulin G, the use of monoclonal antibodies to interleukin-6, anticoagulants, glucocorticoids, depending on the clinical situation, cardioprotectors and symptomatic treatment are recommended to maintain the heart, which in combination can achieve a certain clinical effectiveness. As adjuvant cardioprotective targeted therapy, the sodium salt of phosphocreatine is considered in order to preserve the myocardium, maintain its contractility and vital activity.

Sign in / Sign up

Export Citation Format

Share Document