Outcomes of COVID-19 in a cohort of pediatric patients with rheumatic diseases

Abstract Background There are few reports of COVID-19 in pediatric patients with rheumatic diseases. This study describes the clinical presentation and outcomes of COVID-19 in this population. Methods We analyzed a single-center case series of pediatric patients with rheumatic diseases and laboratory-confirmed COVID-19. Demographic, baseline and COVID-19 associated clinical features were compared between ambulatory and hospitalized patients using univariate analysis. Results Fifty-five cases were identified: 45 (81.8%) in the ambulatory group and 10 (18.2%) hospitalized. African American race (OR 7.78; 95% CI [1.46–55.38]; p = 0.006) and cardiovascular disease (OR 19.40; 95% CI 2.45–254.14; p = 0.001) predominated in hospitalized patients. Active rheumatic disease (OR 11.83; 95% CI 1.43–558.37; p = 0.01), medium/high-dose corticosteroid use (OR 14.12; 95% CI [2.31–106.04]; p = 0.001), mycophenolate use (OR 8.84; 95% CI [1.64–63.88]; p = 0.004), rituximab use (OR 19.40; 95% CI [2.45–254.14]; p = 0.001) and severe immunosuppression (OR 34.80; 95% CI [3.94–1704.26]; p = < 0.001) were associated with increased odds of hospitalization. Fever (OR 7.78; 95% CI [1.46–55.38]; p = 0.006), dyspnea (OR 26.28; 95% CI [2.17–1459.25]; p = 0.003), chest pain (OR 13.20; 95% CI [1.53–175.79]; p = 0.007), and rash (OR 26.28; 95% CI [2.17–1459.25]; p = 0.003) were more commonly observed in hospitalized patients. Rheumatic disease flares were almost exclusive to hospitalized patients (OR 55.95; 95% CI [5.16–3023.74]; p < 0.001).. One patient did not survive. Conclusions Medium/high-dose corticosteroid, mycophenolate and rituximab use, and severe immunosuppression were risk factors for hospitalization. Fever, dyspnea, chest pain, and rash were high-risk symptoms for hospitalization. Rheumatic disease activity and flare could contribute to the need for hospitalization.

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Outcomes of COVID-19 in a cohort of pediatric patients with rheumatic diseases

10.21203/rs.3.rs-145918/v1 ◽

2021 ◽

Author(s):

Diana Sofia Villacis-Nunez ◽

Christina A. Rostad ◽

Kelly Rouster-Stevens ◽

Arezou Khosroshahi ◽

Shanmuganathan Chandrakasan ◽

...

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Pediatric Patients ◽

Univariate Analysis ◽

Case Series ◽

Hospitalized Patients ◽

High Dose ◽

High Dose Corticosteroid ◽

Severe Immunosuppression ◽

Dose Corticosteroid

Abstract Background There are few reports of COVID-19 in pediatric patients with rheumatic diseases. This study describes the clinical presentation and outcomes of COVID-19 in this population. Methods We analyzed a single-center case series of pediatric patients with rheumatic diseases and laboratory-confirmed COVID-19. Demographic, baseline and COVID-19 associated clinical features were compared between ambulatory and hospitalized patients using univariate analysis. Results Forty cases were identified: 32 (80%) in the ambulatory group and 8 (20%) hospitalized. Older age (median age 18 years vs 16 years; p = 0.01) and African American race (OR 8.42; 95% CI [1.20-101.69]; p = 0.01) predominated in hospitalized patients. Systemic lupus erythematosus (OR 6.77; 95% CI [1.01–56.71]; p = 0.02), medium/high-dose corticosteroid use (OR 10.62; 95% CI [1.46–99.57]; p = 0.008), mycophenolate use (OR 11.91; 95% CI [1.64-149.35]; p = 0.005), and severe immunosuppression (OR 16.83; 95% CI [1.74-861.43]; p = 0.004) were associated with increased odds of hospitalization. Patients with fever (OR 11.91; 95% CI [1.64-149.35]; p = 0.004), dyspnea (OR 16.51; CI [1.10-998.37]; p = 0.02), and myalgias (OR 13.40; 95% CI [1.43-194.56)]; p = 0.009) were more commonly encountered in the hospitalized group. Rheumatic disease flares were almost exclusive to hospitalized patients (OR 42.13; 95% CI [3.40-2463.87]; p < 0.001).. All patients recovered. Conclusions Medium/high-dose corticosteroid use, mycophenolate use, and severe immunosuppression were risk factors for hospitalization. Fever, dyspnea and myalgias were high-risk symptoms. The type of rheumatic disease, as well as disease flare could be contributing factors to the need for hospitalization.

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Invasive fungal disease in specific at-risk patients

Reviews in Health Care ◽

10.7175/rhc.43131s41-48 ◽

2012 ◽

Vol 3 (1S) ◽

pp. 41

Author(s):

Elio Castagnola ◽

Francesco Giuseppe De Rosa ◽

Anna Maria Nosari ◽

Rosario Urbino

Keyword(s):

Pediatric Patients ◽

Fungal Infections ◽

Invasive Fungal Disease ◽

High Dose ◽

High Dose Corticosteroid ◽

Purine Analogs ◽

High Incidence ◽

Risk Patients ◽

Dose Corticosteroid ◽

Lymphoproliferative Syndromes

Hematological patients, such as patients with lymphoproliferative syndromes, pediatric patients and patients in ICU, are not conventionally classified as high risk patients for the development of IFI, however invasive fungal infections should not be underestimated. In this subset of patients, particularly patients with lymphoproliferative syndromes are classified at intermediate risk for IFI especially if treated with monoclonal antibodies, purine analogs or steroids. With regard to pediatric patients the incidence of IFD is lower than in adults and is greater in patients with acute myeloid leukemia and in allotransplant patients. Finally, in patients in ICU there is high incidence of mold and Candida. Factors associated with increased mortality is the delay in admission in intensive care units, high-dose corticosteroid therapy, and GvHD.

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Invasive fungal disease in specific at-risk patients

Reviews in Health Care ◽

10.7175/rhc.v3i1s.431 ◽

2012 ◽

Vol 3 (1S) ◽

pp. 41-48

Author(s):

Elio Castagnola ◽

Francesco Giuseppe De Rosa ◽

Anna Maria Nosari ◽

Rosario Urbino

Keyword(s):

Pediatric Patients ◽

Fungal Infections ◽

Invasive Fungal Disease ◽

High Dose ◽

High Dose Corticosteroid ◽

Purine Analogs ◽

High Incidence ◽

Risk Patients ◽

Dose Corticosteroid ◽

Lymphoproliferative Syndromes

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High-Dose Corticosteroid Pulse Therapy Increases the Survival Rate in COVID-19 Patients at Risk of Cytokine Storm

SSRN Electronic Journal ◽

10.2139/ssrn.3633168 ◽

2020 ◽

Author(s):

Miguel Ángel López-Zúñiga ◽

Aida Moreno-Moral ◽

Ana Ocaña-Granados ◽

Francisco Padilla-Moreno ◽

Alba María Castillo-Fernández ◽

...

Keyword(s):

At Risk ◽

Survival Rate ◽

Pulse Therapy ◽

High Dose ◽

Cytokine Storm ◽

High Dose Corticosteroid ◽

Patients At Risk ◽

Corticosteroid Pulse Therapy ◽

Dose Corticosteroid

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Magnetic Resonance Imaging Evaluation in Patients with Linear Morphea Treated with Methotrexate and High-Dose Corticosteroid

Dermatology Research and Practice ◽

10.1155/2018/8391218 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Mohammad Shahidi-Dadras ◽

Fahimeh Abdollahimajd ◽

Razieh Jahangard ◽

Ali Javinani ◽

Amir Ashraf-Ganjouei ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Dose ◽

Skin Thickness ◽

Resonance Imaging ◽

High Dose Corticosteroid ◽

Before And After ◽

Lesion Extension ◽

Dose Corticosteroid ◽

Mri Changes

Background. Morphea is an inflammatory disease of the connective tissue that may lead to thickening and hardening of the skin due to fibrosis. The aim of this study was to document magnetic resonance imaging (MRI) changes in patients with linear morphea who were treated with methotrexate (MTX) and high-dose corticosteroid. Methods. This study was conducted on 33 patients from the outpatient’s dermatology clinic of our institute, who fulfilled the inclusion criteria. Patients received 15 mg/week of MTX and monthly pulses of methylprednisolone for three days in six months. The effectiveness of the treatment was evaluated by MRI, modified LS skin severity index (mLoSSI), and localized scleroderma damage index (LoSDI). Results. All parameters of mLoSSI and LoSDI including erythema, skin thickness, new lesion/lesion extension, dermal atrophy, subcutaneous atrophy, and dyspigmentation were also noticeably improved after treatment. Subcutaneous fat enhancement was the most common finding in MRI. MRI scores were significantly associated with clinical markers both before and after the treatment with the exception of skin thickness and new lesion/lesion extension which were not associated with MRI scores before and after the treatment, respectively. Limitations. The lack of correlative laboratory disease activity markers, control group, and clearly defined criteria to judge the MRI changes. Conclusion. MRI could be a promising tool for the assessment of musculoskeletal and dermal involvement and also monitoring treatment response in patients with morphea.

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Indications for Tonsillectomy in Infectious Mononucleosis

PEDIATRICS ◽

10.1542/peds.48.2.338 ◽

1971 ◽

Vol 48 (2) ◽

pp. 338-339

Author(s):

Edward J. Feroli ◽

Gordon W. Mella ◽

Frank A. Pedreira ◽

Regis T. Storch ◽

Howard P. Gutgesell

Keyword(s):

Case Report ◽

Infectious Mononucleosis ◽

Community Hospital ◽

Nasotracheal Intubation ◽

Benign Disease ◽

Therapeutic Modality ◽

High Dose ◽

High Dose Corticosteroid ◽

Acute Airway Obstruction ◽

Dose Corticosteroid

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients. A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.

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