scholarly journals Short follow-up of multisystem inflammatory syndrome after covid19 infection in children: case report

2021 ◽  
Author(s):  
Angelo M. Acquafredda ◽  
Chiara Lorusso ◽  
Anna L. S. Di Giovinazzo ◽  
Anna Maria Pastoressa ◽  
Maria Simone ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Inflammatory Markers ◽  
Lung Ultrasound ◽  
Gastrointestinal Symptoms ◽  
Recovery Phase ◽  
Kawasaki Syndrome ◽  
Clinical Recovery ◽  
Interstitial Disease ◽  
Inflammatory Syndrome

Abstract Background: covid19 infection, in children compared to adults, often occurs in a pauci and/or asymptomatic manner, but in some cases, a multisystem inflammatory syndrome (MIS) may occur in the 4-6 weeks following the infection. There are few data on the features of MIS after the clinical recovery phase, therefore we have described three cases of children with post-covid19 infection syndrome. Case presentation: out of the three cases described, in two children the onset clinical symptoms were similar to Kawasaki syndrome, while in the other neurological impairment was prevalent. In none of the three there were gastrointestinal symptoms, while the signs of interstitial disease were constant on lung ultrasound. In all of them, there was an increase in the inflammatory markers, high levels of ferritin, lymphocytopenia and thrombocytopenia only in one case. The lipid profile at onset was characterized by an increase in triglyceride levels. In all cases the course was benign with resolution of the symptoms upon admission within 4-5 days. After 1 month from the clinical recovery phase, the patients showed normalization of cytokines, inflammatory markers and triglyceride levels, while the total cholesterol value increased. Covid19 infection leads to an acute phase response with increase of the triglyceride in addition to inflammatory markers and the signs of interstitial disease on lung ultrasound. Conclusions: the inflammatory markers and lung involvement normalize over 30 days, while an initial increase of the triglyceride - and later in total cholesterol - suggest a direct relationship between triglyceride and inflammatory markers at the beginning, and between total cholesterol and host immune response during the follow-up.

scholarly journals A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

PRILOZI ◽  
2021 ◽  
Vol 42 (2) ◽  
pp. 95-101
Author(s):  
Lidija Kareva ◽  
Katarina Stavrik ◽  
Kristina Mironska ◽  
Arjeta Hasani ◽  
Sonja Bojadzieva ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Close Contact ◽  
Multiorgan Failure ◽  
Gastrointestinal Symptoms ◽  
Gastrointestinal Diseases ◽  
Serological Testing ◽  
Inflammatory Syndrome ◽  
Pcr Test

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

scholarly journals Combined presentation of severe pulmonary COVID-19 and multisystem inflammatory syndrome in children (MIS-C): two reported Egyptian pediatric cases

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Tarek Hamed ◽  
Dina T. Sarhan
Keyword(s):  
Critical Illness ◽  
Inflammatory Markers ◽  
Immune Modulation ◽  
Pediatric Patients ◽  
Clinical Findings ◽  
Case Presentation ◽  
Clinical Criteria ◽  
Inflammatory Syndrome ◽  
Lung Ct

Abstract Background Initial reports from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease (COVID-19) than adults. Later on, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe pulmonary COVID-19 and MIS-C. Both are described as two distinct conditions, and the differentiation between them was the scope of many studies. In this report from Egypt, we will describe two unique pediatric cases presented by combined manifestations of severe pulmonary COVID-19 and MIS-C. Case presentation Two patients presented with severe pulmonary COVID-19 evident by pulmonary symptoms, signs, and advanced CO-RADS stage in lung CT were simultaneously fulfilling the clinical criteria of MIS-C including fever, multi-system affection, increased inflammatory markers in addition to the proved COVID-19 by positive serologic tests for SARS-CoV-2 but PCR was negative. Both patients responded well to immune-modulation therapy by IVIG and steroids and discharged well under closed follow-up. Conclusions Although it is debatable to present simultaneously, MIS-C should be considered in patients presenting with typical clinical findings and concerns for pulmonary COVID-19 once the criteria for MIS-C diagnosis is fulfilled. Starting treatment without delay can favor better prognosis.

IDIOPATHIC CELIAC DISEASE

PEDIATRICS ◽  
1953 ◽  
Vol 11 (3) ◽  
pp. 224-237
Author(s):  
PAUL A. DI SANT'AGNESE
Keyword(s):  
Celiac Disease ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Gastrointestinal Symptoms ◽  
Adult Life ◽  
Early Years ◽  
Clinical Recovery ◽  
Upper Respiratory ◽  
Latent Phase

The mortality and course of the illness of 58 patients with celiac disease, previously reported, are described. Three patients died; the remaining 55 went on to clinical recovery. The greatest clinical gains were made by these cases in the 6 to 24 months following initiation of treatment, but the abnormal character of the stools persisted for months or years. Relapses were not uncommon during the early years of improvement following upper respiratory infections or dietary indiscretions. The results of the follow-up study of 23 patients, 3 to 11 years after the original admission to Babies Hospital, are reported. It was found that despite remission of clinical symptoms, many abnormal laboratory and roentgenographic findings persisted (termed "latent phase of celiac disease"). It is reasonable to expect that some patients who have had severe celiac disease during infancy or early childhood may experience a recurrence of gastrointestinal symptoms in adult life.

Multisystem inflammatory syndrome with persistent neutropenia in neonate exposed to SARS-CoV-2 virus: A case report and review of literature

2021 ◽  
pp. 1-5
Author(s):  
K. Diwakar ◽  
B.K. Gupta ◽  
M.W. Uddin ◽  
A. Sharma ◽  
S. Jhajra
Keyword(s):  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Review Of Literature ◽  
Course Of Illness ◽  
Children And Adolescent ◽  
Immune Mediated ◽  
Microbial Etiology ◽  
Inflammatory Syndrome ◽  
Elevated Inflammatory Marker

BACKGROUND: Multisystem inflammatory syndrome in Children (MIS-C) is a postinfectious immune mediated hyperinflammatory state seen in children and adolescent below 21 year of age and develop after 4–6 weeks of severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) infection, however, it is rare in neonates. We report an extremely rare and first of its kind case of MIS-C in a neonate with persistent neutropenia. CASE DESCRIPTION: A 19-day old boy presented with complaints of fever and loose stools for 1 day and developed rash after admission. Baby was investigated for sepsis and commenced on IV antibiotics empirically. In view of persistent fever, diarrhoea, rash and absence of obvious microbial etiology of inflammation, with elevated inflammatory marker and an epidemiologic link to SARS-CoV-2 infection, the diagnosis of MIS-C-was made. Intravenous immunoglobulin (IVIg) was administered and defervescence occurred within 24 hours. He also developed neutropenia during course of illness which persisted on follow up. CONCLUSION: MIS-C in neonates is uncommon and fever with elevated inflammatory markers during COVID-19 pandemic should alert the pediatrician to the possibility of MIS-C. Neutropenia may be associated with MIS-C in neonates and warrants prolonged follow up.

scholarly journals An Arab Adolescent with Multisystem Inflammatory Syndrome Associated with COVID-19: A Report from Syria

2021 ◽  
Author(s):  
Jaafer Zaino ◽  
Abdullah Bakri ◽  
Amani Al Sayed Ahmad ◽  
Ghadeer Hadba
Keyword(s):  
Inflammatory Markers ◽  
Gastrointestinal Symptoms ◽  
Epidemiological Data ◽  
Intravenous Immunoglobulins ◽  
Arab Countries ◽  
Rt Pcr ◽  
High Grade Fever ◽  
Multiorgan Dysfunction ◽  
Laboratory Profile ◽  
Inflammatory Syndrome

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a rare and critical condition that affects children following exposure to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, leading to multiorgan dysfunction and shock. MIS-C has been reported from different parts of the world but rarely from Arab countries. In this report, we describe a 15-year-old Arab boy who was admitted to the ICU during the surge of Coronavirus transmission in Syria with a clinical picture consistent with MIS-C, including high-grade fever, gastrointestinal symptoms, rash, multiorgan dysfunction, and shock. Laboratory profile showed significant elevation of inflammatory markers, negative SARS-CoV-2 RT-PCR testing but positive serologic testing for SARS-CoV-2. The patient received intravenous immunoglobulins (IVIG) and glucocorticoids with remarkable cardiac improvement and significant alleviation in inflammatory markers. To our knowledge, this is the first reported case of MIS-C from Syria, which adds to the epidemiological data about this new syndrome.

Re-Increased Male Suicide Rates in the Recovery Phase Following the Great East Japan Earthquake

Crisis ◽  
2020 ◽  
Vol 41 (6) ◽  
pp. 422-428 ◽  
Author(s):  
Masatsugu Orui
Keyword(s):  
Social Connectedness ◽  
Recovery Phase ◽  
Great East Japan Earthquake ◽  
Temporary Housing ◽  
Period Analysis ◽  
Suicide Rates ◽  
Male Suicide ◽  
The Social ◽  
The Difference

Abstract. Background: Monitoring of suicide rates in the recovery phase following a devastating disaster has been limited. Aim: We report on a 7-year follow-up of the suicide rates in the area affected by the Great East Japan Earthquake, which occurred in March 2011. Method: This descriptive study covered the period from March 2009 to February 2018. Period analysis was used to divide the 108-month study period into nine segments, in which suicide rates were compared with national averages using Poisson distribution. Results: Male suicide rates in the affected area from March 2013 to February 2014 increased to a level higher than the national average. After subsequently dropping, the male rates from March 2016 to February 2018 re-increased and showed a greater difference compared with the national averages. The difference became significant in the period from March 2017 to February 2018 ( p = .047). Limitations: Specific reasons for increasing the rates in the recovery phase were not determined. Conclusion: The termination of the provision of free temporary housing might be influential in this context. Provision of temporary housing was terminated from 2016, which increased economic hardship among needy evacuees. Furthermore, disruption of the social connectedness in the temporary housing may have had an influence. Our findings suggest the necessity of suicide rate monitoring even in the recovery phase.

HRA Model for Hypercholesterolemia Based on a Longitudinal Health Database

1998 ◽  
Vol 37 (02) ◽  
pp. 130-133
Author(s):  
T. Kishimoto ◽  
Y. Iida ◽  
K. Yoshida ◽  
M. Miyakawa ◽  
H. Sugimori ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Model Analysis ◽  
Serum Total Cholesterol ◽  
Hazards Model ◽  
The Mean ◽  
Health Database ◽  
Observation Period

AbstractTo evaluate the risk factors for hypercholesterolemia, we examined 4,371 subjects (3,207 males and 1,164 females) who received medical checkups more than twice at an AMHTS in Tokyo during the period from 1976 through 1991; and whose serum total cholesterol was under 250 mg/dl. The mean follow-up duration was 6.6 years. A self-registering questionnaire was administered at the time of the health checkup. The endpoint of this study was the onset of hypercholesterolemia when the level of serum total cholesterol was 250 mg/dl and over. We compared two prognosis groups (normal and hypercholesterol) in terms of age, examination findings and lifestyle. After assessing each variable, we employed Cox's proportional hazards model analysis to determine the factors related to the occurrence of hypercholesterolemia. According to proportional hazards model analysis, total cholesterol, triglyceride and smoking at the beginning, and hypertension during the observation period were selected in males; and total cholesterol at the beginning and age were selected in females to determine the factors related to the occurrence of hypercholesterolemia.

Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajendra Bhati ◽  
Pramendra Sirohi ◽  
Bharat Sejoo ◽  
Deepak Kumar ◽  
Gopal K Bohra ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
North West ◽  
Cryptococcal Disease ◽  
Increased Risk ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

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