scholarly journals Osteomyelitis in a General Pediatric Ward

2021 ◽  
Author(s):  
Mafalda Casinhas Santos ◽  
Sara Limão ◽  
Ana Sofia Vilardouro ◽  
Clara Júlio ◽  
Florbela Cunha
Keyword(s):  
Staphylococcus Aureus ◽  
Salmonella Enteritidis ◽  
Primary Diagnosis ◽  
Polymerase Chain Reaction Test ◽  
Positive Polymerase Chain Reaction ◽  
Single Center Study ◽  
Previous Trauma ◽  
Oropharyngeal Swab ◽  
Hand Involvement ◽  
Chain Reaction Test

INTRODUCTION: Pediatric acute osteomyelitis (AO) is a serious condition and a challenging diagnosis. It mainly affects previously healthy individuals and Staphylococcus aureus is the leading causative agent. The objective of this study was to characterize all pediatric AO cases admitted to a second-level hospital during a six-year period.METHODS: Retrospective single-center study, including all children under 18 years-old with a primary diagnosis of AO. Descriptive statistics analysis was performed.RESULTS: Ten cases were identified, 60% males. The median age was 6.7 years. Previous trauma was referred by five. Affected locations were foot (n=3), tibia (n=3), femur (n=2), sacrum (n=1) and hand (n=1). All presented with local pain and limping or inability to walk (except one case with hand involvement). Four patients had fever and inflammatory signs, namely erythema and edema, were reported by four. At admission, nine had elevated inflammatory markers and six out of eight had normal radiographs. Magnetic resonance imaging confirmed the diagnosis in seven. Blood cultures were positive for Staphylococcus aureus (n=3) and Streptococcus pyogenes (n=1). Salmonella enteritidis was isolated from pus (n=1) and there was one presumed Kingella kingae AO defined as a positive polymerase chain reaction test from an oropharyngeal swab. The average duration of parenteral and oral antibiotherapy was 14.7 days 3.9 weeks, respectively. The antibiotic of choice was flucloxacillin. Two patients developed local complications.DISCUSSION: An unspecific and subacute clinical and radiological presentation together with low positive blood culture rates difficults timely diagnosis and management. An early empirical parenteral antibiotherapy is mandatory, followed by an oral regimen for at least four weeks.

scholarly journals Severe acute respiratory syndrome coronavirus 2 reinfection in a coronavirus disease 2019 recovered young adult: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Hussein Awada ◽  
Hasan Nassereldine ◽  
Adel Hajj Ali
Keyword(s):  
Immune Response ◽  
Polymerase Chain Reaction ◽  
Severe Acute Respiratory Syndrome ◽  
Healthcare Providers ◽  
Polymerase Chain Reaction Test ◽  
Chain Reaction ◽  
Positive Polymerase Chain Reaction ◽  
Serology Test ◽  
Polymerase Chain ◽  
Chain Reaction Test

Abstract Background Coronavirus disease 2019 has been a public health threat and a worldwide emergency for more than a year. Unfortunately, many questions concerning the pathophysiology, management, and long-term side effects remain unanswered, and novel aspects of the disease keep on emerging. Of concern to healthcare providers are the recent reported cases of reinfection. Serum coronavirus disease 2019 antibodies have been detected within a few days after onset of the disease. However, it remains unclear whether this immune response is universal, or whether it can lead to latent immunity. Case presentation A previously healthy 27-year-old white man presented with fever, chills, back pain, and other constitutional symptoms, 2 days after being exposed to coronavirus disease 2019 positive patients. His severe acute respiratory syndrome coronavirus 2 polymerase chain reaction was positive, and his symptoms resolved over the next 2 weeks. One month after a confirmatory negative severe acute respiratory syndrome coronavirus 2 polymerase chain reaction, he was found to be ineligible for plasma donation as his anti-severe acute respiratory syndrome coronavirus 2 serology was negative. The patient redeveloped symptoms similar to his first infection 3 weeks after the negative serology test. He and his wife both tested positive via polymerase chain reaction. Their symptoms resolved over the next few days, and they had a negative polymerase chain reaction test 10 days after the positive polymerase chain reaction. Conclusion While studies showed that anti-severe acute respiratory syndrome coronavirus 2 immunoglobulins start to develop early after infection, our healthy young patient’s immune system failed to mount latent immunity against the virus. This left him, especially amid widespread social and medical misconceptions, vulnerable to reinfection by severe acute respiratory syndrome coronavirus 2. Our case disputes the timelines for immune response that were set and supported by research studies. Our case also raises questions regarding prioritizing vaccinating other individuals over those with prior infection.

scholarly journals 82. Multisystem Inflammatory Syndrome in Children and non-sars-cov-2 Infections: A Retrospective Cross-sectional Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S173-S173
Author(s):  
Jeffrey Campbell ◽  
Jordan E Roberts ◽  
Melanie Dubois ◽  
Caitlin Li ◽  
Thomas Sandora ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Evaluation Research ◽  
Cross Sectional Study ◽  
Case Definition ◽  
Polymerase Chain Reaction Test ◽  
Parasitic Infections ◽  
Cross Sectional ◽  
Positive Polymerase Chain Reaction ◽  
Chain Reaction Test ◽  
Inflammatory Syndrome

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) has been described in areas with high Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) burden. Clinical features included in the MIS-C case definition (e.g fever, elevated inflammatory markers) overlap with features of other childhood infections. The prevalence of non-SARS-CoV-2 infection in patients evaluated for MIS-C has not been described. Patients evaluated for MIS-C, and therapies administered. Methods Retrospective cohort study of patients < 21 years of age admitted to a freestanding children’s hospital in Boston, MA from May 14-June 6, 2020 who were evaluated for MIS-C. We identified patients undergoing Rheumatology consultation and echocardiogram (per the hospital’s protocol for evaluating children with suspicion for MIS-C). We tabulated patients evaluated for MIS-C found to have non-SARS-CoV-2 infection detected on standard microbiologic testing. Results 39 patients met inclusion criteria. Median age was 5 years (IQR 2–12 years). Of evaluated patients, 19/39 (49%) were diagnosed with MIS-C according to the Massachusetts Department of Public Health case definition; 10/39 (26%) required ICU admission. Non-SARS-CoV-2 infections were identified in 7/39 (18%), of whom 5/7 (71%) had bacterial infections, 1/7 (14%) had viral infection, and 1/7 (14%) had viral and bacterial co-infections; no fungal or parasitic infections were identified. Of patients diagnosed with MIS-C, 2/19 (11%) were found to have non-SARS-CoV-2 infection. Additionally, 5/19 (26%) had a positive polymerase chain reaction test for SARS-CoV-2 at time of MIS-C diagnosis, of whom 4/5 (80%) received remdesivir. Of patients evaluated for MIS-C, 17/39 (44%) received intravenous immune globulin, 14/39 (36%) aspirin, 4/39 (10%) anakinra, and 14/39 (36%) methylprednisolone. Additionally, 21/39 (54%) received antibacterial and 5/39 (13%) antiviral therapy (Table). Conclusion In this study, non-SARS-CoV-2 infections were diagnosed in 18% of children evaluated for MIS-C. Clinicians should consider alternative or concomitant infectious diagnoses in patients undergoing MIS-C evaluation. Research is needed to identify clinical and laboratory features that may distinguish patients with MIS-C from those with non-SARS-CoV-2 infection. Disclosures All Authors: No reported disclosures

scholarly journals Chronic seronegative spondyloarthropathy following acute Mycoplasma pneumoniae infection in a human leukocyte antigen B27-positive patient: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Georgios Pilianidis ◽  
Ariti Tsinari ◽  
Dimitrios Pandis ◽  
Hara Tsolakidou ◽  
Nikolaos Petridis
Keyword(s):  
Human Leukocyte Antigen ◽  
Mycoplasma Pneumoniae ◽  
Reactive Arthritis ◽  
Human Leukocyte ◽  
Polymerase Chain Reaction Test ◽  
Limb Weakness ◽  
Positive Polymerase Chain Reaction ◽  
Leukocyte Antigen ◽  
Chain Reaction Test ◽  
Proximal Myopathy

Abstract Background We report a case of a 30-year-old patient who presented with acute Mycoplasma pneumoniae infection that was complicated by reactive arthritis and asymmetric proximal myopathy and progressed to chronic spondyloarthropathy. Reactive arthritis and sacroiliitis are unusual extrapulmonary manifestations of M. pneumoniae infection, which is a common condition. Case presentation A 30-year-old Greek previously healthy man presented to our emergency department with fever, progressively worsening bilateral lower limb weakness, and asymmetric oligoarthritis. Our diagnosis was based on a positive polymerase chain reaction test for M. pneumoniae using blood and cerebrospinal fluid and magnetic resonance imaging findings that suggested sacroiliitis. Our patient was also found to be human leukocyte antigen B27 positive. His infection was successfully treated with a 14-day course of doxycycline; the arthritis was treated with naproxen and corticosteroids. His arthritis, which restricted his mobility, improved progressively, and he was discharged without any neurological symptoms. Conclusions In our case, an acute M. pneumoniae infection eventually progressed to chronic spondyloarthropathy. In our patient, M. pneumoniae infection may represent a random event, or it might be a necessary factor for the development of reactive arthritis, asymmetric proximal myopathy, and sacroiliitis, always in combination with the appropriate genetic background. Extrapulmonary manifestations of M. pneumoniae may occur even in the complete absence of respiratory symptoms, and the diagnosis of unusual complications, such as reactive arthritis, requires high clinical suspicion and extensive investigation.

scholarly journals Initial Observations of COVID-19 in US Children

2020 ◽  
Vol 10 (10) ◽  
pp. 902-905
Author(s):  
Rabia Agha ◽  
Tsoline Kojaoghlanian ◽  
Jeffrey R. Avner
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Respiratory Illness ◽  
Polymerase Chain Reaction Test ◽  
Positive Polymerase Chain Reaction ◽  
Targeted Testing ◽  
Polymerase Chain ◽  
Chain Reaction Test ◽  
Us Children

Coronavirus disease (COVID-19) has affected children differently from adults worldwide. Data on the clinical presentation of the infection in children are limited. We present a detailed account of pediatric inpatients infected with severe acute respiratory syndrome coronavirus 2 virus at our institution during widespread local transmission, aiming to understand disease presentation and outcomes. A retrospective chart review was performed of children, ages 0 to 18 years, with a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal specimens admitted to our hospital over a 4-week period. We present clinical data from 22 patients and highlight the variability of the presentation. In our study, most children presented without respiratory illness or symptoms suggestive of COVID-19; many were identified only because of universal testing. Because children may have variable signs and symptoms of COVID-19 infection, targeted testing may miss some cases.

scholarly journals Miocarditis in Patients with COVID-19 Confirmed by Immunohistochemical

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 4-10 ◽  
Author(s):  
E. A. Kogan ◽  
Yu. S. Berezovskiy ◽  
O. V. Blagova ◽  
A. D. Kukleva ◽  
G. A. Bogacheva ◽  
...  
Keyword(s):  
Histological Study ◽  
Viral Myocarditis ◽  
Polymerase Chain Reaction Test ◽  
The Novel ◽  
Morphological Examination ◽  
Positive Polymerase Chain Reaction ◽  
Lymphocytic Myocarditis ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Chain Reaction Test

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3–4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.

scholarly journals Prolonged QT Interval in SARS-CoV-2 Infection: Prevalence and Prognosis

2020 ◽  
Vol 9 (9) ◽  
pp. 2712 ◽  
Author(s):  
Núria Farré ◽  
Diana Mojón ◽  
Marc Llagostera ◽  
Laia C. Belarte-Tornero ◽  
Alicia Calvo-Fernández ◽  
...  
Keyword(s):  
Qt Interval ◽  
Polymerase Chain Reaction Test ◽  
Infection Prevalence ◽  
Qtc Interval ◽  
Positive Polymerase Chain Reaction ◽  
Reaction Test ◽  
Prolonged Qt Interval ◽  
Polymerase Chain ◽  
Prolonged Qt ◽  
Chain Reaction Test

Background: The prognostic value of a prolonged QT interval in SARS-Cov2 infection is not well known. Objective: To determine whether the presence of a prolonged QT on admission is an independent factor for mortality in SARS-Cov2 hospitalized patients. Methods: Single-center cohort of 623 consecutive patients with positive polymerase-chain-reaction test (PCR) to SARS Cov2, recruited from 27 February to 7 April 2020. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval. A prolonged QT interval was defined as a corrected QT (QTc) interval >480 milliseconds. Patients were followed up with until 10 May 2020. Results: Sixty-one patients (9.8%) had prolonged QTc and only 3.2% had a baseline QTc > 500 milliseconds. Patients with prolonged QTc were older, had more comorbidities, and higher levels of immune-inflammatory markers. There were no episodes of ventricular tachycardia or ventricular fibrillation during hospitalization. All-cause death was higher in patients with prolonged QTc (41.0% vs. 8.7%, p < 0.001, multivariable HR 2.68 (1.58–4.55), p < 0.001). Conclusions: Almost 10% of patients with COVID-19 infection have a prolonged QTc interval on admission. A prolonged QTc was independently associated with a higher mortality even after adjustment for age, comorbidities, and treatment with hydroxychloroquine and azithromycin. An electrocardiogram should be included on admission to identify high-risk SARS-CoV-2 patients.

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