Pediatric inflammatory multisystem syndrome associated with COVID-19: A report of 10 cases in a Peruvian hospital

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 is a potentially severe and rare condition that still needs a better understanding to guide its management. Reports worldwide, and especially in Latin America, are still scarce. This report presents ten cases of pediatric inflammatory multisystem syndrome temporally associated with COVID-19 in children between 2 and 12 years old treated in a Peruvian hospital, diagnosed using the Centers for Disease Control and Prevention criteria. Severe acute respiratory syndrome coronavirus 2 was detected through serological tests (immunoglobulin M or G). Most had gastrointestinal symptoms. Therapeutics consisted mainly of intravenous immunoglobulin, corticosteroids, ivermectin, hydroxychloroquine, digoxin, and antibiotic therapy. Three patients underwent mechanical ventilation; no mortality occurred in this case series. In conclusion, the manifestations presented here are similar to those reported in the literature. A timely diagnosis is necessary for proper management.

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375. COVID 19 infection in a Massachusetts community hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.570 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S257-S258

Author(s):

Raul Davaro ◽

alwyn rapose

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Essential Hypertension ◽

Severe Acute Respiratory Syndrome ◽

High Mortality ◽

Case Series ◽

World Health ◽

Minimal Risk ◽

The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

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Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus 2 infection: a systematic review

Singapore Medical Journal ◽

10.11622/smedj.2021100 ◽

2021 ◽

Author(s):

J Cho ◽

J Lee ◽

CH Sia ◽

CS Koo ◽

BYQ Tan ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Respiratory Symptoms ◽

Case Reports ◽

Meta Analysis ◽

Severe Disease ◽

Late Phase ◽

Cardiac Injury ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Venous Thromboembolic Events

Introduction: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity. Methods: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded. Results: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum. Conclusion: Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.

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Longitudinal Change of Severe Acute Respiratory Syndrome Coronavirus 2 Antibodies in Patients with Coronavirus Disease 2019

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa229 ◽

2020 ◽

Vol 222 (2) ◽

pp. 183-188 ◽

Cited By ~ 38

Author(s):

Guoxin Zhang ◽

Shuke Nie ◽

Zhaohui Zhang ◽

Zhentao Zhang

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Disease Onset ◽

Immunoglobulin M ◽

Longitudinal Change ◽

Igg Antibody ◽

Serological Tests ◽

Significant Difference ◽

Rapid Spread ◽

Novel Coronavirus ◽

Acid Test

Abstract Background A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently emerged and caused the rapid spread of coronavirus disease 2019 (COVID-19) worldwide. Methods We did a retrospective study and included COVID-19 patients admitted to Renmin Hospital of Wuhan University between 1 February and 29 February 2020. Antibody assay was conducted to detect COVID-19 envelope protein E and nucleocapsid protein N antigen. Results One hundred twelve patients were recruited with symptoms of fever, cough, fatigue, myalgia, and diarrhea. All patients underwent antibody tests. Fifty-eight (51.79%) were positive for both immunoglobulin M (IgM) and immunoglobulin G (IgG), 7 (6.25%) were negative for both antibodies, 1 (0.89%) was positive for only IgM, and 46 (41.07%) were positive for only IgG. IgM antibody appeared within a week post–disease onset, lasted for 1 month, and gradually decreased, whereas IgG antibody was produced 10 days after infection and lasted for a longer time. However, no significant difference in levels of IgM and IgG antibodies between positive and negative patients of nucleic acid test after treatment was found. Conclusions Our results indicate that serological tests could be a powerful approach for the early diagnosis of COVID-19.

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SARS-CoV-2 and Norovirus Co-Infection after Lung Transplantation

Transplantology ◽

10.3390/transplantology1010002 ◽

2020 ◽

Vol 1 (1) ◽

pp. 16-23 ◽

Cited By ~ 2

Author(s):

Carolin Steinack ◽

René Hage ◽

Christian Benden ◽

Macé M. Schuurmans

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Transplant Recipient ◽

Antibiotic Therapy ◽

Lung Transplantation ◽

Lung Transplant ◽

Gastrointestinal Symptoms ◽

Lung Transplant Recipient ◽

Disease Evolution ◽

Moderate Disease ◽

Thoracic Transplantation

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is spreading as a pandemic in 2020. Few reports on infections in thoracic transplantation have been published so far. We present a case of COVID-19 in a 55-year old female lung transplant recipient infected 5 months posttransplant, who additionally was co-infected with a Norovirus. Respiratory and gastrointestinal symptoms were observed without need of therapeutic escalation except for antibiotic therapy. We observed a moderate disease evolution likely due to triple immunosuppression.

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Septic arthritis of the acromioclavicular joint: a case series and review of the literature

Shoulder & Elbow ◽

10.1177/1758573218815289 ◽

2018 ◽

Vol 12 (4) ◽

pp. 272-283

Author(s):

Raymond G Steinmetz ◽

Jeremiah J Maupin ◽

Joel N Smith ◽

Christopher B White

Keyword(s):

Antibiotic Therapy ◽

Septic Arthritis ◽

Acromioclavicular Joint ◽

English Literature ◽

Effective Means ◽

Case Series ◽

Rare Condition ◽

Surgical Debridement ◽

Review Of The Literature ◽

High Index Of Suspicion

Objective To report a case series of three patients with septic arthritis of the acromioclavicular joint and a review of the literature for this condition. Additionally, we developed an algorithm for diagnosing and treating septic arthritis of the acromioclavicular joint. Methods A retrospective review of patients treated at our institution for septic arthritis of the acromioclavicular joint during the collection period was performed and three cases were identified. A review of the English literature on this rare condition was also performed with only 28 cases being identified. Results A series of three consecutive patients were treated for septic acromioclavicular arthritis with resolution of the infection. Two patients underwent open surgical debridement and one underwent aspiration. All patients were treated with a minimum of six weeks of tailored intravenous antibiotic therapy. Conclusion Septic arthritis of the acromioclavicular joint can be difficult to diagnose and requires a high index of suspicion. Surgical debridement, open or arthroscopic, with tailored antibiotic therapy is an effective means for the management of septic arthritis of the acromioclavicular joint. In patients who are unable to have surgical debridement, aspiration and tailored antibiotics have been shown to be effective.

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Rapid and Simple Diagnosis of Chlamydophila pneumoniae Pneumonia by an Immunochromatographic Test for Detection of Immunoglobulin M Antibodies

Clinical and Vaccine Immunology ◽

10.1128/cvi.00085-08 ◽

2008 ◽

Vol 15 (7) ◽

pp. 1128-1131 ◽

Cited By ~ 5

Author(s):

Naoyuki Miyashita ◽

Kazunobu Ouchi ◽

Fumio Kishi ◽

Mitsuaki Tabuchi ◽

Naoki Tsumura ◽

...

Keyword(s):

Antibiotic Therapy ◽

Sensitivity And Specificity ◽

Chlamydophila Pneumoniae ◽

Immunoglobulin M ◽

Immunochromatographic Test ◽

Serological Tests ◽

Specific Immunoglobulin ◽

Selection Of

ABSTRACT To evaluate a newly developed immunochromatographic test (the MySet test) for the detection of Chlamydophila pneumoniae-specific immunoglobulin M antibodies, the results obtained by the MySet test were compared with those obtained by two serological tests. The sensitivity and specificity of the MySet test were 100% and 92.9%, respectively. The MySet test is rapid and simple to use and is thought to be a useful tool for the selection of appropriate antibiotic therapy.

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Spontaneous Pneumomediastinum: A Possible Severe Condition in SARS-CoV-2 Pneumonia

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0041-1735478 ◽

2021 ◽

Vol 10 (01) ◽

pp. e55-e58

Author(s):

Geoffrey Jacqmin ◽

Manuel Pirotte ◽

Carlo Caravaggio ◽

Philippe Devaux

Keyword(s):

Mechanical Ventilation ◽

Severe Acute Respiratory Syndrome ◽

Rare Condition ◽

Case Description ◽

Severe Condition ◽

Potential Predictor ◽

Spontaneous Pneumomediastinum ◽

Free Air

Abstract Background Spontaneous pneumomediastinum (SP) is the presence of free air into extra-alveolar tissues within the mediastinum, without notion of trauma. This rare condition may occur as a complication of an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Higher rates of mechanical ventilation are reported in coronavirus disease 2019 (COVID-19) patients with pneumomediastinum. Case Description We report two cases of COVID-19 infected patients suffering from mild and severe SP and their outcome. Discussion The objective of this report is to review the literature about this condition. We discuss about the pathological pathways underlying this complication and how it reflects the severity of COVID-19 pneumonia. Conclusion Currently, it remains unclear if SP in SARS-CoV-2 pneumonia is a potential predictor of disease worsening, for it does not seem to be related with a higher rate of mortality.

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The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2–Related Multisystem Inflammatory Syndrome in Children: A Systematic Review

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa112 ◽

2020 ◽

Cited By ~ 3

Author(s):

Stephen C Aronoff ◽

Ashleigh Hall ◽

Michael T Del Vecchio

Keyword(s):

Systematic Review ◽

Natural History ◽

Severe Acute Respiratory Syndrome ◽

Myocardial Dysfunction ◽

Case Reports ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Case Series ◽

History Of ◽

Inflammatory Syndrome

Abstract Background The clinical manifestations and natural history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related multisystem inflammatory syndrome in children (MIS-C) are poorly defined. Using a systematic review of individual cases and case series and collating elements of the clinical course, the objective of this study was to provide a detailed clinical description and natural history of MIS-C. Methods Case reports and series of MIS-C were recovered from repeated MEDLINE searches, a single EMBASE search, and table of contents reviews of major general medicine and pediatric journals performed between June 3 and July 23, 2020. Fever, evidence of inflammation, and evidence of organ dysfunction were required for inclusion. Results MEDLINE and EMBASE searches produced 129 articles, and 10 articles were identified from journal contents or article bibliographies; 16 reports describing 505 children with MIS-C comprise this review. Thirty-two children (14.7%) had negative results for SARS-CoV-2 by nucleic acid and/or antibody testing. The weighted median age was 9 years (6 months to 20 years). Clinical findings included fever (100%), gastrointestinal symptoms (88.0%), rash (59.2%), conjunctivitis (50.0%), cheilitis/ “strawberry tongue” (55.7%), or extremity edema/erythema (47.5%). Median serum C-reactive protein, ferritin, fibrinogen, and D-dimer concentrations were above the normal range. Intravenous gammaglobulin (78.1%) and methylprednisolone/prednisone (57.6%) were the most common therapeutic interventions; immunomodulation was used in 24.3% of cases. Myocardial dysfunction requiring ionotropic support (57.4%) plus extracorporeal membrane oxygenation (5.3%), respiratory distress requiring mechanical ventilation (26.1%), and acute kidney injury (11.9%) were the major complications; anticoagulation was used commonly (54.4%), but thrombotic events occurred rarely (3.5%). Seven (1.4%) children died. Conclusions MIS-C following SARS-CoV-2 infection frequently presents with gastrointestinal complaints and/or rash; conjunctivitis, cheilitis, and/or extremity changes also occur frequently. Serious complications occur frequently and respond to aggressive supportive therapy.

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Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

Journal of Neurology ◽

10.1007/s00415-021-10406-y ◽

2021 ◽

Author(s):

Biyan Nathanael Harapan ◽

Hyeon Joo Yoo

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Case Reports ◽

Case Series ◽

Altered Mental Status ◽

Neurological Complications ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Fisher Syndrome ◽

Novel Coronavirus ◽

The Impact

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

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Persistent Multispecies Actinomyces Mastitis Treated With Repeated Aspiration and Long-Term Oral Antibiotics

The American Surgeon ◽

10.1177/00031348211025748 ◽

2021 ◽

pp. 000313482110257

Author(s):

Colin Jenkins ◽

Anand Ganapathy ◽

Crystal Fancher ◽

Kazuhide Matsushima

Keyword(s):

Antibiotic Therapy ◽

Rare Condition ◽

Breast Abscess ◽

Amoxicillin Clavulanic Acid ◽

Recurrent Breast ◽

Causative Bacterium ◽

Repeated Aspiration ◽

Prolonged Antibiotic Therapy

Actinomycosis is an infection characterized by abscess formation, draining sinuses, and tissue fibrosis. The causative bacterium is a Gram-positive facultative anaerobe from the genus Actinomyces. Infections classically affect the cervicofacial, thoracic, or pelvic region and often require prolonged antibiotic therapy. Actinomycosis of the breast is a rare condition that may present as a recurrent breast abscess. We present a 33-year-old female with a recurrent breast abscess which grew A. radingae and A. israeli on aspirated fluid cultures. Treatment with surgical aspiration and a 6-week course of oral amoxicillin/clavulanic acid 875 mg twice daily resulted in clinical improvement. Our case demonstrates how recurrent breast abscesses caused by Actinomyces can be difficult to manage. Long-term antibiotic therapy with surgical aspiration and regular follow-up offer the best chance of clinical resolution.

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