ABSTRACT
Background: Peripheral nervous (PNS) system involvement in SARS-CoV-2 infection has been described as a consequence of direct neurotropic invasion or parainfectious autoimmune spinal nerve demyelination in the clinical form of acute inflammatory demyelinating polyraduculoneuropathy (AIDP). Few cases have been described with cranial nerves involvement too. Description of the case: A 62 year-old male patient was admitted in March 2020 to our CoViD Unit in Miulli Hospital in Acquaviva delle Fonti (Bari) for recent onset of cough, fever, with interstitial pneumonia with peripheral and central ground glass opacities and consolidation at lungs CT. Oropharyngeal swab tested positive for SARS-CoV-2. Despite an early clinical and radiological remission, the swab became negative after two months. In May, he came back to our attention for chest pain and fever with echocardiography documenting pericardial effusion;SARS-CoV-2 swab was positive again. Some weeks later, he presented weakness in both legs ascending to arms, with severe fatigue and iporeflexia followed in a few days by bilateral facial palsy. Cerebrospinal fluid (CSF) analysis and electromyography (EMG) were suggestive for AIDP, so we started infusion of human immunoglobulins, with immediate partial recovery followed by complete recovery in a few weeks after rehabilitation. Conclusions: The persistence of SARS-CoV-2 induces an abnormal immunological activation that may result in neurologic issues such as involvement of peripheral nervous system (PNS) with spinal - and in some cases - cranial nerves inflammatory demyelination.
ABSTRACT
Background and Aim of the study: Tocilizumab (TCZ), a monoclonal antibody against IL-6 receptor, has been recently employedas a treatment for SARS-Cov2-associated pneumonia (COVID),due to the central role of IL-6 on the citokyne-storm associatedhyperinflammatory syndrome. Aim of this observational retrospective study was to evaluate effectiveness and safety of TCZ for thetreatment of COVID.Materials and Methods: We retrospectively evaluated, from 16thMarch 2020 to 7th April 2020, outcomes of 16 patients affected bynasopharyngeal swab-confirmed SARS-COV-2 Pneumonia who received TCZ i.v. treatment (8 mg/kg once or twice in 12 hours). Weevaluated clinical features, Arterial Blood Gas Test (ABG), laboratoryfindings collected at baseline and after consecutive two days. Results: We analyzed 16 patients (M/F: 12/4) with mean age (±SD) 69±9 years and mean disease duration 15±5 days. At baseline, mean CRP level was 14±10 mg/dl and IL-6 249±264 pg/ml.To evaluate respiratory improvement after treatment, we collectedABG data at 6,24 and 48 hours;we observed a rapid improvement of P/F ratio to 165,6±55,4 mmHg (p=0,01). We also observed a significant reduction of CRP levels to 6±6 mg/dl(p=0,0002) and a rapid increase of IL-6 serum levels to941±1317 pg/ml (p=0,05). Clinically we observed a global improvement in ten patients, while six died for infective complications. No adverse event was detected following TCZ administration.Conclusions: In our real-life experience TCZ treatment was effective and safe in a group of patients affected by SARS COV2-associated pneumonia.
ABSTRACT
Background and Aim of the study: A novel coronavirus (SARSCoV2) in 2019 has been recognized as the responsible of an interstitial pneumonia characterized by a severe acute respiratorysyndrome initially reported in China with a subsequent pandemicoutbreak. Aim of this observational retrospective cohort study wasto describe the CT findings of this new disease in a cohort of patients treated in our COVID Unit.Materials and Methods: TC scan of 49 patients with naso-pharyngeal swab confirmed SARS CoV2 pneumonia admitted toCOVID Unit of F. Miulli General Hospital from 19th March 2020 to03rd May 2020 were retrospectively analyzed.Results: The cohort included 49 patients (42 males, 86%;7 female, 14%);mean age 63,2 years (SD 14,8). Radiological findings distribution was bilateral in the whole cohort;peripheralinvolvement was constant (n=46 [93%]), in some cases exclusively subpleural (n=10;20%), with pleuric sparing in few cases(n=7, 14%). 2 patients had central distribution of alterations (4%).The great part of the cohort showed mixed (central/periferic) distribution (n=29 [60%]). Radiological phenotypes were: predominant ground-glass (GG) (n=20 [41%]), consolidative (C) (n=3,6%) and mixed pattern (n=23, 47%).Conclusions: SARS-CoV2 is characterized by a wide range of CTfeatures with a frequently mixed presence of ground glass and consolidative with a periferic and central - usually bilateral - distribution. Combining assessment of imaging with clinical and laboratory findings could facilitate early diagnosis of COVID-19.
ABSTRACT
Background and Aim of the study: The SARS-CoV 2 pandemicinvolved about 230.00 people in Italy with about 35.000 deaths.In China the lethality rate of confirmed cases is 4.7% in men compared to 2.8% in women. In Italy women represent 34.0% of thetotal and are older than men (respectively 83 years vs 79). A single-center observational cohort study was conducted to evaluategender differences in clinical features, laboratory, length of stayand mortality in patients admitted in sub-intensive COVID Unit ofF. Miulli Hospital (Acquaviva delle Fonti, Bari, Italy) from 17 marchto 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients were analyzed. Females accountfor 39.6%. The average age was 66 yrs and 70 yrs respectively inmales and females. No difference was observed with respect to themain inflammation markers (IL6, d-Dimer, CRP);the length of hospital stay was similar, 20 days in females and 21 days in males.Chronic heart failure, COPD, diabetes, chronic renal failure, wereequally represented in the two groups. Disease severity and mortalitywere similar. The only significant difference (p <0.02) was in the useof hydroxychloroquine, prevalent in the group of male subjects.Discussion and Conclusions: The data of our study, although witha limited sample of subjects, do not show significant differencesbetween males and females. Length of stay and mortality are notinfluenced by gender. We could conclude that when women getsick they feel the disease in the same way as men.