ABSTRACT
AIM: The aim of this study was to describe the incidence of complicated appendicitis during the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic lockdown. METHODS: This was a retrospective study of pediatric patients diagnosed with acute appendicitis in a single pediatric institution that assumed care responsibility for most of the pediatric emergencies during the lockdown period in Madrid (Spain). A control group was made up of the same number of patients diagnosed the previous year. RESULTS: One hundred fifty-one patients diagnosed with acute appendicitis were included (77 during self-quarantine and 74 during the previous year). The incidence of complicated appendicitis was 38.9% versus 28.3%, showing no significant differences. The 2 groups were homogeneous, with no differences in time elapsed between symptom onset and first emergency department visit, laboratory test results, median length of stay, intensive care admissions, or patients correctly diagnosed on their first visit. CONCLUSIONS: COVID-19 (coronavirus disease 2019) self-quarantine has not increased the incidence of complicated appendicitis, and children who developed complicated appendicitis did not have worse clinical outcomes. Parents did not delay presenting for medical attention, and emergency department pediatricians did not fail to diagnose this condition. Reorganization of hospital resources, fast-track treatment protocols for noncomplicated appendicitis, and extended use of home-stay hospitalization for complicated appendicitis could have contributed to these favorable outcomes.
Subject(s)
Appendectomy/methods , Appendicitis/diagnosis , Delayed Diagnosis , Emergencies , Acute Disease , Appendicitis/epidemiology , Appendicitis/surgery , Child , Female , Humans , Incidence , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Spain/epidemiologySubject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Hospitals, Pediatric/organization & administration , Hospitals, University/organization & administration , Telemedicine/organization & administration , Tertiary Care Centers/organization & administration , Adolescent , Attitude of Health Personnel , Child , Child, Preschool , Emergency Service, Hospital/statistics & numerical data , Facilities and Services Utilization/statistics & numerical data , Female , Hospitals, Pediatric/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Spain , Telemedicine/methods , Telemedicine/statistics & numerical data , Tertiary Care Centers/statistics & numerical dataABSTRACT
During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/pathology , Erythema Multiforme/diagnosis , Erythema Multiforme/virology , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Adolescent , COVID-19 , Child , Female , Humans , Male , Pandemics , SARS-CoV-2ABSTRACT
BACKGROUND: Different skin manifestations of COVID-19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID-19 pandemic. MATERIAL AND METHODS: A retrospective review of 22 children and adolescents with chilblain-like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID-19 in Madrid, Spain. RESULTS: All patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D-dimer results, but without systemic symptoms or other laboratory anomalies. SARS-CoV-2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow-up, all cases showed spontaneous marked improvement or complete healing. CONCLUSION: Acute chilblains were observed during COVID-19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.