Heart Transplantation as a Result of Pediatric Inflammatory Multisystem Syndrome in an Adolescent.

Several reviews have shown that COVID-19 in children is a relatively mild disease. However, a rare complication affecting children and adolescents after COVID-19 has been identified. Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), which in some cases manifests itself as a hyperinflammatory syndrome with a multiorgan failure, may lead to death. We report a case of a 17-year-old patient who was admitted to the hospital with cardiogenic shock of unknown etiology. The disease was life-threatening, thus necessitating mechanical ventilation, circulatory support, and extracorporeal therapy due to renal and liver dysfunction. The patient tested negative for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction. Other infectious causes of illness were excluded. However, the patient had a positive IgG antibody test result and high levels of interleukin-6, which helped to diagnose PIMS-TS. Intravenous immunoglobulin and steroid therapies were initiated, unfortunately, with poor outcome. The patient's critical condition, particularly end-stage heart failure, led to mechanical circulatory support implantation and finally orthotopic heart transplantation. After the surgery, the patient's condition improved gradually. PIMS-TS manifests itself with different clinical images and as a state of varying severity, ultimately causing multiorgan dysfunction with shock resembling toxic shock syndrome. Ultimately, myocardial complications of PIMS-TS necessitated heart transplantation in the described patient.

Are COVID-19 antivirals active against adenovirus?

Purpose : Presently, there is no FDA approved antiviral therapy for the treatment of adenovirus (Ad) ocular infections, the most common ocular viral infection worldwide. During the COVID-19 pandemic, much attention has been placed on several potential antiviral treatments for SARS-CoV-2 infections. Remdesivir, hydroxychloroquine, ivermectin, and umifenovir (Arbidol) have been touted as potential COVID-19 treatments. The goal of the current study was to determine whether these potential COVID-19 antivirals produced in vitro antiviral activity against a panel of ocular adenovirus types. Methods : The 50% inhibitory concentrations (IC ) of remdesivir (REM), hydroxychloroquine (HCQ), ivermectin (IVM), and umifenovir (UMF) and cidofovir (CDV) (positive antiviral control) were determined for the human Ad types Ad3, Ad4, Ad5, Ad7a, Ad8, Ad19/64 and Ad37 using standard plaque-reduction assays on A549 cells. Briefly, cells infected with ∼100 PFU of the Ad types were treated with final concentrations of the antivirals of 100, 10, 1.0, 0.1, 0.01 and 0.001 μM. After incubation, the numbers of plaques from each virus/drug concentration were counted and the mean IC50concentrations from 2-3 assays were determined by regression analysis. Results : The range of mean in vitro IC50concentrations for each antiviral across the range of Ad types are as follows: The positive antiviral control, CDV, ranged from 0.47 - 9.62 μM;REM ranged from 0.21 - 11.27 μM;UMF ranged from 3.72 - 64.8 μM;IVR ranged from 2.60 - 201.3 μM;and HCQ was > 10 μM for all Ad types because of toxicity to the A549 cells demonstrated at the 100 μM concentrations. REM produced lower IC50concentrations than CDV for 5 of 7 Ad types. Conclusions : REM demonstrated anti-adenovirus activity in vitro in a range similar to that demonstrated by cidofovir. UMF and IVR demonstrated less antiviral activity than CDV and REM. The anti-adenovirus activity of HCQ could not be accurately determined. Further investigation of REM as an antiviral for adenovirus is indicated.