ABSTRACT
Tuberculosis (TB) is a deadly infection that can lead to disseminated disease in children <15years of age exhibiting risk factors such as low host immunity, concurrent infection(s), and/or malnutrition. A case involving a 14-year-old boy diagnosed with disseminated tuberculosis is reported. On investigation, the patient was positive for coronavirus disease 2019 (COVID-19) antibodies, GeneXpert (Cepheid, Sunnyvale, CA) positive for TB with multisystem involvement, lymphopenia, and highly elevated inflammatory markers, indicating multisystem inflammatory syndrome in children (MIS-C) and disseminated TB. The patient was started on antitubercular treatment (ATT), steroids, and supportive treatment. His condition improved over the ensuing few days, and he was discharged with ATT and antiepileptics. Although a few studies involving adults have established a connection between the progression of TB and COVID-19, this case report establishes a similar clinical picture in a child, which has not yet been reported. Copyright © 2022 Shandong University, published by Wolters Kluwer, Inc.
ABSTRACT
Introduction: Tuberculosis is a deadly infection, which can lead to disseminated TB in children in the presence of risk factors like low host immunity, concurrent infections, etc. This led us to wonder about the relationship between a common killer infection like TB and Coronavirus disease 2019 (COVID-19) and how the disease pattern will present in the pediatric age group. Case Description: We report a case of a 14-year-old male child who was a known case of childhood TB meningitis and hydrocephalus;treated with VP shunt, who recently presented with disseminated TB/TB flare up, causing TB meningitis, TB peritonitis, and pulmonary TB. On investigation, the patient was positive for COVID antibodies, multisystem involvement, lymphopenia and highly raised inflammatory markers suggesting it to be a case of MIS-C induced TB dissemination. He was started on anti-tubercular treatment (ATT), steroids, and supportive treatment, while he never required intravenous immunoglobulin (IVIG). His condition subsequently improved over a few days and he was discharged on ATT and antiepileptics. Discussion: COVID-19 has been reported to be associated with other infections of the respiratory system. Few studies in adults have established a connection between the progression of TB following COVID-19 infection. The link between TB and COVID-19 is mostly bi-directional. The temporary immunosuppression caused by tuberculosis may lead to increased predisposition to COVID-19 infection, while COVID may, in turn, also increase susceptibility to TB infection due to substantial depletions in T-cell lymphocyte counts, promoting the development of active TB in patients with latent TB. Conclusion: In this case report, the child recovered only with corticosteroids and supportive care, with no requirement of immunoglobulins or intensive care after a few days and showing almost a complete recovery. This is an important point to be considered when exploratory therapy is considered for TB with MIS-C. Hence, a better understanding of the pathogenic mechanism of the disease may help in defining the appropriate interventions required for specific cases. USG abdomen showing moderate ascites with few thick internal septations (Red arrow) MRI Brain showing communicating hydrocephalus with dilated lateral and third ventricles (Red star) and an ill-defined area of non-diffusion restricting T2 FLAIR hyperintensity in the right ganglio-capsular region of the brain- likely gliosis (Red arrow).
ABSTRACT
Background: Acute respiratory distress syndrome (ARDS) is characterized by dysregulated inflammation resulting in hypoxemia and respiratory failure and causes both morbidity and mortality. Objectives: To describe the clinical profile, outcome, and predictors of mortality in ARDS in children admitted to the Pediatric intensive care unit. Materials and methods: This is a single-center retrospective study conducted at a tertiary referral hospital in a 12-bed PICU involving children (1 month to 18 years) with ARDS as defined by Pediatric Acute Lung Injury Consensus Conference (PALICC) guidelines, over a period of 5 years (2016-2020). Demographic, clinical, and laboratory details at onset and during PICU stay were collected. Predictors of mortality were compared between survivors and non-survivors. Results: We identified 89 patients with ARDS. The median age at presentation was 76 months (12-124 months). The most common precipitating factor was pneumonia (66%). The majority of children (35.9%) had moderate ARDS. Overall mortality was 33% with more than half belonging to severe ARDS group (58%). On Kaplan-Meier survival curve analysis, the mean time to death was shorter in the severe ARDS group as compared to other groups. Multiorgan dysfunction was present in 46 (51.6%) of the cases. Non-survivors had higher mean pediatric logistic organ dysfunction (PELOD2) on day 1. PRISM III at admission, worsening trends of ventilator and oxygenation parameters (OI, P/F, MAP, and PEEP) independently predicted mortality after multivariate analysis. Conclusion: High PRISM score predicts poor outcome, and worsening trends of ventilator and oxygenation parameters (OI, P/F, MAP, and PEEP) are associated with mortality. How to cite this article: Pujari CG, Lalitha AV, Raj JM, Kavilapurapu A. Epidemiology of Acute Respiratory Distress Syndrome in Pediatric Intensive Care Unit: Single-center Experience. Indian J Crit Care Med 2022;26(8):949-955.
ABSTRACT
BACKGROUND: Isolated and predominant gastrointestinal presentation in coronavirus disease 2019 (COVID-19) is reported less often. With evolving evidence that gastrointestinal tract can be a portal of entry, multiplication, primary site of affliction and symptomatic manifestation, and source of infectivity through prolonged fecal shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), it is essential that isolated gastrointestinal symptoms can also be a mode of presentation of this novel virus and illness. CASE DESCRIPTION: The index case is a 10-year-old female child who presented with acute onset abdominal pain. Emergency surgery showed extensive gangrenous small bowel. The small bowel had herniated into a transmesenteric defect near the mid-ileum and was obstructed. Reverse-transcription polymerase chain reaction for SARS-CoV2 sent as preoperative work-up turned positive. The histopathology showed platelet aggregate thrombus in the venules with patent adjacent arterioles. CONCLUSION: This is probably the first reported case of COVID-19-related bowel gangrene. HOW TO CITE THIS ARTICLE: Kenchappa Y, Hegde S, Kumar P, Lalitha AV, Bukelo M. Caught Off Guard with COVID-19 Bowel Gangrene: A Case Report. Indian J Crit Care Med 2020;24(12):1269-1271.