COVID-19-associated transverse myelitis treated by therapeutic plasma exchange: A case report.

BACKGROUND: Transverse myelitis (TM) is a very uncommon condition in children which can be associated with viral infections. Acute TM cases have been reported after Coronavirus disease 2019 (COVID-19) infection during the pandemic. CASE REPORT: We report a child with TM related to severe acute respiratory syndrome coronavirus 2, who was successfully treated with therapeutic plasma exchange (TPE). Inability to walk and urinary retention were the central nervous system symptom. Spinal magnetic resonance imaging revealed signal changes in the spinal cord. Her neurological symptoms worsened despite receiving IVIG and high-dose steroids for the first 3 d. We performed 10 TPE sessions with 5% albumin replacement and the neurological symptoms rapidly improved. CONCLUSION: We demonstrated that a child diagnosed with acute TM related to COVID-19 infection, was successfully treated with TPE.

Attitudes and Seropositivity Rates of Healthcare Workers for CoronaVac® During the COVID-19 Pandemic in a Pediatric Department

Objective: Healthcare workers (HCWs) are known be at a high risk of transmission during the coronavirus disease-2019 (COVID-19) pandemic. The present study evaluated HCWs' attitudes toward COVID-19 vaccines, and COVID-19 serologic status before and after the vaccination. Methods: This study is a prospective observational study. All participants completed a brief survey and were questioned about their intentions and hesitations about getting CoronaVac®. Before the CoronaVac® vaccine, the anti-body levels of all participants were checked. For those who agreed to get the vaccine, in the second step of the study, anti-body titers were checked twice: 1 month after the 1st and the 2nd doses of vaccination. In the last step of the study, COVID-19 surveillance was performed on all participants for 6 months. Results: A total of 127 participants, 104 females, and 23 males, with a median age of 29 years were included in the study. A total of 43 HCWs had a positive history of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the most affected group was physicians (41.8%) followed by nurses (27.6%). Among 43 participants who had COVID-19 history positive, 31 of them tested positive for anti-bodies, while 12 of them were negative. Anti-body levels were tested as positive in 4 of 84 participants who had no positive history of COVID-19. Seventy-six (59.8%) were vaccinated. The reasons for vaccine hesitancy were;a previous infection with the SARS-CoV-2 (n=15, 29.4%), and the belief in vaccine ineffectiveness (n=22, 43.1%). Anti-body response rates were 80.2% after 1st dose and 100% after 2nd dose. In the 6-month follow-up period, unvaccinated 7 (13.7%) HCWs and vaccinated 1 (1.3%) HCW had COVID-19 infections. Conclusion: Vaccination is essential in terms of protection from COVID-19. CoronaVac® provides an adequate anti-body response rate among HCWs. Vaccine hesitancy against COVID-19 can be a barrier to ending the pandemic in communities. HCWs work also advocates for patients and the public. It is essential to make the HCWs competent with in-service training on vaccines, vaccination, and against vaccine hesitancy. (English) [ FROM AUTHOR] Amaç: Sağlık çalışanlarının (SÇ) koronavirüs hastalığı-2019 (COVÍD-19) pandemisi sırasında yüksek bulaşma riski altında oldukları bilinmektedir. Bu çalışmanın amacı, SÇ'nin COVÍD-19 aşılarına yönelik tutumlarını, aşılama öncesi ve sonrasında COVÍD-19 serolojik durumlarını değerlendirmektir. Gereç ve Yöntem: Bu çalışma prospektif gözlemsel bir çalışmadır. Tüm katılımcılar gerekli anketi doldurdu, CoronaVac® alma konusundaki niyetleri ve tereddütleri hakkında sorgulandı. CoronaVac® aşısından önce tüm katılımcıların antikor seviyeleri kontrol edildi. Aşı olmayı kabul edenler, çalışmanın ikinci aşamasında, birinci ve ikinci doz aşıdan 1 ay sonra olmak üzere iki kez antikor titreleri kontrol edildi. Çalışmanın son aşamasında tüm katılımcılara 6 ay boyunca COVÍD-19 sürveyansı yapıldı. Bulgular: Çalışmaya 104'ü kadın ve 23'ü erkek olmak üzere, ortanca yaşı 29 olan toplam 127 katılımcı dahil edildi. Toplam 43 sağlık çalışanında pozitif şiddetli akut solunum sendromu koronavirüs-2 (SARS-CoV-2) enfeksiyonu öyküsü vardı;çok etkilenen grup doktorlar (%41,8) ve sonrasında hemşirelerdi (%27). COVÍD-19 öyküsü pozitif olan 43 katılımcıdan 31'inin antikor testi pozitif, 12'si negatif çıktı. COVÍD-19 geçirme öyküsü olmayan 84 katılımcıdan 4'ünün antikoru pozitif bulundu. Tüm katılımcıların 76'sı (%59,8) aşılanmıştır. Aşı tereddüt nedenleri;geçirilmiş SARS-CoV-2 enfeksiyonu (n=15, %29,4) ve aşının etkisiz olduğunun düşünülmesi (n=22, %43,1) olarak bildirilmiştir. Antikor yanıt oranları, 1. doz aşıdan sonra %80,2 ve 2. doz aşıdan sonra %100 saptandı. Altı aylık takip döneminde, aşılanmamış 7 (%13,7) ve aşılı 1 (%1,3) sağlık çalışanı COVÍD-19 enfeksiyonu geçirdi. Sonuç: COVÍD-19'dan korunmak için aşılamak esastır. CoronaVac®, sağlık çalışanlarında yeterli antikor yanıtı sağlamaktadır. COVÍD-19'a karşı aşı tereddütü, toplumların pandemiyi sonlandırmasında bir engel olabilir. Sağlık çalışanları, hastalar ve halk için örnek teşkil etmektedirler. Sağlık çalışanlarının aşı, aşılanma ve aşı tereddütüne karşı hizmet içi eğitimlerle yetkin hale getirilmesi önemlidir. (Turkish) [ FROM AUTHOR] Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

New dermatological findings of MIS-C: Can mucocutaneous involvement be associated with Severe Disease Course?

BACKGROUND: Little is known about mucocutaneous involvement in critically ill patients with the multisystem inflammatory syndrome in children (MIS-C). The aim of our study was to describe the localisation and variety of rash and to investigate whether presenting with rash at admission alters the clinical course of MIS-C. METHODS: This prospective, observational cohort study was conducted amongst children under 18 years of age who were admitted to our paediatric intensive care unit (PICU) between May 2020 and May 2021 with a possible diagnosis of MIS-C. RESULTS: A total of 33 children with MIS-C, 21 boys (64%), with a median age of 9.4 years (3.4-11.5) were enrolled. Twenty-four children presented with mucocutaneous symptoms (72%). Age, male gender, PICU length of stay, presenting symptoms, inotrope requirement, the existence of myocarditis or respiratory failure were higher but not significantly different in patients with rash compared to those without rash (P > 0.05). The median duration of symptoms before admission and presence of cervical lymphadenopathy were significantly higher in patients than those without rash (P < 0.05). Children with a rash had a significantly higher neutrophil count, CRP, procalcitonin, troponin levels and lower lymphocyte counts and albumin levels than those without rash (P < 0.05). Twelve children with rash (50%) had symmetrical intertriginous distribution. Two children had erythematous lesions on the areola and the surroundings. In conclusion, intertriginous involvement, periareolar erythema and other mucocutaneous manifestations might be the first alarming symptoms of moderate to severe MIS-C. Therefore, close monitoring with a multidisciplinary approach should be considered for these patients to assess potential disease progression.

COVID-19-associated Acute Disseminated Encephalomyelitis-like Disease in 2 Children.

BACKGROUND: The coronavirus disease 2019 pandemic was caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the predominant clinical presentation is a respiratory disease, neurologic manifestations are being recognized increasingly. CASE REPORT: We report 2 children 9 years of age who developed acute disseminated encephalomyelitis-like disease associated with SARS-CoV-2. Seizures and encephalopathy were the main central nervous system symptoms. The cerebrospinal fluid analysis performed within the first week of disease onset showed elevated protein in both children with normal cell count and no evidence of infection including negative SARS-CoV-2 by antibody and polymerase chain reaction. Brain magnetic resonance imaging revealed T2A, fluid-attenuated inversion recovery cortical and subcortical hyperintensity without restricted diffusion consistent with acute disseminated encephalomyelitis-like disease. They received methylprednisolone followed by therapeutic plasma exchange. One of them showed complete clinical improvement and resolution in magnetic resonance imaging findings. The other developed laminar necrosis in brain magnetic resonance imaging and showed significant clinical improvement after therapeutic plasma exchange. He was positive for positive SARS-CoV-2 antibody in cerebrospinal fluid on day 55 of admission. They were both positive for SARS-CoV-2 antibodies in serum after 2 weeks. CONCLUSIONS: Our two cases highlight the occurrence of acute disseminated encephalomyelitis-like disease as a postinfectious/immune-mediated complication of SARS-CoV-2 infection.

Axonal Guillain-Barre syndrome associated with SARS-CoV-2 infection in a child.

The relation between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and demyelinating Guillain-Barre syndrome (GBS) has been defined. We aim to report the clinical features of a child with axonal GBS associated with SARS-CoV-2. A 6-year-old male presented with symmetric ascending paralysis progressed over a 4-day course and 2 days of fever. He had bilateral lower and upper limb flaccid weakness of 1/5 with absent deep tendon reflexes. He had severe respiratory muscle weakness requiring invasive mechanical ventilation. On admission, SARS-CoV-2 returned as positive by real-time polymerase chain reaction on a nasopharyngeal swab. Cerebrospinal fluid analysis showed elevated protein without pleocytosis. He was diagnosed with GBS associated with SARS-CoV-2 infection. The nerve conduction study was suggestive of acute motor axonal neuropathy. Ten consecutive therapeutic plasma exchange sessions with 5% albumin replacement followed by four sessions on alternate days were performed. On Day 12, methylprednisolone (30 mg/kg/day for 5 days) was given. On Day 18, intravenous immunoglobulin (2 g/kg/day) was given and repeated 14 days after due to severe motor weakness. On Day 60, he was discharged from the hospital with weakness of neck flexor and extensor muscles of 3/5 and the upper limbs and the lower limbs of 2/5 on home-ventilation. Our patient is considered to be the youngest patient presenting with a possible para-infectious association between axonal GBS and SARS-CoV-2 infection. The disease course was severe with a rapid progression, an earlier peak, and prolonged duration in weakness as expected in axonal GBS.