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The aim of the work - to provide variants of extrapulmonary manifestations of coronavirus disease (COVID-19) based on the analysis of the relevant course of the disease in adults.Results. The paper presents two clinical cases of coronavirus disease (COVID-19) with the manifestation of extrapulmonary symptoms, which required some individualization of therapy.The first clinical observation showed that in a 56-year-old patient with moderate COVID-19, the development of oxygen dependence on the 8th day of the disease was combined with the manifestation of extrapulmonary symptoms in the form of cutaneous manifestations. Individualization of glucocorticosteroid therapy and endothelioprotective therapy has been shown to be effective in regressing both oxygen dependence and cutaneous vasculitis.The second clinical observation showed that in a 35-year-old patient, moderate COVID-19 without oxygen dependence was accompanied by the development of extrapulmonary manifestations, namely short-lasting diarrheal syndrome, which manifested in the onset of the disease and of the development of orchiepididymitis on the 9th day of illness, which required the appointment of anti-inflammatory therapy.Conclusions. The abovementioned clinical observations of COVID-19 cases show relatively rare cases of SARS-CoV-2-associated extrapulmonary manifestations in patients with moderate disease, but their development necessitated individualization of treatment.
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The aim of the study is to analyze the literature data on modern views concerning extrapulmonary manifestations of coronavirus disease (COVID-19).Based on the analysis of current publications, the article analyzes the clinical manifestations of coronavirus disease (COVID-19) as a multisystem disorder with two main types of clinical manifestations, namely pulmonary and extrapulmonary. Determining pathogenetic mechanisms of extrapulmonary symptoms are, on the one hand, the tropism of SARS-CoV-2 to ACE2 receptors, expressed not only by alveolar epithelial type II cells, but also by cells of the heart, nervous system, vascular endothelium, small and large intestine, basal layer cells of the epidermis, cells of endocrine organs, etc., and on the other hand, immune-dependent mechanisms, in particular the development of "cytokine storm".It is shown that the spectrum of extrapulmonary manifestations of COVID-19 is very wide, and clinical manifestations are characterized by significant polymorphism. Extrapulmonary symptoms of COVID-19 were analyzed considering the organs of the gastrointestinal tract, nervous, cardiovascular and endocrine systems, skin and others. Attention is drawn to a certain association between definite extrapulmonary manifestations and the severity of COVID-19 course.Thus, particular extrapulmonary manifestations are associated with a milder course of COVID-19 (anosmia, dysgeusia, etc.), others, vice versa, occur in severe disease (damage to liver, kidney, heart, pancreas). In addition, some extrapulmonary manifestations, especially of the nervous system, may remain in patients even after an acute period of the disease. Some extrapulmonary manifestations, which are currently described in a small number of patients, are also reviewed.Conclusions. COVID-19 is characterized by a wide range and high frequency of extrapulmonary manifestations, which is ex-plained by both the direct action of SARS-CoV-2 and immune-dependent mechanisms. Some extrapulmonary manifestations are associated with a milder course of COVID-19, others, on the contrary, occur in severe disease.
ABSTRACT
The pathogenetic basis for Pediatric Multisystem Inflammatory Syndrome (PMIS) associated with SARS-CoV-2 is systemic vasculitis resulting from hyperproduction of pro-inflammatory cytokines associated with dysregulation of the immune response. Clinical manifestations of PMIS include fever with features of Kawasaki Syndrome (KS) and multi-organ dysfunction coupled with frequent unusual heart involvement, ranging from mild with minimal ECG changes or elevated troponin to fulminant myocarditis or Takotsubo syndrome (TTS). The purpose of the research was to study the characteristics of cardiovascular disorders in Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 in children observed in the East Siberian area of Russia. A single-center retrospective cohort study was carried out on the basis of the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia): 36 patients with PMIS associated with COVID-19 in Nov. 18, 2020 - Dec. 31, 2021, including 21 boys (M/F ratio 1.4:1) at the average age of 7.5 years old (1.5 months to 17 years old). The diagnostic signs of KS were observed in 34 (94%) children, including the complete set of diagnostic signs in 21 (58%). Refractory fever and a sharp increase in inflammatory biomarkers were detected in all 36 (100%) children;multiorgan dysfunction in 31 (86%);thrombocytopenia in 24 (67%);gastrointestinal syndrome in 25 (69%);cerebral dysfunction in 24 (66)%;various cardiovascular disorders in 30 (83%), including: dilatation of the left ventricle (LV) and a decrease in myocardial contractility in 3 (8%);moderate coronary dilatation in 5 (14%);thickening of the posterior LV walls in diastole in 5 (13%);thickening of the interventricular septum in diastole in 6 (16%). According to the MRI results performed in 15 children the signs of myocardial damage were found in 6 (40%). LV dilatation and decreased myocardial contractility were noted in 3 (8%) children, clinically apparent thrombotic complications in 3 (8%) children as well, and severe neurological deficit in one patient (3%). An increase in the level of D-dimer was observed in 26 (72%) patients, thrombocytopenia in 24 (67%), a statistically significant correlation between thrombocytopenia and myocardial damage was found (R=-0.506, p=0.001). The treatment measures were given as follows: inotropic support (dobutrex/dobutamine) was received by 8 (22%), artificial lung ventilation - by 8 (22%), intravenous human immunoglobulin 1.5-2.0 g/kg/course - by 28 (77%), dexamethasone - by 24 (67%), tocilizumab - by 2 (5%) patients. All 36 (100%) patients have survived. Conclusion(s): the Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 was accompanied by the cardiovascular disorders (pericarditis, arrhythmias, abnormal ECG changes, elevated troponin and/or natriuretic peptide, LV thickening on echocardiography, coronary dilatation) in most patients, although LV dilatation and decreased myocardial contractility were observed in a few cases only. A negative correlation between thrombocytopenia and myocardial damage was found, which may indicate the involvement of thrombotic microvascular inflammation in the genesis of myocardial disorders. Copyright © 2022, Pediatria Ltd. All rights reserved.
ABSTRACT
Introduction: The COVID-19 pandemic and statewide mask mandates (MM) affected elective surgical procedures throughout the United States, with declines in the prevalence of pediatric otitis media (OM) and tympanostomy tube (TT) placement during the first year of the pandemic. This study aims to follow the trends in OM and TT placement as it presents to our community pediatric hospital before, during, and after the MM, as there are no current studies on this effect. Method(s): Retrospective data collection of patients who received TT placement in the months of July to September before, during, and after Ohio's statewide MM in 2019, 2020, and 2021, respectively. Collected data included patient demographics, symptoms, risk factors, and complications related to OM, intraoperative findings, and postoperative evaluation. Result(s): We identified 542 patients who underwent TT placement before (n=223), during (n=93), and after (n=226) the MM. There were significantly fewer bouts of ear infections reported per patient prior to clinical evaluation in 2021 following MM removal, compared with 2019 (median 4 vs 5, P<.001) and 2020 (median 4 vs 5, P=.003). There were no significant differences in complications due to OM prior to TT placement before, during, or after the MM (6.7% vs 10.8% vs 3.5%, P=.283). There were no significant differences in the median age, perceived hearing or speech concerns, or cigarette smoke exposure at home per year. Significantly more children were attending daycare after the MM than before or after (P<=.01). There was increased severity of middle ear disease with significantly more cases of drainage after the MM in 2021 compared with during (50% vs 30.1%, P=.005). There were no significant differences in postoperative complications. Conclusion(s): The increased severity of OM at time of TT surgery may be associated with the lifting of MM and/or increased daycare attendance in 2021. The COVID-19 pandemic and associated social changes may have a role on elective surgical procedures and middle ear disease in the pediatric population.