Symptomatology, prognosis and clinical findings of myocarditis as an adverse event of COVID-19 mRNA vaccine: a systematic review

Funding Acknowledgements Type of funding sources: None. Background Myocarditis, an inflammation of the myocardium in the absence of ischemic injury, may be caused by viruses, drugs, and vaccines. The Myocarditis following COVID-19 vaccinations is most commonly seen in young adult males and commonly after the second dose of the mRNA vaccine. It usually presents with chest pain, dyspnoea, palpitations but has a diverse clinical presentation and varied therapeutic response. We aim to systematically collate the symptomatology, prognosis, and clinical findings of COVID-19 vaccine adverse events causing Myocarditis. Method Following the PRISMA statement 2020, a systematic search was conducted to isolate confirmed cases of COVID-19 vaccine-induced Myocarditis. By applying the BOOLEAN logic, the following keywords were used: COVID-19, SARS-CoV-2, Myocarditis, Mortality. Four databases were searched from January 2021 through August 2021: PubMed, Science Direct, Google Scholar, and Cochrane Library;the reference lists of screened studies were searched as well (umbrella methodology). Results In total, 12 case reports, 10 case series and 1 cohort study with a total of 107 patients were included in the final analysis. A total of 101 male patients were recorded, and 6 were female showing male dominance. The mean age of all participants was 24.73 years(SD = 13.18), ranging from 14 to 70. The most common presenting symptoms were chest pain (47.66%), fever (35.51%), and myalgia (25.23%). Lab findings showed elevated Troponin I, CRP, and ESR levels in the majority of patients. ECG was abnormal in most of the patients, which include sinus rhythm (24%), ST-elevation (42.05%) and T wave inversion (13.08%). Echo findings include decreased Ejection fraction in 19.62% of patients while 13.08% of patients having a hypokinetic left ventricular wall. Further, CMR finding suggestive of confirmed myocarditis cases in 36% patients while rest are suspected one. Overall mortality(1.86%) was low among patients. Conclusion There is increasing evidence for Myocarditis as a rare adverse event of COVID-19 mRNA vaccination in young adults. This evidence is strongest amongst young male patients. The majority of the patients complain of chest pain and fever. In lab findings Troponin I, CRP and ESR are usually increased and ST elevation is common in the ECG. This entity is mainly treated with nonsteroidal anti-inflammatory drugs, Colchicine, Beta-blockers, ACE inhibitors, Steroids. However, prognosis and outcomes are favourable with a very low mortality rate.

Encephalitis as a clinical manifestation of COVID-19: A Case Series (preprint)

We present a case series of 5 patients who were found to have COVID-19 encephalitis. There is still no disease defining test for diagnosis so the mainstay of diagnosis is the exclusion of all common causes of encephalitis. Brain MRI and CSF analysis perform an ancillary in the diagnostic tools.

“Of clots and failures” A case of Covid causing STEMI and subsequent heart failure ultimately requiring LVAD (preprint)

COVID-19 is known to cause hypercoagulable and pro-inflammatory states and increase the risk of cardiovascular events. We present a case of a 57-year-old female with prior COVID who subsequently developed a STEMI requiring LVAD due to new-onset heart failure. There are no similar reports of this cardiovascular complication in COVID-19.

A Systematic Review of COVID - 19 Induced Myocarditis - Symptomatology, Prognosis, and Clinical Findings (preprint)

Objective: With the advent of a novel coronavirus in December 2019, several case studies have reported its adversity on cardiac cells. We conducted a systematic review that describes the symptomatology, prognosis, and clinical findings of patients with COVID-19-related myocarditis. Methods: Search engines including PubMed, Google Scholar, Cochrane Central, and Web of Science were queried for SARS-CoV-2 or COVID 19 and myocarditis. PRISMA guidelines were employed, and peer-reviewed journals in English related to COVID-19 were included. Results: This systematic review included 22 studies and 37 patients. Eight patients (36%) were confirmed myocarditis, while the rest were possible myocarditis. Most patients had elevated cardiac biomarkers, including troponin, CRP, CK, CK-MB, and NT-pro BNP. Electrocardiogram results noted tachycardia (47%), left ventricular hypertrophy (50%), ST-segment alterations (41%), and T wave inversion (18%). Echocardiography presented reduced LVEF (77%), left ventricle abnormalities (34%), right ventricle aberrations (12%), and pericardial effusion (71%). Further, CMR showed reduced myocardial edema (75%), non-ischemic patterns (50%), and hypokinesis (26%). The mortality was significant at 25%. Conclusions: Mortality associated with COVID-19 myocarditis appears significant but underestimated. Further studies are warranted to evaluate and quantify patients actual prognosis and outcomes with COVID-19 myocarditis.

INFLUENCE OF NOVEL CORONAVIRUS DISEASE (COVID-19) ON PARKINSONS DISEASE: SYSTEMATIC REVIEW (preprint)

Background: The novel Coronavirus (COVID 19) infection has affected the population with various medical issues including the underlying neurological comorbidities such as Parkinson disease. COVID 19 is found to bind with the host angiotensin-converting enzyme 2 (ACE2) receptors for viral entry. ACE2 receptors are normally expressed in various body surfaces as well as in the neurons and glial cells where they act as an entry port to SARS-CoV-2 infection to invade the central nervous system (CNS). ACE2 are also highly expressed in dopamine neurons which might worsen the outcome in terms of motor symptoms in PD with the treatment course. It may lead to an indirect response via immune-mediated cytokine storms and propagate through CNS leading to damage. Parkinsons disease has also been noticed due to certain post viral infections apart from COVID-19 such as, HSV, Influenza virus A, Measles virus, Cytomegalovirus and Mumps (Olsen et al, 2018). We aim to provide a thorough review on neurological outcomes and impact of COVID-19 in Parkinson disease. Methods: A systematic review was conducted to analyze the impact of COVID 19 in patients with Parkinson disease (> 21 yo). Systematic literature search was done using PubMed, Science Direct, Google Scholar and Cochrane databases. PRISMA guidelines were followed summarized in Fig. 3 for study acquisition. Results: Of the Parkinsons patients that were tested positive for SARS-CoV 2, worsening of motor symptoms were reported along with other COVID 19 symptoms (Fig. 4 and 5). These symptoms include bradykinesia, tremors, gait disturbances, delirium and dementia and severe spasms of arms and legs. Encephalopathy was also one of the main symptoms presented in two of the studies. Increased mortality rates were identified for those who were hospitalized due to COVID-19 and PD when compared to other patients. Conclusion: Parkinsons disease may experience substantial worsening of motor and non motor symptoms during COVID 19. Due to the novelty of the virus, studies were reported from recent years and further extensive studies are needed to explore more about the disease severity and neurological outcomes when compared to other non-PD patients. Authors identify this as a limitation for this paper. Additional studies are needed to understand the role of ACE2 in increasing vulnerability to viruses and role of ACE inhibitors as treatment modality.