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1.
J Neurol ; 2022 Mar 22.
Article in English | MEDLINE | ID: covidwho-1750705

ABSTRACT

BACKGROUND AND OBJECTIVES: In 2020, a wide range of hygiene measures was implemented to mitigate infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In consequence, pulmonary infections due to other respiratory pathogens also decreased. Here, we evaluated the number of bacterial and viral meningitis and encephalitis cases during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In a multicentre retrospective analysis of data from January 2016 until December 2020, numbers of patients diagnosed with bacterial meningitis and other types of CNS infections (such as viral meningitis and encephalitis) at 26 German hospitals were studied. Furthermore, the number of common meningitis-preceding ear-nose-throat infections (sinusitis, mastoiditis and otitis media) was evaluated. RESULTS: Compared to the previous years, the total number of patients diagnosed with pneumococcal meningitis was reduced (n = 64 patients/year in 2020 vs. n = 87 to 120 patients/year between 2016 and 2019, all p < 0.05). Additionally, the total number of patients diagnosed with otolaryngological infections was significantly lower (n = 1181 patients/year in 2020 vs. n = 1525 to 1754 patients/year between 2016 and 2019, all p < 0.001). We also observed a decline in viral meningitis and especially enterovirus meningitis (n = 25 patients/year in 2020 vs. n = 97 to 181 patients/year between 2016 and 2019, all p < 0.001). DISCUSSION: This multicentre retrospective analysis demonstrates a decline in the number of patients treated for viral and pneumococcal meningitis as well as otolaryngological infections in 2020 compared to previous years. Since the latter often precedes pneumococcal meningitis, this may point to the significance of the direct spread of pneumococci from an otolaryngological focus such as mastoiditis to the brain as one important pathophysiological route in the development of pneumococcal meningitis.

2.
Life (Basel, Switzerland) ; 12(1), 2022.
Article in English | EuropePMC | ID: covidwho-1647633

ABSTRACT

With the onset of the COVID-19 pandemic, it became apparent that, in addition to pulmonary infection, extrapulmonary manifestations such as cardiac injury and acute cerebrovascular events are frequent in patients infected with SARS-CoV-2, worsening clinical outcome. We reviewed the current literature on the pathophysiology of cardiac injury and its association with acute ischaemic stroke. Several hypotheses on heart and brain axis pathology in the context of stroke related to COVID-19 were identified. Taken together, a combination of disease-related coagulopathy and systemic inflammation might cause endothelial damage and microvascular thrombosis, which in turn leads to structural myocardial damage. Cardiac complications of this damage such as tachyarrhythmia, myocardial infarction or cardiomyopathy, together with changes in hemodynamics and the coagulation system, may play a causal role in the increased stroke risk observed in COVID-19 patients. These hypotheses are supported by a growing body of evidence, but further research is necessary to fully understand the underlying pathophysiology and allow for the design of cardioprotective and neuroprotective strategies in this at risk population.

3.
Fortschritte der Neurologie, Psychiatrie ; 89(6):289-295, 2021.
Article in German | APA PsycInfo | ID: covidwho-1441732

ABSTRACT

The notion of an increased risk of acute ischemic stroke in patients with COVID-19 emerged during the first months after the outbreak of the COVID-19 pandemic at ground zero in Wuhan. Subsequently, this association was confirmed by multiple case reports, cohort studies and meta-analyses. However, substantial geographical variability in prevalence of COVID-19 associated stroke underscores a persistent need of encompassing epidemiological study. Accumulative evidence suggested a rather complex underlying pathophysiology. Possible mechanisms include small and large vessel thromboembolism induced by systemic hypercoagubility, vasculitis and cardiac embolism caused by virus-induced cardiomyopathy. Multidisciplinary care of acute stroke patients in general does not seem to be compromised by the pandemic in otherwise compensated hospitals. However, it remains to be answered whether more aggressive approaches of secondary prevention and intensified monitoring strategies after COVID-19 related stroke are necessary to optimize clinical outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (German) Dass COVID-19 mit einem erhohten Risiko fur das Auftreten ischamischer Schlaganfalle einhergeht, wurde bereits in den ersten Monaten nach dem weltweiten Bekanntwerden des Ausbruchs der Pandemie im Ground Zero Wuhan deutlich. Spatere Kohortenanalysen, Fallserien und Meta-Analysen bestatigten diesen Zusammenhang. Eine nicht unerhebliche geographische Variabilitat der Pravalenz COVID-19-bezogener Schlaganfalle verdeutlicht allerdings den fortbestehenden Bedarf an umfassenden epidemiologischen Analysen. Im Ubrigen fanden sich zunehmend Hinweise dafur, dass dem mit COVID-19 assoziierten Schlaganfall ein multifaktorieller pathophysiologischer Mechanismus zugrundeliegenden konnte. Neben einer durch die SARS-CoV-2-Infektion verursachten Hyperkoagubilitat, die sowohl im mikrovaskularen System als auch in Grosgefasen thrombogen wirkt, scheinen vaskulitische arterielle Veranderungen und kardiogene Embolien infolge virusassoziierter myokardialer Schadigung bei der Atiologie des COVID-19-assoziierten Schlaganfalls eine Rolle zu spielen. Die Versorgung von Schlaganfallpatienten/ innen in Zeiten der Pandemie durch multidisziplinare Teams scheint in insgesamt kompensierten Kliniken im Wesentlichen nicht kompromittiert zu sein. Hinweise, dass Patienten/ innen mit COVID-19-assoziiertem Schlaganfall von einem intensivierten Monitoring und einer aggressiveren Sekundarpravention profitieren, bedarf klinischer Prufung. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

4.
Life (Basel) ; 11(7)2021 Jul 19.
Article in English | MEDLINE | ID: covidwho-1323289

ABSTRACT

We aimed to assess how evidence-based stroke care changed over the two waves of the COVID-19 pandemic. We analyzed acute stroke patients admitted to a tertiary care hospital in Germany during the first (2 March 2020-9 June 2020) and second (23 September 2020-31 December 2020, 100 days each) infection waves. Stroke care performance indicators were compared among waves. A 25.2% decline of acute stroke admissions was noted during the second (n = 249) compared with the first (n = 333) wave of the pandemic. Patients were more frequently tested SARS-CoV-2 positive during the second than the first wave (11 (4.4%) vs. 0; p < 0.001). There were no differences in rates of reperfusion therapies (37% vs. 36.5%; p = 1.0) or treatment process times (p > 0.05). However, stroke unit access was more frequently delayed (17 (6.8%) vs. 5 (1.5%); p = 0.001), and hospitalization until inpatient rehabilitation was longer (20 (1, 27) vs. 12 (8, 17) days; p < 0.0001) during the second compared with the first pandemic wave. Clinical severity, stroke etiology, appropriate secondary prevention medication, and discharge disposition were comparable among both waves. Infection control measures may adversely affect access to stroke unit care and extend hospitalization, while performance indicators of hyperacute stroke care seem to be untainted.

8.
J Neurol ; 268(3): 773-784, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-696700

ABSTRACT

OBJECTIVE: To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19). METHODS: In a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and meta-analysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis. Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran's Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity. RESULTS: Pooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52-2.81; p < 0.0001]. This association was also observed in clusters of studies that defined severe manifestation of the disease by clinical parameters (RR 1.44, 95% CI 1.22-1.71; p < 0.0001), necessity of intensive care (RR 2.79, 95% CI 1.83-4.24; p < 0.0001) and in-hospital death (RR 2.18, 95% CI 1.75-2.7; p < 0.0001). CONCLUSION: A history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19  suggesting a need of tailored infection prevention and clinical management strategies for this population at risk.


Subject(s)
COVID-19/complications , Cerebrovascular Disorders/etiology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cerebrovascular Disorders/epidemiology , Cluster Analysis , Critical Care/statistics & numerical data , Female , Germany/epidemiology , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome
9.
J Stroke Cerebrovasc Dis ; 29(9): 105061, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-609438

ABSTRACT

OBJECTIVE: Stroke patients are thought to be at increased risk of Coronavirus Disease 2019 (COVID-19). To evaluate yield of universal laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in acute stroke patients and its impact on hyperacute stroke care. METHODS: Between weeks 14 and 18 in 2020, a protected code stroke protocol including infection control screening and laboratory testing for SARS-CoV-2 was prospectively implemented for all code stroke patients upon arrival to the emergency department. If infection control screen was positive, patients received protective hygienic measures and laboratory test results were available within four hours from testing. In patients with negative screen, laboratory results were available no later than the next working day. Door-to-imaging times of patients treated with thrombolysis or thrombectomy were compared with those of patients treated during the preceding weeks 1 to 13 in 2020. RESULTS: During the 4-weeks study period, 116 consecutive code stroke patients underwent infection control screen and laboratory testing for SARS-CoV-2. Among 5 (4.3%) patients whose infection control screen was positive, no patient was tested positive for SARS-CoV-2. All patients with negative infection control screens had negative test results. Door-to-imaging times of patients treated with thrombolysis and/or thrombectomy were not different to those treated during the preceding weeks (12 [9-15] min versus 13 [11-17] min, p = 0.24). CONCLUSIONS: Universal laboratory testing for SARS-CoV-2 provided useful information on patients' infection status and its implementation into a protected code stroke protocol did not adversely affect hyperacute stroke care.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Stroke/diagnosis , Aged , Aged, 80 and over , COVID-19 , COVID-19 Testing , Clinical Decision-Making , Coronavirus Infections/complications , Coronavirus Infections/therapy , Coronavirus Infections/virology , Emergency Service, Hospital , Female , Humans , Infection Control , Male , Pandemics , Patient Safety , Patient Selection , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Predictive Value of Tests , Prospective Studies , Risk Factors , SARS-CoV-2 , Stroke/complications , Stroke/therapy
10.
Stroke ; 51(7): 2224-2227, 2020 07.
Article in English | MEDLINE | ID: covidwho-591363

ABSTRACT

BACKGROUND AND PURPOSE: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. RESULTS: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (-85%, -46%, -42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, -60%; thrombectomy, -61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. CONCLUSIONS: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.


Subject(s)
Betacoronavirus , Brain Ischemia/epidemiology , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Stroke/epidemiology , Acute Disease , Aged , Brain Ischemia/therapy , COVID-19 , Catchment Area, Health , Female , Germany/epidemiology , Hospitals, Special/statistics & numerical data , Humans , Ischemic Attack, Transient/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Patient Admission/statistics & numerical data , Procedures and Techniques Utilization , Reperfusion/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Stroke/therapy
11.
J Stroke Cerebrovasc Dis ; 29(9): 104938, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-210006

ABSTRACT

BACKGROUND AND PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. METHODS: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. CONCLUSION: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Hospitalization/trends , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/trends , Stroke/epidemiology , Stroke/therapy , COVID-19 , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/virology , Healthcare Disparities/trends , Hospital Mortality/trends , Host-Pathogen Interactions , Humans , Incidence , Interrupted Time Series Analysis , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Prospective Studies , Registries , Retrospective Studies , Risk Factors , SARS-CoV-2 , Stroke/diagnosis , Stroke/mortality , Time Factors , Treatment Outcome
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