Once again about the new coronavirus infection COVID-19.

The COVID-19 pandemic continues to affect millions of people with increasing morbidity and mortality. Substantial variations exists in drug treatment of COVID-19. Extracorporeal membrane oxygenation (ECMO) facilitates survival of select critically ill patients with COVID-19 with about 25-45% survival rate;survivors tend to be younger and have a shorter duration from diagnosis to cannulation. The practioners found the severe complications including concomitant neurological manifestations (from headache, anosmia, ageusia to encephalopathy, stroke and others) and multisystem inflammation syndrome (MIS) predominantly in children few weeks after SARS-CoV-2 infection and characterized by persistent fever, vomiting, headache, Kawasaki - like rash and fatigue. Regarding MIS the authors did not find strong association between the complications rate and outcomes and regime of immunomodulation treatment. The neurological manifestations in pts with COVID-19 were associated with higher in-hospital mortality.Copyright © 2022 Sinergia Press. All rights reserved.

An unusual presentation of recurrent COVID-19 associated systemic capillary leak syndrome in a patient with multi-system inflammatory syndrome in adults (MIS-A) due to prior COVID-19 infection: Case report and literature review.

Introduction: and importance: Systemic capillary leak syndrome (SCLS) and multisystem inflammatory syndrome in adults (MIS-A) are very rare multifactorial etiology disorders associated with COVID-19 infection. Both conditions are thought to be manifested by the inflammatory state induced by COVID-19 infection. Recurrent COVID-19-associated concomitant/successive manifestations of both disorders have not been reported yet. Case presentation: We report a 38-year-old Asian gentleman who presented initially with fever, cough, shortness of breath, body aches, dizziness, and epigastric pain due to COVID-19 infection. A few days before this presentation, the same patient developed multisystem inflammatory syndrome in adults (MIS-A). Later, based on clinical and laboratory investigations, he was diagnosed with new-onset systemic capillary leak syndrome (SCLS). Despite resuscitative measures, the patient passed away. Clinical discussion: The increased risk of inflammatory complications associated with COVID-19 infection is an emerging concern. Our case report signifies the importance of COVID-19 awareness in less educated and underserved areas with fewer information resources. Rare and fatal manifestations should also be advertised and discussed with the general masses with equal emphasis. Conclusion: This case signifies the importance of understanding the pathophysiology of new-onset systemic capillary leak syndrome in a patient with recurrent COVID-19 infection and utilizing clinical knowledge and decision-making to manage such rare and complex disorders.

Medium-Term Cardiac Outcomes in Young People with Multi-system Inflammatory Syndrome: The Era of COVID-19.

Multi-system inflammatory syndrome in children (MIS-C) causes widespread inflammation including a pancarditis in the weeks following a COVID infection. As we prepare for further coronavirus surges, understanding the medium-term cardiac impacts of this condition is important for allocating healthcare resources. A retrospective single-center study of 67 consecutive patients with MIS-C was performed evaluating echocardiographic and electrocardiographic (ECG) findings to determine the point of worst cardiac dysfunction during the admission, then at intervals of 6-8 weeks and 6-8 months. Worst cardiac function occurred 6.8 ± 2.4 days after the onset of fever with mean 3D left ventricle (LV) ejection fraction (EF) 50.5 ± 9.8%. A pancarditis was typically present: 46.3% had cardiac impairment; 31.3% had pericardial effusion; 26.8% demonstrated moderate (or worse) valvar regurgitation; and 26.8% had coronary dilatation. Cardiac function normalized in all patients by 6-8 weeks (mean 3D LV EF 61.3 ± 4.4%, p < 0.001 compared to presentation). Coronary dilatation resolved in all but one patient who initially developed large aneurysms at presentation, which persisted 6 months later. ECG changes predominantly featured T-wave changes resolving at follow-up. Adverse events included need for ECMO (n = 2), death as an ECMO-related complication (n = 1), LV thrombus formation (n = 1), and subendocardial infarction (n = 1). MIS-C causes a pancarditis. In the majority, discharge from long-term follow-up can be considered as full cardiac recovery is expected by 8 weeks. The exception includes patients with medium sized aneurysms or greater as these may persist and require on-going surveillance.

Intravenous Immunoglobulin may Reverse Multisystem Inflammation in COVID-19 Pneumonitis and Guillain-Barré Syndrome.

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) poses an unprecedented crisis for public health, although several potential therapies have been provisionally applied but a unified consensus is yet to be achieved. CASE DESCRIPTION: A 75-year-old man, COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) positive on admission, presented with acute onset progressively ascending weakness of all four limbs. Nerve conduction velocity (NCV) study suggested acute demyelinating and axonal type of motor polyradiculoneuropathy. Hence, Guillain-Barré syndrome (GBS) related to COVID-19 infection was considered. His respiratory status worsened to severe acute respiratory distress syndrome (ARDS) on the second week of illness. He was started on intravenous immunoglobulin (IVIg) dosed over 5 days. His ventilator support started to improve after the 10th day of admission. His inflammatory markers started to improve, ventilator supports were weaned down and he was extubated on the 17th day of illness. Intravenous immunoglobulin is rich in viral immunoglobulin G (IgG), competitively binds Fcy receptor, preventing SARS-CoV-2 spike protein from attaching to the angiotensin-converting enzyme 2 (ACE 2) receptor, inhibiting viral entry into the cell. CLINICAL SIGNIFICANCE: Intravenous immunoglobulin can inhibit the production of inflammatory factors and decrease inflammatory injury, multisystem inflammation (MSI) in SARS-CoV-2. CONCLUSION: While the use of hyperimmune globulin requires a tedious job of collection from convalescent patients with verified and adequate titers, the use of IVIg could be an easier option to modulate the immune storm and faster recovery in SARS-CoV-2. HOW TO CITE THIS ARTICLE: Chakraborty N, Kumar H. Intravenous Immunoglobulin may Reverse Multisystem Inflammation in COVID-19 Pneumonitis and Guillain-Barré Syndrome. Indian J Crit Care Med 2020;24(12):1264-1268.

Childhood Multisystem Inflammatory Syndrome: An Emerging Disease with Prominent Cardiovascular Involvement-A Scoping Review.

Multisystem inflammatory syndrome in children (MIS-C) or paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is an emerging disease in children affected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and thought to be an immune-mediated post-infectious complication of SARS-CoV-2. The disease presentation is similar to Kawasaki disease but has certain distinguishing features. The exact pathogenesis is still not clear but an aberrant immune response, antibody-mediated vascular damage and virus-mediated abnormal type I and III interferon-gamma response are thought to be responsible. Most children who are previously healthy present after 2-4 weeks of SARS-CoV-2 infections with febrile illness of short duration with prominent gastrointestinal, cardiac and hematologic manifestations, progressing to vasoplegic shock, requiring vasopressor therapy. Cardiovascular involvement is prominently marked by acute myocardial injury/myocarditis and the development of coronary artery aneurysms. Laboratory markers of inflammation are elevated uniformly. Most children require intensive care, and few need invasive ventilation. The treatment mainly consists of anti-inflammatory and immunomodulatory therapy like intravenous immunoglobulins and steroids. The overall prognosis is good and reported mortality rates are 0-4%.