Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19 Clinical characteristics of MIS-C associated with COVID-19

Aim: Coronavirus disease 2019 (COVID-19) has become a public health threat to people all over the world in 2020 and 2021. The Centers for Disease Control and Prevention (CDC) and WHO (World Health Organization) have named a novel disease multisystem inflammatory syndrome in children (MIS-C). Herein we aimed to present a group of pediatric patients with MIS-C, who were followed up in our clinic. Material(s) and Method(s): We retrospectively reviewed the medical records of patients who were followed up at our University Hospital with the diagnosis of MIS-C between January 2021 and May 2021. Result(s): The mean age of 9 patients was 87.4 +/-17.8 years (range 6-161 months);six of the patients were male. All patients had fever at admission. The duration of the fever was between 3 and 7 days. Four patients (44.4%) had terminal ileitis on ultrasonic examination. The laboratory tests of the patients revealed leukocytosis in 4 (44.4%) patients, anemia in 5 (55.5%) patients, thrombocytopenia in 1 (11.1%) patient, and a high CRP level in 8 (88.8%) patients. All patients had high sedimentation rates and procalcitonin levels. One (11.1%) patient was operated on for terminal ileitis. All patients were treated with steroids (1-2 mg/kg prednisolone) and IVIG (2gr/kg). Patients who needed ICU admission were also treated with vasoactive drug infusion (intravenous dopamine). Discussion(s): There is a need for increased awareness among pediatricians that MIS-C should come to mind, especially in patients with long-lasting fever and signs and symptoms that resemble Kawasaki disease.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Terminal ileitis and cytotoxic lesion of corpus callosum as the presenting features of Multisystem inflammatory syndrome in children (MIS-C): a case report.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a post-viral inflammatory vasculopathy characterized by persistent fever, multiorgan dysfunction, significant laboratory markers of inflammation, lack of an alternative diagnosis, and prior SARS-CoV-2 infection or exposure in children and adolescents. The most common early symptoms include a prolonged fever, as well as dermatologic, mucocutaneous, and gastrointestinal symptoms such abdominal pain, vomiting, and diarrhea. CASE PRESENTATION: We present a pediatric patient with multisystem inflammatory syndrome with the development of abdominal pain and seizure who was found to have a circumferential wall thickening of the terminal ileum and ileocecal junction in abdominal CT scan. The brain MRI of the patient showed cytotoxic lesions of the corpus callosum (CLOCC) which had hypersignal intensity with a few diffusion restrictions in the splenium of the corpus callosum. CONCLUSION: This case is being reported to raise awareness of MIS-C presenting characteristics. Given the rising number of MIS-C patients and a lack of understanding regarding early diagnostic clinical characteristics and therapy, further research into clinical presentations, treatment, and outcomes is urgently needed.

The Clinical Conundrum of Diagnosing Children with Fever and Pain Abdomen Amidst a Clustering of Pims-Ts Cases in the Omicron Dominant Era

Aims The Omicron variant of SARS-CoV-2 variant has rapidly spread in the UK since December 2021.There was a significant increase in the number of children testing positive for SARS-CoV-2 in December 2021 in the population served by this DGHS. A clustering of cases of PIMS- TS was noted in the last week of December 2021 and the first week of January 2022. The focus of this descriptive study of PIMS-TS patients from a single centre is to report the clustering of cases in the Omicron dominant period and to describe the dilemma of managing children who present with fever and pain abdomen. Methods Children confirmed to have PIMS-TS and one child who presented mimicking PIMS -TS were identified, their investigations, treatment and outcomes were reviewed Results A cluster of 6 children diagnosed as PIMS -TS presented from the 29th of December 2021 to the 8th of January 2022.The mean age of patients was 9.3 years. There was ethnic variation with 3 Asian, 2 Afro Caribbean and one White child. Mean CRP was 226( range 85-400). All children presented with fever of more than 3 days.3 children presented with partial Kawasaki features, 2 children were treated for shock and 2 children presented with pain abdomen and fever. A 15 year old presented with fever, pain abdomen and tenderness in the right iliac fossa. He was managed initially as appendicitis. Blood markers for PIMS-TS were significantly raised along with raised CRP of 204. CT abdomen showed ileitis. His NPA RT- PCR was positive for SARS-CoV-2. He continued to have high fever, a diagnosis of PIMS-TS was made. There was significant improvement in both clinical condition and biochemical markers following IV Methylprednisolone. On the same day a 11 year old presented with fever, pain abdomen and increased irritability. He had global developmental delay and was PEG fed. He was initially managed as PIMS-TS then diagnosed to have appendicitis. CT abdomen showed a perforated appendix. He had a good outcome after surgery Conclusion The clustering of cases of PIMS- TS may be specific to this geographical area and multi-ethnic population following a period of high SARS-CoV-2 prevalence in the community with the Omicron variant. PIMS-TS can closely mimic appendicitis and distinguishing between both can be difficult. In the first child, CRP was unusually high (202) which helped in making a diagnosis avoiding unnecessary surgery. In the second child clinical acumen and involvement of multiple specialist teams helped in making the diagnosis of appendicitis. The global developmental delay and the child being nonverbal proved to be confounding factors. Cases of PIMS-TS can have bowel inflammation, it is also possible that COVID-19 can occur with other pathologies. Radiology findings need to be interpreted with the clinical picture. Clinical acumen, considering a range of differentials working closely with other specialities enables us to make a correct diagnosis for the unwell child who presents in the COVID-19 pandemic.

Enteritis in calves: anamnestic, clinical, diagnostic and therapeutic evaluations with special attention to enteropathogenic rotavirus and bovine coronavirus

Introduction: Neonatal calf diarrhoea is a multifactorial disease that sometimes leads to high economic losses. It can be fatal due to dehydration and acidosis and has been one of the main causes of calf mortality. Material and methods: This retrospective study considered calves of a maximum of 35 days of age and with a diagnosed infection with rotavirus and/or bovine coronavirus. We examined the clinical records of 156 calves that were referred to the University Clinic for Ruminants in Vienna. Results Calves that had been treated with antibiotics before admission to the Clinic had a higher risk of staying longer, suggesting either that these calves had a more serious illness or that antibiotic treatment was not indicated and so therapeutic success was not achieved. Twenty-three calves died or were euthanized at the Clinic. At the time of admission, they were younger than the surviving calves and they had a lower inner body temperature and a lower base excess at the first examination. The four most common pathogens in faecal samples were rotavirus, bovine coronavirus, Cryptosporidium parvum and Escherichia coli, which were detected in 67.1%, 53.9%, 48.1% and 94.1% of the faecal samples examined. The most common co-infection was rotavirus with Cryptosporidium parvum (17 faecal samples). We inspected the four most common pathogens in more detail. There were significant correlations between bovine coronavirus and season, with the risk of suffering from bovine coronavirus 1.6 times higher in winter than in other seasons. There was also a correlation between Cryptosporidium parvum and general behaviour: the risk of being infected with Cryptosporidium parvum was 2.6 times higher in calves that were moderately to severely depressed at the first examination. There was a correlation between co-infections and mortality, with calves with a co-infection at three times higher risk of dying than calves with a mono-infection.

Molecular detection of Avian coronavirus (infectious bronchitis virus) associated with poultry enteritis

Poultry enteritis is an important multifactorial disease. Avian coronavirus (ACV) is one of many viruses related to enteric diseases and infectious bronchitis. Aim of this study was to find out the occurrence of ACV in enteritis affected broiler, molecular detection, phylogenetic analysis of avian corona virus and to examine intestine and liver for gross and microscopic lesions. Dead poultry birds (N=604) affected with enteritis were examined for presence of ACV. Intestinal samples of four birds were pooled to make one biological sample enteric ACV as the causative agent of enteritis in commercial poultry sector in and around four major districts of Rajasthan by RT-PCR. Molecular characterization was carried out by partial gene sequencing. Liver and intestine were examined grossly during post-mortem and by histopathology. Out of 151 pooled samples tested 51 (35.10%) were found positive for ACV. Prevalence of enteric ACV was highest in Ajmer (45.94%) and lowest in Dungarpur (23.07%) districts. 0-1 weeks age chicken flocks were found more susceptible for enteric ACV with 33.80% prevalence. Comparison of ACV sequence of this study revealed nucleotide (nt) identities from 99.44% among themselves, 99.44% with ACV from abroad. The amino acid (aa) identities of ACV of this study among themselves and with abroad sequences was 47.06 to 100%. Further severe congestion in intestine and necrotic patches on liver were recorded. Histopathology showed severe villous atrophy, congestion and cystic glands in sub-mucosa in intestine and severe congestion and haemorrhages along with infiltration of inflammatory cells in liver parenchyma.

Decreased effectiveness of vaccination against infectious bronchitis as the result of increased incidence of vesicular enteritis in broilers

The incidence of infectious bronchitis (IB) in chickens has increased in Russian Federation during 2020- 2021 despite the widespread vaccination of the susceptible poultry. The effectiveness of vaccinations against IB virus and Newcastle disease can be significantly affected by vesicular enteritis (runting stunting syndrome) accompanied by malabsorption. The study presented demonstrated that virally induced malabsorption in broilers is accompanied by the synchronous decreases in the concentrations of magnesium and zinc in blood serum. Evaluation of the effectiveness of vaccination by RT-PCR for the presence of IB viral RNA in the intestine at day 2 after the vaccination indicates a sharp decrease in the PCR prevalence in individuals with vesicular enteritis and allows for the exclusion of possible population-wide decrease in post-vaccination immunity. When considering biochemical parameters as markers of organopathologies the population-based approach to data analysis should be applied.

Risk assessment of public health emergencies concerned in the mainland of China, October 2021

Objective: To assess the risk of public health emergencies, both the indigenous ones and the imported ones, which might occur in the mainland of China in October 2021.

Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series.

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.