ABSTRACT
Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).
ABSTRACT
CASE: A 83-year-old male with a history of non-insulin dependent diabetes mellitus, and coronary artery disease presented with four days of worsening myalgias, subjective fevers, and abdominal distention. He had no history of abdominal surgery, sick contacts or medication changes. He had a temperature of 99.2°F, a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, a blood pressure of 105/80 mmHg, and an oxygen saturation of 96% on room air. On examination, the abdomen was distended but without tenderness or guarding. Abdomen Computed Tomography (CT) scan revealed pancolonic severe gaseous dilatation with no transition point. COVID 19 polymerase chain reaction was noted to be positive, along with an elevated D-dimer of 2.58, ESR of 60 mm/h and CRP 40 mg/l;otherwise the laboratory workup including a respiratory and gastrointestinal panel, blood and sputum culture were negative. Following multidisciplinary and shared decisionmaking, a rectal tube was placed and the patient was given neostigmine with resolution of symptoms and subsequent radiographic demonstration of improvement in the colonic distention within 48 hours. Unfortunately, the patient suffered a cardiac arrest on day 5 of his hospitalization and per the family's request, aggressive treatment was aborted in favor of comfort measures. IMPACT/DISCUSSION: While COVID-19 is primarily an airborne infection, widespread expression of its receptor, Angiotensin Converting Enzyme type 2 (ACE2), throughout the gastrointestinal (GI) tract causes GI tract-related clinical symptoms in the absence of respiratory symptoms, leading to a delay in COVID-19 infection diagnosis. While anorexia (50.2%) and diarrhea (49.5%) are the most common gastrointestinal symptoms of COVID 19, our patient presented with abdominal discomfort (2%). Acute colonic pseudo-obstruction or Ogilvie syndrome is a functional disorder characterized by profound dilatation of the colon without a true mechanical obstruction. An association between certain viral infections (Herpes) and intestinal pseudo-obstruction has been demonstrated previously. The mechanism of such a development is hypothesized to be due to the viral invasion of the myenteric plexus. Similarly, COVID-19 has demonstrated neurotropic potential leading to the development of Ogilvie syndrome. Treatment modalities available for the treatment include bowel rest, nasogastric and rectal tube placement, electrolyte correction, neostigmine and possible endoscopic/surgical intervention with a preferably good prognosis. CONCLUSION: 1. The full range of effects of the COVID 19 virus are yet to be discovered. Loss of parasympathetic spinal control of bowel motility may be one possible manifestation of this disease. 2. Gastrointestinal sequelae of COVID 19 respond well to conservative management and should warrant a low threshold for the investigation and implementation of such treatment.
ABSTRACT
Background. Comparative data on bloodstream infections (BSI) in hospitalized patients with and without SARS-CoV2 positive test is lacking. Methods. A retrospective observational study comparing (BSI) with and without COVID-19 infection was performed was performed from Jan1- May 1, 2020. Patient demographics, clinical microbiological characteristics of infections, therapeutic interventions and outcomes was compared between the two groups. Results. Of 155 patients with BSI, 104 were SARS-CoV2 PCR negative (N) while 51 were positive (Table 1). Majority of SARS-CoV2 positives (P) had ARDS (58.8%), required mechanical ventilation (73%), inotropic support (55%), therapeutic anticoagulation (28%), proning (35%), Rectal tube (43%), Tocilizumab (18%), and steroids (43%) (Table 2). BSI was higher in N with HIV (16.3% vs 3.9% p=0.027). Duration of antibiotic therapy (DOT) prior to BSI was significantly longer in P (15 days vs. 5 days, p < 0.0001) (table 2). In-hospital mortality was significantly higher among P with BSI (49% vs. 21% p < 0.0001). 185 BSI events were observed during the study period with 117 in N patients and 68 in P. Primary BSI was predominant (76%) in N while secondary BSI (65%) was common in P of which 50% were CLABSI. Median time from admission to positive culture was 0.86 days in N compared to 12.4 in P (p = 0.001). Majority of BSI in P were monomicrobial (88%) and hospital acquired (71%) when compared to N (p< 0.001). Enterococcus spp (28%), Candida spp(12%), MRSA (10%) and E.coli (10%) were predominant microbes in P compared to Streptococcus grp (16%), MSSA (14%), MRSA (13%) and E.coli (12%) in N (figure 1). Mortality from BSI was associated with COVID-19 infection (OR 2.403, p = 0.038), DM (OR 2.335, p = 0.032), Charlson comorbidity index >3 (OR 1.236, p = 0.004), and mechanical ventilation (OR 11.398, p < 0.001) on multivariate analysis. Conclusion. Increased events of hospital acquired, secondary BSI (CLABSI) due to Enterococcus was observed in adult P compared to N. These patients were critically ill, developed BSI in the second week of hospitalization, had longer DOT prior to positive cultures and worse outcomes. Breakdown of infection control measures and inappropriate antimicrobial use during the surge could be contributory.
ABSTRACT
Background. There is a paucity of data of bloodstream infections (BSI) before and during the COVID-19 pandemic. The aim of our study was to compare the incidence and characteristics of blood stream infections (BSI) in hospitalized patients before and during the surge of COVID-19 pandemic in a community hospital in South Bronx. Methods. This is a retrospective observational comparative study of adult hospitalized patients with BSI admitted before (Jan 1-Feb 28, 2020) and during COVID-19 surge (Mar 1- May 1,2020). The incidence of BSI, patient demographics, clinical and microbiological characteristics of infections including treatment and outcomes were compared. Results. Of the 155 patients with BSI, 64 were before COVID and 91 were during the COVID surge (Table 1). Incidence of BSI was 5.84 before COVID and 6.57 during surge (p = 0.004). Majority of patients during COVID period had ARDS (39.6%), required mechanical ventilation (57%), inotropic support (46.2%), therapeutic anticoagulation (24.2%), proning (22%), rectal tube (28.6%), Tocilizumab (9.9%), and steroids (30.8%) in comparison to pre-COVID (Table 2). Days of antibiotic therapy prior to BSI was 5 days before COVID and 7 during COVID. Mortality was higher among patients with BSI admitted during COVID surge (41.8% vs. 14.1% p < 0.0001). Of 185 BSI events, 71 were Pre-COVID and 114 during surge. Primary BSI were predominant (72%) before COVID contrary to secondary BSI (46%) (CLABSI) during COVID. Time from admission to positive culture was 2.5 days during COVID compared to 0.9 pre-COVID. Majority of BSI during COVID period were monomicrobial (93%) and hospital acquired (50%) (p=0.001). Enterococcus (20.2%), E.coli (13.2%), and MSSA (12.3%) were predominant microbes causing BSI during COVID vs. MRSA (15.5%), Streptococci (15.5%), and S. pneumoniae (14.1%) before COVID (Figure 1). In multivariate logistic regression, Enterococcal coinfection was associated with COVID positivity (OR 2.685, p = 0.038), mechanical ventilation (OR 8.739, p = 0.002), and presence of COPD/Asthma (OR 2.823, p = 0.035). Conclusion. Higher incidence of secondary BSI (CLABSI) due to Enterococcus spp. was observed during the surge of COVID-19 infection in the South Bronx. Breakdown of infection control measures during the COVID-19 pandemic could have been contributory.