What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar.

Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.

Malaria and COVID-19 coinfection in a non-malaria-endemic area in Brazil.

Differential diagnosis of coronavirus disease 2019 (COVID-19) from other febrile diseases is one of several challenges imposed by the pandemic. We present a case of severe malaria and COVID-19 coinfection in a non-malaria-endemic region. A 44-year-old female with malaise, fever, hypotension, jaundice, and enlarged liver and spleen was admitted to the intensive care unit. Reverse transcription-quantitative PCR results for severe acute respiratory syndrome coronavirus 2 were positive. Rapid tests, microscopy, and quantitative PCR were positive for Plasmodium vivax. Cytokine storm profiles were identified. We could not determine whether the severe vivax malaria in our patient was triggered by COVID-19 coinfection.

A comprehensive analysis of systematically screened laboratory tests: based on a COVID-19 cohort.

INTRODUCTION: The study aimed at screening indicators with differential diagnosis values and investigating the characteristics of laboratory tests in COVID-19 patients. METHODOLOGY: All the laboratory tests from COVID-19 patients and non-COVID-19 patients in this cohort were included. Test values from the groups during the course, days 1-7, and days 8-14 were analyzed. Mann-Whitney U test, univariate logistic regression analysis, and multivariate regression analysis were performed. Regression models were established to verify the diagnostic performance of indicators. RESULTS: 302 laboratory tests were included in this cohort, and 115 indicators were analyzed; the values of 61 indicators had significant differences (p < 0.05) between groups, and 23 indicators were independent risk factors of COVID-19. During days 1-7, the values of 40 indicators had significant differences (p < 0.05) between groups, while 20 indicators were independent risk factors of COVID-19. During days 8-14, the values of 45 indicators had significant differences (p < 0.05) between groups, and 23 indicators were independent risk factors of COVID-19. About 10, 12, and 12 indicators showed significant differences (p < 0.05) in multivariate regression analysis in different courses respectively, and the diagnostic performance of the model from them was 74.9%, 80.3%, and 80.8% separately. CONCLUSIONS: The indicators obtained through systematic screening have preferable differential diagnosis values. Compared with non-COVID-19 patients, the screened indicators indicated that COVID-19 patients had more severe inflammatory responses, organ damage, electrolyte and metabolism disturbance, and coagulation disorders. This screening approach could find valuable indicators from a large number of laboratory test indicators.

Diagnosis of delirium: a practical approach.

Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. These features include fluctuations, prominent inattentiveness with other cognitive deficits, a change in awareness and visual hallucinations. We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests.

Fever, Rash, and Cough in a 7-Year-Old Boy.

A 7-year-old boy presented to the emergency department with fever, cough, congestion, abdominal pain, myalgias, and morbilliform rash. Several aspects of the patient's history, including recent travel, living on a farm, exposure to sick contacts, and new medications, resulted in a wide differential diagnosis. Initial laboratory testing revealed leukocytosis with neutrophilia and elevated atypical lymphocytes, but did not reveal any infectious causes of illness. He was discharged from the hospital, but then represented to the emergency department a day later with worsening rash, continued fever, abdominal pain, and poor intake. He was then admitted. A more comprehensive laboratory evaluation was initiated. During this hospital course, the patient's physical examination changed when he developed head and neck edema, and certain laboratory trends became clearer. With the assistance of several specialists, the team was able to reach a more definitive diagnosis and initiate treatment to appropriately manage his condition.

[A Case of Epiploic Appendagitis after COVID-19].

Acute epiploic appendagitis is an uncommon cause of abdominal pain resulting from appendageal ischemia caused by torsion or thrombosis of the draining vein. It is frequently misdiagnosed as acute appendicitis or diverticulitis. The coronavirus disease 2019 (COVID-19) pandemic has changed how this rare disease is diagnosed. There was a report of a young men diagnosed with COVID-19 and epiploic appendagitis as a rare cause of abdominal pain. In addition, a 50-year-old men was diagnosed with epiploic appendagitis during the treatment of COVID-19. This paper reports the case of a 53-year-old men who presented with right lower quadrant abdominal pain after COVID-19 and was diagnosed with acute epiploic appendagitis by computed tomography image findings. The thrombotic condition of COVID-19 may contribute to acute appendagitis, but more studies are needed to confirm this hypothesis.

Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19.

Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 2-6 weeks. The median age of patients with MIS-C is 6-11 years. Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. Respiratory tract, neurological system, musculoskeletal system, and kidney are less frequently affected. Mucocutaneous manifestations and coronary artery abnormalities characteristic for Kawasaki disease (KD) may be observed in a significant proportion of MIS-C patients that may make the differential diagnosis be difficult for some patients, especially in the post-pandemic era. The mortality rate is 1-3%. Management and prognosis of MIS-C are similar to that of KD. MIS-C and KD may share a common pathogenic process. Based on the observation of MIS-C-like illness in uninfected neonates, i.e. multisystem inflammatory syndrome in neonates, both MIS-C and KD may be a consequence of dysregulated, over-exaggerated humoral immune responses triggered by a specific infectious agent.

Differential diagnosis of precocious puberty in girls during the COVID-19 pandemic: a pilot study.

BACKGROUND: To investigate the differential diagnosis of girls aged 6 to 8 years with idiopathic premature thelarche (IPT) and central precocious puberty (CPP) during the COVID-19 pandemic. We explored predicted adult height (PAH) discrepancy to guide appropriate diagnosis and treatment. METHODS: From January 2020 to December 2021, Chinese girls aged 6 to 8 years with precocious puberty were recruited. They were divided into IPT and CPP groups. Clinical characteristics, including height, weight, body mass index (BMI), basal luteinizing hormone (LH), oestradiol, uterine length and volume, follicle numbers (d > 4 mm) and bone age (BA) were recorded. We analysed differential diagnosis and PAH discrepancy in both groups. Binary logistic regression analysis was used to explore risk factors for CPP, and receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic value of related indexes. RESULTS: Sixty patients, including 40 girls with IPT and 20 girls with CPP, were recruited. The prevalence of overweight and obesity in the entire cohort was 25% (15/60) and was significantly higher in IPT than CPP, 32.5% (13/40) vs. 10% (2/20), respectively (P=0.045). There were significant differences in LH, uterine volume, follicle numbers and BA (P<0.05). The impaired PAH of IPT and CPP was 0.01 ± 1.19 SD and 0.62 ± 0.94 SD with significant differences (P=0.047). Logistic regression analysis showed that LH and follicle numbers were independent risk factors for CPP. The ROC curve showed that the area under the curve (AUC) of LH and follicle numbers were 0.823 and 0.697. The sensitivity and specificity of LH with a cut off of 0.285 IU/L were 78.9% and 77.8%. The sensitivity and specificity of follicle numbers with a cut off of 3.5 were 89.5% and 52.8%. CONCLUSION: The prevalence of overweight and obesity in 6- to 8-year-old girls with precocious puberty was high. Auxological data should not be used in the differential diagnosis of IPT and CPP. Basal LH above 0.285 IU/L and follicle numbers greater than 4 were important features suggestive of CPP. PAH was impaired in individuals with CPP, but it was not impaired in individuals with IPT.

Differential Diagnosis, Prevention, and Treatment of mpox (Monkeypox): A Review for Dermatologists.

The current 2022 mpox (monkeypox) outbreak has been officially recognized as a public health emergency. The mpox clinical symptoms include high fever, fatigue, chills, headache, swollen lymph nodes, muscle aches, and a disseminated painful rash. However, recent cases of mpox have shown a shift in clinical symptoms, with anogenital skin lesions emerging as the predominant feature. Due to the predominant skin manifestations of mpox, dermatologists could be crucial in detecting new mpox cases and educating frontline healthcare professionals about mpox. The mpox virus is continuously evolving and has several variants. Genome sequencing has revealed that the Clade IIb variant is responsible for the 2022 mpox outbreak. Mpox spread may occur through animal-to-human and human-to-human transmission; however, unlike coronavirus disease 2019 (COVID-19), long-range airborne transmission has not been reported. Healthcare professionals are at higher risk of becoming infected since they are usually in close contact with both the patients and potentially contaminated fomites (e.g., examination table, gowns, gloves). Both public and healthcare professionals should take preventive and avoidance measures to limit the spread. Mpox is usually self-limiting and may require only symptomatic treatment; however, it may cause severe complications in special populations such as immunocompromised individuals. For severe infection, clinicians may consider antiviral drugs (off-label), tecovirimat and brincidofovir, originally approved for smallpox treatment. Two smallpox vaccines, ACAM2000® and JYNNEOSTM, can be used as pre-exposure prophylaxis against mpox. JYNNEOSTM, which carries approval for mpox use, has less adverse effect potential than ACAM2000®, and may also be used as post-exposure prophylaxis, preferably within 4 days of exposure.

Pediatric Cardiac Emergencies: When to Worry and When to Reassure.

Cardiac symptoms are a frequent reason for pediatric patients to present to the emergency department. As stressful as these visits can be for both parents and inexperienced providers, many of these symptoms may have a benign explanation, and recognition of red flags are of the utmost importance to provide optimal care. In this article, we present four clinical scenarios that have a cardiac etiology and are common to the pediatric emergency department. In addition to highlighting differential diagnoses, we discuss important red flags, key signs, and findings on physical examination that should not be missed. A brief review of important workup and management is also discussed. Lastly, we review common electrocardiogram pearls and pitfalls important for the ordering provider to recognize. In this article, we hope to provide guidance on when to provide reassurance and when to refer to a pediatric cardiologist for evaluation. [Pediatr Ann. 2023;52(4):e128-e134.].