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Pediatrics ; 147(5)2021 05.
Article in English | MEDLINE | ID: covidwho-1256104


A male individual aged 18 years with no significant past medical history presented with fever, headache, dry cough, and chest pain. On clinical examination, he had tachycardia and hypotension needing intravenous fluid resuscitation and inotropic support. A chest radiograph revealed streaky lung opacities, and he was treated with antibiotics for suspected community-acquired pneumonia complicated by septic shock. Significant elevation of cardiac enzymes was noted, and there was a continued need for inotropes to maintain normotension. He also developed intermittent bradycardia, with serial electrocardiograms showing first-degree atrioventricular block, low-voltage QRS complexes, and ST-T wave changes and telemetry demonstrating junctional and ventricular escape rhythm. A complete workup for sepsis and acute myocarditis were performed to find the etiologic agent. Intravenous immunoglobulins were started to treat myocarditis, with eventual clinical improvement. He was eventually diagnosed with an unusual etiology for his illness. He was noted to still have intermittent ventricular escape rhythm on electrocardiograms on follow-up 2 weeks after discharge but continues to remain asymptomatic and in good health.

Mycoplasma pneumoniae/isolation & purification , Myocarditis/microbiology , Pneumonia, Mycoplasma/diagnosis , Adolescent , Arrhythmias, Cardiac/etiology , Bradycardia/diagnosis , Bradycardia/physiopathology , COVID-19/diagnosis , COVID-19/therapy , Diagnosis, Differential , Fever/etiology , Humans , Hypotension/etiology , Immunoglobulins, Intravenous/therapeutic use , Male , Mycoplasma pneumoniae/immunology , Neutropenia/etiology , Pneumonia, Mycoplasma/complications , Shock, Septic/microbiology , Tachycardia/etiology
Artif Organs ; 45(6): E187-E194, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1087949


The coronavirus disease 2019 (COVID-19) has been shown to involve the gastrointestinal tract, which implies bacterial translocation and endotoxemia. The aim of this study was to evaluate the role of extracorporeal endotoxin removal by Polymyxin B hemoperfusion (PMX-HP), in the treatment of patients with COVID-19 and secondary bacterial infection. We conducted a subgroup analysis of a multicenter, multinational, prospective, and observational web-based database (EUPHAS2 registry). We included 12 patients with severe acute respiratory syndrome coronavirus 2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction from nasal/oral swab, admitted to the intensive care unit between February and May 2020, who were affected by septic shock and received PMX-HP as per clinical indication of the attending physician. Septic shock was diagnosed in nine patients (75%), with a median time between symptoms onset and PMX-HP treatment of 16 (14-22) days. We identified Gram-negative bacteria in most of the microbiological cultures (N = 17, 65%), followed by Gram-positive bacteria in (N = 4, 15%), fungi (N = 3, 12%) and no growth (N = 2, 8%). Sequential Organ Failure Assessment (SOFA) score progressively improved over the next 120 hours following PMX-HP and it was associated with median endotoxin activity assay (EAA) decrease from 0.78 [0.70-0.92] at T0 to 0.60 [0.44-0.72] at T120 (P = .245). A direct correlation was observed between SOFA score and EAA. Lung Injury Score decreased and was associated with hemodynamic improvement over the same period. No statistically significant difference was observed for RIFLE score at each time point. Nine out of 12 patients (75%) required continuous renal replacement therapy because of acute kidney injury. In a series of consecutive COVID-19 patients with endotoxic shock, PMX-HP was associated with organ function recovery, hemodynamic improvement, and contemporary EAA level reduction. No PMX-HP-related complications were observed.

Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Endotoxemia/drug therapy , Endotoxemia/microbiology , Polymyxin B/therapeutic use , Shock, Septic/drug therapy , Shock, Septic/microbiology , Anti-Bacterial Agents/administration & dosage , Biomarkers/blood , COVID-19/mortality , Critical Illness , Endotoxemia/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Organ Dysfunction Scores , Prospective Studies , Registries , SARS-CoV-2 , Shock, Septic/mortality