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2.
Am J Emerg Med ; 49: 148-152, 2021 11.
Article in English | MEDLINE | ID: covidwho-1316366

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19. OBJECTIVE: The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting. DISCUSSION: MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit. CONCLUSION: MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Aspirin/therapeutic use , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Child , Child, Preschool , Emergency Service, Hospital , Humans , Immunoglobulins, Intravenous , Infant , Infant, Newborn , Point-of-Care Systems , Resuscitation , SARS-CoV-2 , Shock/physiopathology , Systemic Inflammatory Response Syndrome/mortality , Ultrasonography
3.
Am J Cardiol ; 153: 135-139, 2021 08 15.
Article in English | MEDLINE | ID: covidwho-1242860

ABSTRACT

Patients with serious COVID infections develop shock frequently. To characterize the hemodynamic profile of this cohort, 156 patients with COVID pneumonia and shock requiring vasopressors had interpretable echocardiography with measurement of ejection fraction (EF) by Simpson's rule and stroke volume (SV) by Doppler. RV systolic pressure (RVSP) was estimated from the tricuspid regurgitation peak velocity. Patients were divided into groups with low or preserved EF (EFL or EFP, cutoff ≤45%), and low or normal cardiac index (CIL or CIN, cutoff ≤2.2 L/min/m2). Mean age was 67 ± 12.0, EF 59.5 ± 12.9, and CI 2.40 ± 0.86. A minority of patients had depressed EF (EFLCIL, n = 15, EFLCIN, n = 8); of those with preserved EF, less than half had low CI (EFPCIL, n = 55, EFPCIN, n = 73). Overall hospital mortality was 73%. Mortality was highest in the EFLCIL group (87%), but the difference between groups was not significant (p = 0.68 by ANOVA). High PEEP correlated with low CI in the EFPCIL group (r = 0.44, p = 0.04). In conclusion, this study reports the prevalence of shock characterized by EF and CI in patients with COVID-19. COVID-induced shock had a cardiogenic profile (EFLCIL) in 9.6% of patients, reflecting the impact of COVID-19 on myocardial function. Low CI despite preservation of EF and the correlation with PEEP suggests underfilling of the LV in this subset; these patients might benefit from additional volume. Hemodynamic assessment of COVID patients with shock with definition of subgroups may allow therapy to be tailored to the underlying causes of the hemodynamic abnormalities.


Subject(s)
COVID-19/epidemiology , Hemodynamics/physiology , Shock/physiopathology , Aged , Comorbidity , Echocardiography , Female , Humans , Incidence , Male , Middle Aged , Pandemics , Prospective Studies , SARS-CoV-2 , Shock/diagnosis , Shock/epidemiology , United States/epidemiology
4.
Crit Pathw Cardiol ; 20(2): 100-102, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1234149

ABSTRACT

PURPOSE: To understand the hemodynamic effect of angiotensin II as a vasopressor in patients with shock secondary to COVID-19 infection. METHODS: A retrospective analysis was performed on all patients at a single center with COVID-19 infection and shock who were treated with angiotensin II. The hemodynamic response to angiotensin II was estimated by recording the mean arterial pressure, norepinephrine equivalent dose (NED) and urine output. RESULTS: Ten patients with COVID-19 related shock were treated with angiotensin II. Over the initial 6 hours, the average the NED decreased by 30.4% (from 64.6 to 44 µg/min) without a significant change in the mean arterial pressure (0.7% decrease). Six patients experienced at least a 25% reduction in NED by 6 hours, and 2 experienced at least a 50% reduction. CONCLUSIONS: On average, the hemodynamic response to angiotensin II in COVID-19 related shock was favorable. Two patients had a marked rapid improvement. Given the relationship of SARS-CoV-2 with the renin-angiotensin-aldosterone system, further evaluation of angiotensin II for the treatment of COVID-19 related shock is warranted.


Subject(s)
Angiotensin II/therapeutic use , COVID-19/complications , Shock/drug therapy , Vasoconstrictor Agents/therapeutic use , Aged , Arterial Pressure , COVID-19/physiopathology , COVID-19/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Shock/physiopathology , Shock/virology
5.
Pediatr Rheumatol Online J ; 19(1): 29, 2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1136233

ABSTRACT

BACKGROUND: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.


Subject(s)
COVID-19/physiopathology , Coronary Artery Disease/physiopathology , Hypotension/physiopathology , Lymphopenia/physiopathology , Mucocutaneous Lymph Node Syndrome/physiopathology , Myocarditis/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Age Distribution , Antirheumatic Agents/therapeutic use , Aspirin/therapeutic use , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/therapy , Child , Child, Preschool , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Female , Glucocorticoids/therapeutic use , Heart Failure/physiopathology , Humans , Hyperferritinemia/metabolism , Hyperferritinemia/physiopathology , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Infant , Intensive Care Units, Pediatric , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Italy/epidemiology , Male , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/metabolism , Mucocutaneous Lymph Node Syndrome/therapy , Platelet Aggregation Inhibitors/therapeutic use , SARS-CoV-2 , Shock/physiopathology , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/metabolism , Systemic Inflammatory Response Syndrome/therapy , Tachypnea/physiopathology , Troponin T/metabolism , Vomiting/physiopathology
6.
Iran J Allergy Asthma Immunol ; 19(6): 570-588, 2020 Dec 19.
Article in English | MEDLINE | ID: covidwho-1068115

ABSTRACT

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.


Subject(s)
COVID-19/physiopathology , Conjunctivitis/physiopathology , Exanthema/physiopathology , Fever/physiopathology , Gastrointestinal Diseases/physiopathology , Shock/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Abdominal Pain/physiopathology , Acute Kidney Injury/physiopathology , COVID-19/epidemiology , COVID-19/therapy , Cheilitis/physiopathology , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Headache/physiopathology , Humans , Meningism/physiopathology , Myalgia/epidemiology , Prognosis , Respiration, Artificial , Sex Distribution , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Vomiting/physiopathology
7.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066836

ABSTRACT

This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.


Subject(s)
Bacillus cereus/genetics , Exotoxins/genetics , Foodborne Diseases/diagnosis , Acetylcysteine/therapeutic use , Acidosis/physiopathology , Acidosis/therapy , Adult , Anti-Arrhythmia Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Bacillus cereus/isolation & purification , Blood Coagulation Disorders/physiopathology , Blood Coagulation Disorders/therapy , Blood Transfusion , Brain Diseases , Continuous Renal Replacement Therapy , Fatal Outcome , Female , Foodborne Diseases/microbiology , Foodborne Diseases/physiopathology , Foodborne Diseases/therapy , Free Radical Scavengers/therapeutic use , Humans , Immunocompetence , Liver Failure/physiopathology , Liver Failure/therapy , Multiple Organ Failure/physiopathology , Multiple Organ Failure/therapy , Plasmapheresis , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy , Rhabdomyolysis/physiopathology , Rhabdomyolysis/therapy , Sepsis/physiopathology , Sepsis/therapy , Shock/physiopathology , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Whole Genome Sequencing
9.
Rheumatology (Oxford) ; 60(2): 911-917, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-944404

ABSTRACT

OBJECTIVES: The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context. METHODS: This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework. RESULTS: Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework: 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19. CONCLUSIONS: We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.


Subject(s)
Abdominal Pain/therapy , Adrenal Cortex Hormones/therapeutic use , Antirheumatic Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/therapy , Immunologic Factors/therapeutic use , Mucocutaneous Lymph Node Syndrome/diagnosis , Shock/therapy , Systemic Inflammatory Response Syndrome/therapy , Abdominal Pain/physiopathology , Acyclovir/therapeutic use , Adolescent , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/physiopathology , Child , Diagnosis, Differential , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Inflammation , Infliximab/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Male , Patient Care Team , Physician's Role , Retrospective Studies , Rheumatologists , SARS-CoV-2 , Severity of Illness Index , Shock/physiopathology , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/physiopathology , United Kingdom
10.
Trends Endocrinol Metab ; 31(12): 893-904, 2020 12.
Article in English | MEDLINE | ID: covidwho-867128

ABSTRACT

Coronavirus disease 2019 (COVID-19) patients with pre-existing cardiovascular disease (CVD) or with cardiovascular complications have a higher risk of mortality. The main cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction (AMI), myocarditis, arrhythmia, heart failure, shock, and venous thromboembolism (VTE)/pulmonary embolism (PE). COVID-19 can cause cardiovascular complications or deterioration of coexisting CVD through direct or indirect mechanisms, including viral toxicity, dysregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial cell damage and thromboinflammation, cytokine storm, and oxygen supply-demand mismatch. We systematically review cardiovascular manifestations, histopathology, and mechanisms of COVID-19, to help to formulate future research goals and facilitate the development of therapeutic management strategies.


Subject(s)
COVID-19/physiopathology , Cardiovascular Diseases/physiopathology , Angiotensin-Converting Enzyme 2/metabolism , Arrhythmias, Cardiac/immunology , Arrhythmias, Cardiac/metabolism , Arrhythmias, Cardiac/physiopathology , COVID-19/immunology , COVID-19/metabolism , Cardiovascular Diseases/immunology , Cardiovascular Diseases/metabolism , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/physiopathology , Heart Diseases/immunology , Heart Diseases/metabolism , Heart Diseases/physiopathology , Heart Failure/immunology , Heart Failure/metabolism , Heart Failure/physiopathology , Humans , Hypoxia/immunology , Hypoxia/metabolism , Hypoxia/physiopathology , Myocardial Infarction/immunology , Myocardial Infarction/metabolism , Myocardial Infarction/physiopathology , Myocarditis/immunology , Myocarditis/metabolism , Myocarditis/physiopathology , Pulmonary Embolism/immunology , Pulmonary Embolism/metabolism , Pulmonary Embolism/physiopathology , Renin-Angiotensin System/physiology , SARS-CoV-2/immunology , SARS-CoV-2/metabolism , Shock/immunology , Shock/metabolism , Shock/physiopathology , Troponin/metabolism , Venous Thromboembolism/immunology , Venous Thromboembolism/metabolism , Venous Thromboembolism/physiopathology
11.
Chest ; 158(6): e267-e268, 2020 12.
Article in English | MEDLINE | ID: covidwho-860852

ABSTRACT

Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia, and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute coronavirus disease 2019 (COVID-19) infection who presented with hemoconcentration, shock, and hypoalbuminemia. The patient subsequently developed rhabdomyolysis and compartment syndrome of all four extremities, requiring fasciotomies. This is the first reported case of systemic capillary leak syndrome associated with COVID-19 infection. This case adds to the evolving spectrum of inflammatory effects associated with this viral infection.


Subject(s)
COVID-19/physiopathology , Capillary Leak Syndrome/physiopathology , Compartment Syndromes/physiopathology , Hypoalbuminemia/physiopathology , Shock/physiopathology , Abdominal Pain/etiology , Acidosis, Lactic/etiology , Acidosis, Lactic/physiopathology , Acidosis, Lactic/therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , COVID-19/complications , COVID-19/therapy , Capillary Leak Syndrome/etiology , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Continuous Renal Replacement Therapy , Crystalloid Solutions/therapeutic use , Edema/etiology , Edema/physiopathology , Fasciotomy , Fatal Outcome , Fluid Therapy , Hematocrit , Humans , Hypoalbuminemia/etiology , Hypoalbuminemia/therapy , Male , Middle Aged , Respiration, Artificial , Rhabdomyolysis/etiology , Rhabdomyolysis/physiopathology , Shock/etiology , Shock/therapy , Tomography, X-Ray Computed , Vasoconstrictor Agents/therapeutic use
12.
Anaesth Crit Care Pain Med ; 39(5): 563-569, 2020 10.
Article in English | MEDLINE | ID: covidwho-696277

ABSTRACT

PURPOSE: To survey haemodynamic monitoring and management practices in intensive care patients with the coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists involved in COVID-19 ICU care were invited to answer 14 questions about haemodynamic monitoring and management. RESULTS: Globally, 1000 questionnaires were available for analysis. Responses came mainly from Europe (n = 460) and America (n = 434). According to a majority of respondents, COVID-19 ICU patients frequently or very frequently received continuous vasopressor support (56%) and had an echocardiography performed (54%). Echocardiography revealed a normal cardiac function, a hyperdynamic state (43%), hypovolaemia (22%), a left ventricular dysfunction (21%) and a right ventricular dilation (20%). Fluid responsiveness was frequently assessed (84%), mainly using echo (62%), and cardiac output was measured in 69%, mostly with echo as well (53%). Venous oxygen saturation was frequently measured (79%), mostly from a CVC blood sample (94%). Tissue perfusion was assessed biologically (93%) and clinically (63%). Pulmonary oedema was detected and quantified mainly using echo (67%) and chest X-ray (61%). CONCLUSION: Our survey confirms that vasopressor support is not uncommon in COVID-19 ICU patients and suggests that different haemodynamic phenotypes may be observed. Ultrasounds were used by many respondents, to assess cardiac function but also to predict fluid responsiveness and quantify pulmonary oedema. Although we observed regional differences, current international guidelines were followed by most respondents.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Care/methods , Health Care Surveys , Hemodynamic Monitoring , Pandemics , Pneumonia, Viral/therapy , Africa/epidemiology , Americas/epidemiology , Asia/epidemiology , Australia/epidemiology , COVID-19 , Cardiotonic Agents/therapeutic use , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Disease Management , Echocardiography/statistics & numerical data , Europe/epidemiology , Fluid Therapy , Hemodynamics/drug effects , Humans , Oxygen/blood , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Procedures and Techniques Utilization , Pulmonary Edema/etiology , Pulmonary Edema/physiopathology , SARS-CoV-2 , Shock/etiology , Shock/physiopathology , Vasoconstrictor Agents/therapeutic use
13.
Echocardiography ; 37(9): 1488-1491, 2020 09.
Article in English | MEDLINE | ID: covidwho-695320

ABSTRACT

We report a case of a 17-year-old healthy male presenting with multisystem hyperinflammatory shock temporally associated with COVID-19. Cardiac involvement was suspected based on evidence of significant cardiac injury (elevated cardiac biomarkers, electrocardiographic and echocardiographic abnormalities). Cardiac magnetic resonance imaging was performed demonstrating global biventricular systolic dysfunction, as well as a small area of T2 hyperintensity and mid-wall late gadolinium enhancement. This case discusses the varied cardiac involvement in pediatric patients with COVID-19 infection and highlights that cardiac injury is not just limited to hyperinflammatory syndrome related global dysfunction but a more focal myocarditis can also be seen.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Heart Diseases/diagnosis , Heart Diseases/etiology , Shock/etiology , Adolescent , Contrast Media/pharmacokinetics , Echocardiography/methods , Electrocardiography/methods , Gadolinium/pharmacokinetics , Heart/diagnostic imaging , Heart/physiopathology , Heart Diseases/physiopathology , Humans , Image Enhancement/methods , Magnetic Resonance Imaging/methods , Male , Shock/diagnosis , Shock/physiopathology
14.
Ann Neurol ; 88(4): 851-854, 2020 10.
Article in English | MEDLINE | ID: covidwho-625491

ABSTRACT

Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Although several structural brain abnormalities have been described, their impact on brain function and implications for prognosis are unknown. Functional neuroimaging, which has prognostic significance, has yet to be explored in this population. Here we describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated intact functional network connectivity, and weeks later recovered the ability to follow commands. When prognosticating for survivors of severe COVID-19, clinicians should consider that brain networks may remain functionally intact despite structural injury and prolonged unresponsiveness. ANN NEUROL 2020;88:851-854.


Subject(s)
Brain/diagnostic imaging , Coma/diagnostic imaging , Coronavirus Infections/physiopathology , Persistent Vegetative State/diagnostic imaging , Pneumonia, Viral/physiopathology , Recovery of Function , Betacoronavirus , Brain/physiopathology , COVID-19 , Coma/physiopathology , Coronavirus Infections/therapy , Electroencephalography , Functional Neuroimaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neural Pathways , Pandemics , Persistent Vegetative State/physiopathology , Pneumonia, Viral/therapy , Prognosis , Renal Insufficiency/physiopathology , Respiration, Artificial , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , SARS-CoV-2 , Shock/physiopathology
15.
Neurology ; 95(10): 454-457, 2020 09 08.
Article in English | MEDLINE | ID: covidwho-616669
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