Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease.

Background: Multisystem inflammatory syndrome in children (MIS-C), is a severe complication of coronavirus disease 2019 (COVID-19), characterized by persistent fever, systemic inflammatory response, and organ failure. MIS-C with a history of COVID-19 may share clinical features with other well-defined syndromes such as macrophage activation syndrome, Kawasaki disease, hemophagocytic syndrome and toxic shock syndrome. Case 1: An 11-year-old male with a history of hypothyroidism and precocious puberty with positive antibody test for COVID-19 was admitted for fever, poor general condition, severe respiratory distress, refractory shock, and multiple organ failure. His laboratory examination showed elevated inflammatory parameters, and bone marrow aspirate showed hemophagocytosis. Case 2: A 13-year-old male with a history of attention deficit hyperactivity disorder and cognitive delay presented clinical manifestations of Kawasaki disease, fever, conjunctival congestion, exanthema, and hyperemia in oral mucosa, tongue, and genitals, with refractory shock and multiple organ failure. Reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies for COVID-19 were negative, inflammation parameters were elevated, and bone marrow aspirate showed hemophagocytosis. Patients required intensive care with invasive mechanical ventilation, vasopressor support, intravenous gamma globulin, systemic corticosteroids, low molecular weight heparin, antibiotics, and monoclonal antibodies and, patient 2 required renal replacement therapy. Conclusions: Multisystemic inflammatory syndrome in children can have atypical manifestations, and identifying them early is very important for the timely treatment and prognosis of patients.

Epidemiological and clinical characteristics of pregnant women and neonates with COVID-19 in Northwest Mexico.

INTRODUCTION: The SARS-CoV-2 virus, which causes COVID-19, has spread quickly worldwide, causing millions of cases and thousands of deaths. Some risk factors in the general population are related to the development of severe COVID-19 or death, but in pregnant women and neonates, the information is limited. OBJECTIVE: To determine the epidemiological and clinical characteristics of pregnant women and neonates diagnosed with COVID-19 by RT-PCR and serological tests, and analyze the relationship between the influenza vaccination and COVID-19 symptoms in infected pregnant women in Sinaloa state. METHODS: We collected samples from 116 pregnant women and 84 neonates from the Women´s Hospital of Sinaloa. They were diagnosed with COVID-19 by RT-PCR and serological tests (IgG), and sociodemographic, clinical and laboratory parameters were recorded. RESULTS: A total of 11.2% (13/116) of the pregnant women were RT-PCR+, 25% (29/116) were IgG+ and 4.3% (5/116) were positive for both tests. Symptoms such as rhinorrhea (P = .04), cough (P = .02) and polypnea (P = .04) in pregnant women were related to COVID-19, also leukocyte index was higher in pregnant women with COVID-19 (P = .03), but the associations were lost after the Bonferroni correction. No laboratory parameters or underlying diseases were associated with COVID-19, and most infected pregnant women had mild cases. We found an association between the influenza vaccine and less common COVID-19 symptoms in pregnant women who were infected (P = .01). A total of 7.2% (6/84) of neonates were RT-PCR+, 35.7% (30/84) were IgG+, and there were no symptoms or underlying diseases associated with neonates who were infected. In conclusion, this work demonstrated that some symptoms were related to COVID-19, most pregnant women and neonates had mild cases, and the influenza vaccine could decrease the severity of COVID-19 cases in pregnant women.

Clinical and epidemiological characteristics of COVID-19 in children: experience in two hospitals.

BACKGROUND: The COVID-19 pandemic is the most significant current public health crisis. METHODS: We conducted a retrospective case series, including patients under 18 years of age admitted to respiratory triage and hospitalized with COVID-19 infection in two hospital centers. Epidemiological, clinical, laboratory and radiological findings were documented. The diagnosis of COVID-19 was confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR). For the analysis, patients were classified into three groups: no comorbidities, immunocompromised, and with chronic disease. RESULTS: Fifty-four patients with COVID-19 were identified: 40 (74.1%) were admitted through respiratory triage. Of these, 28 (70%) were hospitalized, and 14 (25.9%) were already in the hospital. In addition, 26 (48.1%) presented comorbidities. A mild clinical course was observed in 14 cases (53.7%). The mean age was 6 years, with an interquartile range from 11 months to 13 years. The male sex was more frequent, representing 59.3%. Fever was the most common symptom in 74% of the patients. Lymphopenia was observed in 28.6%, and 69.3% had elevated C-reactive protein. Ground glass injuries were documented in 30.9% of COVID-19 cases; 11.1% of the patients required mechanical ventilation and vasopressor treatment. CONCLUSIONS: Fever was the main symptom, and mild infection was the principal presentation. In hospitalized patients with some comorbidity and COVID-19, the disease was more severe, with a high percentage of mortality.

INTRODUCCIÓN: La pandemia de COVID-19 es la mayor crisis de salud pública actual. MÉTODOS: Análisis de una serie de casos retrospectiva de pacientes menores de 18 años que ingresaron al triaje respiratorio y de pacientes hospitalizados con COVID-19 en dos centros hospitalarios. Se registraron variables epidemiológicas, clínicas, de laboratorio y radiológicas. El diagnóstico de COVID-19 fue confirmado por reacción en cadena de la polimerasa con transcriptasa inversa en tiempo real (RT-PCR). Para el análisis, los pacientes se clasificaron en tres grupos: sin comorbilidad, inmunocomprometidos y con enfermedad crónica. RESULTADOS: Se identificaron 54 pacientes con COVID-19, de los cuales 40 (74.1%) ingresaron por el triaje respiratorio y, de estos, 28 (70%) fueron hospitalizados y 14 (25.9%) ya estaban hospitalizados; 26 pacientes (48.1%) presentaban comorbilidad. El curso clínico leve se observó con mayor frecuencia, en 14 casos (53.7%). La mediana de edad fue de 6 años (rango intercuartílico: 11 meses a 13 años). El sexo masculino fue más frecuente, con el 59.3%. La fiebre fue el síntoma más común, en el 74% de los pacientes. Se observó linfocitopenia en el 28.6%, y el 69.3% presentaron elevación de la proteína C reactiva. Las lesiones en vidrio esmerilado se documentaron en el 30.9% de los casos y el 11.1% de los pacientes requirieron ventilación mecánica y tratamiento vasopresor. CONCLUSIONES: La fiebre fue el síntoma principal y la presentación leve de la enfermedad fue la más frecuente. En los pacientes hospitalizados con alguna comorbilidad e infectados por COVID-19, la gravedad de la enfermedad fue mayor, con un alto porcentaje de mortalidad.

Analysis of Epidemiological and Clinical Characteristics of COVID-19 in Northwest Mexico and the Relationship Between the Influenza Vaccine and the Survival of Infected Patients.

The first cases of unexplained pneumonia were reported in Wuhan, China, in December of 2019. Later, a novel coronavirus (SARS-CoV-2) was identified as the causal agent of pneumonia. This virus has since spread to more than 180 countries and has been declared a pandemic by the World Health Organization. Herein, we aimed to determine the epidemiological and clinical characteristics of symptomatic patients with coronavirus disease 2019 (COVID-19) and the relationship between the influenza vaccine with a lower risk of severe COVID-19 infection in the state of Sinaloa. We collected demographic and clinical data of 4,040 patients with acute respiratory infections across Sinaloa state hospitals from February 28 to May 15, 2020. The prevalence of COVID-19 among hospitalized patients with respiratory symptoms in Sinaloa showed 45.2% of men were more affected than women (p < 0.001), and people aged 40-49 years were the most affected. The main symptoms of COVID-19 infection were cough and fever (p < 0.001), while hypertension, obesity, and type 2 diabetes were the chronic diseases associated with COVID-19 than non-COVID-19 (p < 0.003). Healthcare workers were most likely to be infected compared to other occupations (p < 0.001). The general lethality rate was 14.1%, and males >62 years were the ones who had a higher lethality rate (p < 0.001); the aforementioned chronic diseases were related to higher lethality of COVID-19 (p < 0.001). Likewise, higher lethality was seen in housewives and patient retirees/pensioners compared with other occupations (p < 0.001). Finally, we found there was a relationship between influenza vaccination and a lower risk of severe COVID-19 infection and mortality (p < 0.001). These findings showed that healthcare workers, men >62 years with chronic diseases, and retired people were most affected. Furthermore, the influenza vaccine could decrease the severeness of COVID-19 cases.

Epidemiology of COVID-19 in Mexico: Symptomatic profiles and presymptomatic people.

OBJECTIVES: The COVID-19 diagnosis is difficult and ambiguous due to nonspecific symptoms. Further, data from Mexico arehospitable population-based without signs and symptoms information. Thus, this work aims to provide epidemiology information about the burden of COVID-19 in Mexican outpatients and to identify symptomatic COVID-19 profiles that could help in the early diagnosis of the disease. METHODS: From June to September, epidemiological, clinical, and demographic data of 482,413 individuals diagnosed by RT-PCR test for SARS-CoV-2 in Salud Digna clinics were collected. RESULTS: We observed a 41% incidence of SARS-CoV-2 infections with a mean age of 36 years and with young adults (20-40 years) being the most affected. Among occupations, delivery persons (OR 1.38) or informal traders (OR 1.33) had a higher risk of COVID-19. Moreover, 13% of SARS-CoV-2 infections were in presymptomatic patients. Finally, we identified three different symptomatic profiles (common, respiratory, and gastrointestinal) associated with COVID-19. CONCLUSION: The incidence of SARS-CoV-2 was high among outpatients with a significant proportion of presymptomatic carriers, and thus it is necessary to increase testing and continue SARS-CoV-2 surveillance with a better description of signs and symptoms; in this regard, we identified three symptomatic profiles that could help in the diagnosis of COVID-19.