RESUMEN
A 12-year-old girl presented with fever and signs of systemic inflammation, and was found to have junctional tachycardia. She was subsequently diagnosed with Multisystem Inflammatory Syndrome in Children and treated with intravenous immunoglobulin and steroids, which led to resolution of the arrhythmia.
Asunto(s)
COVID-19 , Niño , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica , Taquicardia/diagnóstico , Taquicardia/etiologíaAsunto(s)
Betacoronavirus , Cardiomiopatías/etiología , Dolor en el Pecho/etiología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Choque Cardiogénico/etiología , Adulto , COVID-19 , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/tratamiento farmacológico , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Disnea/etiología , Ecocardiografía , Electrocardiografía , Femenino , Fiebre/etiología , Humanos , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico , SARS-CoV-2 , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/terapia , Taquicardia/etiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND AIMS: Post Covid-19 syndrome (PCS) is a major cause of morbidity. In this article we intend to review the association and consequences of PCS and diabetes. METHODS: We reviewed all studies on "Long Covid", "Post COVID-19 Syndrome" and diabetes in PubMed and Google Scholar. RESULTS: The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has a bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction (and organ damage) in patients with diabetes. CONCLUSION: PCS in patients with diabetes could be detrimental in multiple ways. Strict control of diabetes and other comorbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS.
Asunto(s)
COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/etiología , COVID-19/terapia , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Fatiga/diagnóstico , Fatiga/epidemiología , Fatiga/etiología , Fatiga/terapia , Humanos , SARS-CoV-2/fisiología , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Sarcopenia/etiología , Sarcopenia/terapia , Taquicardia/diagnóstico , Taquicardia/epidemiología , Taquicardia/etiología , Taquicardia/terapia , Síndrome Post Agudo de COVID-19Asunto(s)
Anemia Hemolítica Autoinmune/etiología , Anemia Hemolítica Autoinmune/terapia , Vacuna BNT162/efectos adversos , COVID-19/inmunología , Anemia Hemolítica Autoinmune/diagnóstico , Anemia Hemolítica Autoinmune/inmunología , Vacuna BNT162/administración & dosificación , Transfusión Sanguínea/métodos , COVID-19/diagnóstico , COVID-19/prevención & control , COVID-19/virología , Terapia Combinada , Prueba de Coombs/métodos , Disnea/etiología , Fatiga/etiología , Femenino , Humanos , Factores Inmunológicos/uso terapéutico , Ictericia/etiología , Persona de Mediana Edad , Palidez/etiología , Rituximab/uso terapéutico , SARS-CoV-2/genética , SARS-CoV-2/inmunología , Taquicardia/etiología , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Mycoplasma pneumoniae/aislamiento & purificación , Miocarditis/microbiología , Neumonía por Mycoplasma/diagnóstico , Adolescente , Arritmias Cardíacas/etiología , Bradicardia/diagnóstico , Bradicardia/fisiopatología , COVID-19/diagnóstico , COVID-19/terapia , Diagnóstico Diferencial , Fiebre/etiología , Humanos , Hipotensión/etiología , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Mycoplasma pneumoniae/inmunología , Neutropenia/etiología , Neumonía por Mycoplasma/complicaciones , Choque Séptico/microbiología , Taquicardia/etiologíaRESUMEN
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic poses broad challenges to healthcare systems and providers. The manifestations of this disease are still being described in a variety of different contexts and patient populations. RESULTS: We report the case of a neonate who demonstrated COVID-19 after surgical correction of transposition of the great arteries. In addition, the patient demonstrated an evolving and persistent tachyarrhythmia consistent with neither the most likely postoperative complications nor typical COVID-19. DISCUSSION: The patient had negative preoperative testing for the virus and presented with profound oxygen desaturation and respiratory failure several days postoperatively. This raised concern for a complication of his arterial switch operation. It was found that one of the patient's caregivers was an asymptomatic carrier of COVID-19, and imaging ruled out intracardiac shunting. After initiating treatment for COVID-19, the patient's oxygen requirements and need for anti-arrhythmic agents improved. CONCLUSION: We propose that, despite negative preoperative testing, coronavirus infection may present as refractory tachyarrhythmia, and may be considered along with surgical complications as a cause for unexplained hypoxemia postoperatively.
Asunto(s)
COVID-19 , Transposición de los Grandes Vasos , Arterias , Humanos , Recién Nacido , SARS-CoV-2 , Taquicardia/etiología , Transposición de los Grandes Vasos/cirugíaRESUMEN
We present a case of a fatal cerebral haemorrhage in an 82-year-old male patient with coronavirus disease 2019 (COVID-19), who was taking prophylactic oral anticoagulation because of atrial fibrillation (rivaroxaban 20 mg q.d. for two years). On admission, the patient was deeply comatose, mechanically ventilated, with tachycardia up to 150 bpm, high blood pressure >210/120 mmHg and a body temperature >39°C. A computed tomography scan of the head showed a large intracerebral haemorrhage located in the deep structures of the right hemisphere, with a mass effect and bleeding to the ventricles. Rivaroxaban was discontinued at admission. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but he did not have typical symptoms of pneumonia. In the following days, the patient's neurological condition did not improve, and a fever of up to 40°C and abnormal coagulation parameters remained resistant to pharmacotherapy. The patient developed multi-system organ failure and died on day 8. Here, we review the recent literature and discuss the possible association of SARS-CoV-2-mediated endothelial injury and cardiovascular disorders with cerebrovascular complications. We postulate that anti-inflammatory treatment in COVID-19 and the stabilisation of endothelium functions can be particularly important in patients with pre-existing cardiovascular conditions.
Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , COVID-19/complicaciones , Hemorragia Cerebral/etiología , Inhibidores del Factor Xa/efectos adversos , Hipertensión/complicaciones , Rivaroxabán/efectos adversos , Accidente Cerebrovascular/prevención & control , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , COVID-19/diagnóstico , COVID-19/fisiopatología , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/terapia , Resultado Fatal , Humanos , Hipotensión/etiología , Masculino , Insuficiencia Multiorgánica/etiología , Insuficiencia Respiratoria/etiología , SARS-CoV-2 , Accidente Cerebrovascular/etiología , Taquicardia/etiologíaRESUMEN
INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders. Previous studies reported pulmonary embolism (PE) in severe COVID-19 patients. Aim of the study was to estimate the prevalence of symptomatic PE in COVID-19 patients and to identify the clinical, radiological or biological characteristics associated with PE. PATIENTS/METHODS: We conducted a retrospective nested case-control study in 2 French hospitals. Controls were matched in a 1:2 ratio on the basis of age, sex and center. PE patients with COVID-19 were compared to patients in whom PE was ruled out (CTPA controls) and in whom PE has not been investigated (CT controls). RESULTS: PE was suspected in 269 patients among 1042 COVID-19 patients, and confirmed in 59 patients (5.6%). Half of PE was diagnosed at COVID-19 diagnosis. PE patients did not differ from CT and CTPA controls for thrombosis risk factors. PE patients more often required invasive ventilation compared to CTPA controls (odds ratio (OR) 2.79; 95% confidence interval (CI) 1.33-5.84) and to CT controls (OR 8.07; 95% CI 2.70-23.82). PE patients exhibited more extensive parenchymal lesions (>50%) than CT controls (OR 3.90; 95% CI 1.54-9.94). D-dimer levels were 5.1 (95% CI 1.90-13.76) times higher in PE patients than CTPA controls. CONCLUSIONS: Our results suggest a PE prevalence in COVID-19 patients close to 5% in the whole population and to 20% of the clinically suspected population. PE seems to be associated with more extensive lung damage and to require more frequently invasive ventilation.
Asunto(s)
COVID-19/complicaciones , Embolia Pulmonar/etiología , Anciano , COVID-19/sangre , COVID-19/terapia , Estudios de Casos y Controles , Dolor en el Pecho/etiología , Terapia Combinada , Angiografía por Tomografía Computarizada , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Embolia Pulmonar/sangre , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/epidemiología , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Evaluación de Síntomas , Taquicardia/etiología , Trombofilia/sangre , Trombofilia/etiología , Tomografía Computarizada por Rayos X , Tratamiento Farmacológico de COVID-19Asunto(s)
COVID-19/complicaciones , SARS-CoV-2 , Rasgo Drepanocítico/diagnóstico , Corticoesteroides/uso terapéutico , Anticoagulantes/uso terapéutico , Azitromicina/uso terapéutico , COVID-19/sangre , COVID-19/terapia , Terapia Combinada , Diagnóstico Tardío , Errores Diagnósticos , Transfusión de Eritrocitos , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Huésped Inmunocomprometido , Osteonecrosis/diagnóstico por imagen , Osteonecrosis/etiología , Terapia por Inhalación de Oxígeno , Fiebre Reumática/diagnóstico , Rasgo Drepanocítico/sangre , Rasgo Drepanocítico/complicaciones , Rasgo Drepanocítico/inmunología , Esplenectomía/efectos adversos , Sobreinfección , Taquicardia/etiología , Trombocitopenia/etiología , Adulto Joven , Tratamiento Farmacológico de COVID-19Asunto(s)
Infecciones por Coronavirus/complicaciones , Síndrome de Guillain-Barré/fisiopatología , Síndrome de Secreción Inadecuada de ADH/fisiopatología , Conducción Nerviosa , Neumonía Viral/complicaciones , Disautonomías Primarias/fisiopatología , Anciano , Betacoronavirus , COVID-19 , Diarrea/etiología , Electromiografía , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/etiología , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiología , Síndrome de Guillain-Barré/terapia , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Hipotensión/etiología , Hipotensión/fisiopatología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/etiología , Masculino , Pandemias , Neumonía Asociada al Ventilador/diagnóstico , Neumonía Asociada al Ventilador/etiología , Disautonomías Primarias/diagnóstico , Disautonomías Primarias/etiología , Disautonomías Primarias/terapia , Cuadriplejía/etiología , Cuadriplejía/fisiopatología , SARS-CoV-2 , Stenotrophomonas maltophilia , Taquicardia/etiología , Taquicardia/fisiopatologíaRESUMEN
BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is an unprecedented global public health challenge, leading to thousands of deaths every day worldwide. Despite the epidemiological importance, clinical patterns of children with COVID-19 remain unclear. The aim of this study was to describe the clinical, laboratorial, and radiological characteristics of children with COVID-19. METHODS: The Medline database was searched between December 1st 2019 and April 6th 2020. No language restrictions were applied. Inclusion criteria were (a) studied patients younger than 18 years old; (b) presented original data from cases of COVID-19 confirmed by reverse-transcription polymerase chain reaction; and (c) contained descriptions of clinical manifestations, laboratory tests, or radiological examinations. RESULTS: A total of 38 studies (1124 cases) were included. From all the cases, 1117 had their severity classified: 14.2% were asymptomatic, 36.3% were mild, 46.0% were moderate, 2.1% were severe, and 1.2% were critical. The most prevalent symptom was fever (47.5%), followed by cough (41.5%), nasal symptoms (11.2%), diarrhea (8.1%), and nausea/vomiting (7.1%). One hundred forty-five (36.9%) children were diagnosed with pneumonia and 43 (10.9%) upper airway infections were reported. Reduced lymphocyte count was reported in 12.9% of cases. Abnormalities in computed tomography were reported in 63.0% of cases. The most prevalent abnormalities reported were ground-glass opacities, patchy shadows, and consolidations. Only one death was reported. CONCLUSIONS: Clinical manifestations of children with COVID-19 differ widely from adult cases. Fever and respiratory symptoms should not be considered a hallmark of COVID-19 in children.