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1.
Clinics (Sao Paulo) ; 75: e2209, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-749235

RESUMEN

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Coronavirus , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Síndrome de Respuesta Inflamatoria Sistémica/epidemiología , Síndrome de Respuesta Inflamatoria Sistémica/virología , Dolor Abdominal/etiología , Betacoronavirus , Niño , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Estudios Transversales , Diarrea/etiología , Fiebre/etiología , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Síndrome Mucocutáneo Linfonodular/epidemiología , Síndrome Mucocutáneo Linfonodular/terapia , Síndrome Mucocutáneo Linfonodular/virología , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Respiración Artificial , Índice de Severidad de la Enfermedad , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Vómitos/etiología
2.
Rev Soc Bras Med Trop ; 53: e20200494, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-740419

RESUMEN

Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Diarrea/diagnóstico , Pandemias , Neumonía Viral/diagnóstico , Dolor Abdominal/etiología , Betacoronavirus , Preescolar , Técnicas de Laboratorio Clínico , Análisis por Conglomerados , Trazado de Contacto , Diarrea/etiología , Fiebre/etiología , Humanos , Masculino , Faringitis/etiología
3.
Am J Case Rep ; 21: e925753, 2020 Jul 29.
Artículo en Inglés | MEDLINE | ID: covidwho-690362

RESUMEN

BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Intestinos/irrigación sanguínea , Isquemia/virología , Oclusión Vascular Mesentérica/virología , Neumonía Viral/complicaciones , Trombosis/virología , Dolor Abdominal/etiología , Betacoronavirus , Diarrea/etiología , Embolectomía , Humanos , Infarto/diagnóstico , Infarto/cirugía , Infarto/virología , Intestinos/diagnóstico por imagen , Intestinos/cirugía , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/cirugía , Persona de Mediana Edad , Pandemias , Trombectomía , Trombosis/diagnóstico por imagen , Trombosis/cirugía , Tomografía Computarizada por Rayos X
5.
BMJ Case Rep ; 13(6)2020 Jun 16.
Artículo en Inglés | MEDLINE | ID: covidwho-601611

RESUMEN

A 33-year-old man presented repeatedly with severe abdominal pain and diarrhoea. Renal colic was suspected, and he was admitted for pain management. Questioning elicited an additional history of sore throat and mild, dry cough. Inflammatory markers were mildly raised (C reactive protein (CRP) 40 mg/L). Initial nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by PCR. CT of the kidneys, ureters and bladder (CT KUB) was normal; however, CT of the thorax showed multifocal bilateral peripheral areas of consolidation consistent with COVID-19 infection. He developed respiratory compromise and was transferred to the intensive care unit (ICU). Sputum was positive for SARS-CoV-2 by PCR, and culture grew Yersinia enterocolitica He recovered following supportive management and treatment with piperacillin-tazobactam.


Asunto(s)
Dolor Abdominal , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Combinación Piperacilina y Tazobactam/administración & dosificación , Neumonía Viral , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Antibacterianos/administración & dosificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Esputo/microbiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Yersinia enterocolitica/aislamiento & purificación
7.
Clin Radiol ; 75(8): 592-598, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-591561

RESUMEN

AIM: To evaluate the diagnostic utility of additional whole-chest computed tomography (CT) in identifying otherwise unheralded COVID-19 lung disease as part of an acute abdominal pain CT imaging pathway in response to the COVID-19 pandemic. MATERIALS AND METHODS: Consecutive patients (n=172) who underwent additional whole-chest CT via a COVID-19 acute abdominal pain CT imaging pathway between 27 March and 3 May 2020 were evaluated in this retrospective single-centre study. Chest CT examinations were graded as non-COVID-19, indeterminate for, or classic/probable for COVID-19. CT examinations in the latter two categories were further divided into one of three anatomical distributions (lung base, limited chest [below carina], whole chest [above carina]) based on location of findings. Reverse transcriptase-polymerase chain reaction (RT-PCR) results and clinical features of COVID-19 were assessed to determine if COVID-19 was clinically suspected at the time of CT referral. RESULTS: Twenty-seven of the 172 (15.7%) patients had CT features potentially indicative of COVID-19 pneumonia, 6/27 (3.5%) demonstrating a classic/probable pattern and 21/27 (12.2%) demonstrating an indeterminate pattern. After correlation with clinical features and RT-PCR 8/172 (4.7%) were defined as COVID-19 positive, of which only 1/172 (0.6%) was clinically unsuspected of COVID-19 at the time of CT referral. All COVID-19 positive cases could be identified on review of the lung base alone. CONCLUSION: Whole-chest CT as part of an acute abdominal pain CT imaging pathway has a very low diagnostic yield for our cohort of patients. All COVID-19-positive patients in our cohort were identified on review of the lung bases on the abdominal CT and this offers an alternative imaging approach in this patient group.


Asunto(s)
Dolor Abdominal/etiología , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Enfermedad Aguda , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos
8.
J Card Surg ; 35(7): 1736-1739, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-526929

RESUMEN

The impact of the coronavirus disease 2019 (COVID-19) pandemic in New York City (NYC) is dramatic. COVID-19 cases surged, hospitals expanded to meet capacity, and NYC remains the global epicenter of this pandemic. During this unprecedented time, a young woman with known Marfan syndrome presented with an acute complicated type B aortic dissection to our Aortic Center. Using the provisional extension to induce a complete attachment technique, we treated this patient and quickly discharged her the next day to decrease the risk of COVID-19 infection. Her progress was monitored using frequent phone calls and one office visit at two weeks.


Asunto(s)
Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Infecciones por Coronavirus/epidemiología , Procedimientos Endovasculares/métodos , Neumonía Viral/epidemiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Enfermedad Aguda , Adulto , Aneurisma Disecante/diagnóstico por imagen , Aneurisma Disecante/etiología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Infecciones por Coronavirus/diagnóstico , Infección Hospitalaria/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Angiografía por Resonancia Magnética/métodos , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico , Ciudad de Nueva York , Pandemias , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
9.
Am J Gastroenterol ; 115(8): 1153-1155, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-525850

Asunto(s)
Infecciones por Coronavirus/fisiopatología , Enfermedades del Sistema Digestivo/fisiopatología , Neumonía Viral/fisiopatología , Dolor Abdominal/etiología , Dolor Abdominal/metabolismo , Dolor Abdominal/fisiopatología , Dolor Abdominal/terapia , Atención Ambulatoria , Anorexia/etiología , Anorexia/metabolismo , Anorexia/fisiopatología , Anorexia/terapia , Antibacterianos/efectos adversos , Antipiréticos/efectos adversos , Antivirales/efectos adversos , Betacoronavirus , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/fisiopatología , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , China , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/metabolismo , Infecciones por Coronavirus/terapia , Diarrea/etiología , Diarrea/metabolismo , Diarrea/fisiopatología , Diarrea/terapia , Enfermedades del Sistema Digestivo/etiología , Enfermedades del Sistema Digestivo/metabolismo , Enfermedades del Sistema Digestivo/terapia , Endoscopía del Sistema Digestivo , Gastroenterología , Humanos , Hepatopatías/etiología , Hepatopatías/metabolismo , Hepatopatías/fisiopatología , Hepatopatías/terapia , Náusea/etiología , Náusea/metabolismo , Náusea/fisiopatología , Náusea/terapia , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/metabolismo , Neumonía Viral/terapia , Probióticos/uso terapéutico , Sociedades Médicas , Vómitos/etiología , Vómitos/metabolismo , Vómitos/fisiopatología
11.
Pancreatology ; 20(4): 665-667, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-175742

RESUMEN

BACKGROUND/OBJECTIVES: Abdominal pain is one of the known symptoms associated with coronavirus disease 2019. Little is known about the development of acute pancreatitis as a complication of severe acute respiratory syndrome coronavirus 2 infection. This case report describes the presentation of acute pancreatitis in two of three family members with severe COVID-19 infection. METHODS: Data were collected from three family members admitted with COVID-19 to the intensive care unit in March 2020. This study was reviewed and approved by the local data and ethics committee (31-1521-253). RESULTS: Two of the three family members were diagnosed with acute pancreatitis associated with SARS-CoV-2. Other causes of acute pancreatitis were excluded for both patients (including alcohol, biliary obstruction/gall stones, drugs, trauma, hypertriglyceridemia, hypercalcemia, and hypotension). CONCLUSIONS: These cases highlight acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Pancreatitis/etiología , Neumonía Viral/complicaciones , Dolor Abdominal/etiología , Enfermedad Aguda , Anciano , Amilasas/sangre , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico por imagen , Cuidados Críticos , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/sangre , Pancreatitis/diagnóstico por imagen , Pandemias , Neumonía Viral/sangre , Neumonía Viral/diagnóstico por imagen , Radiografía , Tórax/diagnóstico por imagen , Ultrasonografía
13.
J Clin Virol ; 127: 104353, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-65320

RESUMEN

BACKGROUND: The outbreak of a new coronavirus, first reported in Wuhan, China, is spreading around the world. Information on the characteristics of children with Coronavirus Disease 2019 (COVID-19) is limited. METHODS: In this retrospective study, we recruited 10 children infected with SARS-COV-2 from January 27 to March 10, 2020, in Changsha, China. We report the epidemiological, clinical, laboratory, and high-resolution CT findings for these children. Qualitative descriptive analysis was used to describe the key results. RESULTS: Ten children were included. Three were male and seven were female. Three were from Wuhan, Hubei Province, and seven were from Changsha. All had a history of close contact with adults with COVID-19 before the onset of disease. Clinical manifestations included fever in four cases, respiratory symptoms in three cases, febrile convulsions in one case, vomiting in one case, abdominal pain in one case, and asymptomatic infection in two cases. All the children tested positive for nucleic acid in throat swabs at admission. Stool swabs of three cases were positive for nucleic acid after several days of fever. In nine children, blood routine results were normal, whereas in one case the white blood cell count was elevated. In four cases, CT findings of the lungs showed light ground-glass opacities, one case showed changes similar to bronchopneumonia, and the remaining cases were normal. All were treated with symptomatic support without complications. CONCLUSION: Our findings indicate that intrafamily transmission may be the main form of transmission of COVID-19 in children, and persistent intestinal excretion of virus is another characteristic among children. The results of stool swab tests should be considered for discharge and release from isolation.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Heces/virología , Pulmón/virología , Neumonía Viral/diagnóstico , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Infecciones Asintomáticas/epidemiología , Betacoronavirus , Niño , Preescolar , China/epidemiología , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/transmisión , Femenino , Fiebre/virología , Humanos , Lactante , Pulmón/diagnóstico por imagen , Masculino , Pandemias , Neumonía Viral/patología , Neumonía Viral/transmisión , Investigación Cualitativa , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
15.
Am J Emerg Med ; 38(7): 1542.e1-1542.e3, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-19588

RESUMEN

The outbreak of a novel coronavirus disease (COVID-19) has been of concern to health care workers (HCW's) in the emergency department (ED) due to potential exposure and transmission. This case report describes a man who was referred to the ED for abdominal and testicular pain who was subsequently found to test positive for COVID-19. Due to the lack of respiratory symptoms, proper protective equipment (PPE) was not donned, and it led to several patients and health care workers being exposed. Given recent new descriptions of patients who present atypically, full PPE for all patients may be considered as community spread increases.


Asunto(s)
Dolor Abdominal/etiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Personal de Salud , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Enfermedades Testiculares/etiología , Adulto , Betacoronavirus , Infección Hospitalaria/virología , Servicio de Urgencia en Hospital , Humanos , Control de Infecciones , Masculino , Pandemias , Equipo de Protección Personal
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