High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru.

INTRODUCTION: Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting. METHODS: Prospective case-control study that included patients <17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality. Fisher's exact test and the Mann-Whitney U test were used for the analysis. RESULTS: Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity. CONCLUSION: Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients. IMPACT: Pediatric patients with COVID-19 can present with hemorrhagic and ischemic strokes on presentation. Neurological presentation in pediatric patients with COVID-19 has high mortality. Mortality of pediatric patients with COVID-19 is associated with comorbidities. Pediatric presentation and outcomes of COVID-19 in different regions can be novel to previously described.

Molecular diagnosis of Aspergillus fumigatus endocarditis.

A 66-year-old male with ischaemic cardiomyopathy and chronic lymphocytic leukemia developed signs of severe systemic inflammatory response syndrome. Serial blood cultures were negative and a SeptiFast test detected the presence of Aspergillus fumigatus DNA. Afterwards, detection of galactomannan and 1,3-ß-D-glucan showed a positive result. Autopsy revealed the presence of branched fungal structures suggestive of Aspergillus.

Síndrome hemofagocítico asociado a síndrome de Richter. Estudio de un caso autópsico y revisión de la literatura / Haemophagocytic syndrome associated to Richter’s Syndrome. Study of an autopsy case and review of the literature

Introducción: El síndrome hemofagocítico (SH) es un padecimiento poco frecuente, de etiología multifactorial, descrito, en sus formas secundarias, asociado a linfomas T, inmunosupresión medicamentosa, concretamente fludarabina, y a infecciones por virus, especialmente virus de Epstein-Barr (VEB). La evolución de la leucemia linfoide crónica (LLC) a linfomas más agresivos no es rara, se llama síndrome de Richter (SR), y se asocia ocasionalmente al VEB. Material y Métodos: Se realiza la autopsia de un varón de 63 años diagnosticado de LLC, estable durante años, que recae y, tras varios ciclos de quimioterapia, desarrolla una insuficiencia medular intensa que evoluciona hacia el éxitus tras fracaso multiorgánico. Resultados: El estudio macroscópico muestra datos inespecíficos. El estudio histológico revela un SH asociado a un síndrome linfoproliferativo complejo que presenta dos patrones mezclados, con predominio en ganglios y bazo del menos diferenciado, constituido por células grandes con inmunofenotipo T, y en otros órganos con persistencia del patrón linfoide de células pequeñas B consistente con el diagnóstico primitivo. El estudio inmunohistoquímico es negativo para VEB en las células tumorales. Conclusiones: La asociación de SH a Síndrome de Richter como tal no está recogida en la literatura revisada. Descartada la etiología vírica, quedan como posibles etiologías del SH el linfoma T desarrollado sobre la inicial LLC, que justifica el empeoramiento final del enfermo sin respuesta a los fármacos, o el uso de fludarabina y, subsecuentemente, insuficiencia medular final asociada al SH

Introduction: The haemophagocytic syndrome (HS) is a rare disease of multifactorial aetiology, which has been described in its secondary forms associated to T-cell lymphomas, drug induced immunsupression, concretely with Fludararabine, and in other cases to virus infection, especially with the Epstein-Barr-Virus (EBV). The evolution of chronic lymphatic leukaemia (CLL) to more aggressive lymphomas is not unusual and it is known as Richter’s Syndrome (RS), also occasionally associated to EBV. Material and methods: Autopsy of male, 63 years old, with diagnosis of CLL, stable for years, relapsing, and after various cycles of chemotherapy develops a medullar insufficiency which leads to death after multiorganic failure. Results: The macroscopic study reveals non-specific signs. The histological study reveals a HS associated to a complex lymphoproliferative syndrome with two patterns predominating in lymph nodes and spleen, the less differentiated formed of large cells with T-immunophenotype and in other organs persistence of the lymphoid pattern of small B-cells in accordance with the primitive diagnosis. The immunohistochemical study does not reveal positivity for EBV in tumour-cells. Conclusions: The association of HS to RS is not described in the revised literature. Being negative the EBV, other possible aetiologies of the HS are the T-cell lymphoma developed on the initial CLL which justifies the final worsening without drug-response or the application of Fludarabine after which the patient develops the final medullar insufficiency associated to the HS (AU)