Multisystem Inflammatory Syndrome Due to COVID-19 Infection in Vaccinated Versus Unvaccinated Adolescents: A Case Report.

Symptoms of COVID-19 infection are usually mild in the healthy pediatric population. In some pediatric patients, COVID-19 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We report two cases. Case 1 is a rare case of MIS-C symptoms, presenting with myalgia, chest pain, and fever three days after the second dose of the Pfizer-BioNTech COVID-19 vaccine, which is compared with Case 2, which is a case of MIS-C in an unvaccinated patient with COVID-19 infection who was noted to have acute kidney injury and fluid refractory hypotension. Although MIS-C was reported as a vaccine side effect, we conclude that COVID-19 infection led to the development of MIS-C in our case, not the COVID-19 vaccine. MIS-C symptoms were also noted to be less severe after the COVID-19 vaccine than in the unvaccinated patients.

A Rare Case of Acute Cholecystitis Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) in an Immunocompetent Person in the Absence of Bacteremia or Pre-Existing Conditions.

Acute cholecystitis, typically caused by gallstone obstruction of the cystic duct, is often complicated by infection. Mostly observed in immunocompromised patients with bacteremia Methicillin-resistant Staphylococcus aureus (MRSA) is not typically associated with this ailment. Here, we present a unique case of acute cholecystitis caused by MRSA in an immunocompetent patient without bacteremia or underlying disease. A male patient aged 59 years was admitted complaining of severe abdominal pain and nausea. Subsequent investigation confirmed acute calculous cholecystitis and thereafter, the patient underwent laparoscopic cholecystectomy. Gallbladder fluid culture indicated elevated quantities of MRSA growths, and suitable antimicrobial therapy was given as part of the treatment process. This exceptional case underlines the significance of recognizing MRSA as a potential pathogen in severe acute cholecystitis cases, particularly those with severe symptoms. Rapid identification and usage of anti-MRSA antibiotics play a crucial role in managing MRSA-related situations. Healthcare providers need to bear in mind the possibility of cholecystitis associated with MRSA particularly when conventional risk factors are not present. Timely intervention is essential for favorable patient outcomes.

A rare case of eczema herpeticum associated with HIV: A case report.

Eczema herpeticum (EH), also known as Kaposi's varicelliform eruption, is a disseminated herpes simplex virus infection seen in patients with underlying skin conditions, most commonly atopic dermatitis. Monomorphic vesicles and "punched-out" erosions with hemorrhagic crusts over eczematous regions are the hallmarks of EH's presentation. Here, we discuss a first reported case of eczema herpeticum in a patient living with well controlled HIV with prior steroid use. A 30-year-old male patient living with HIV presented to the hospital with a generalized rash involving the face, neck, arms, hands, low back region, and both feet. Herpes simplex 1 and 2 by PCR DNA were detected from external auditory ear canal drainage. The patient was treated with intravenous acyclovir and responded well. He had long term history of eczema and required acyclovir prophylaxis later.

A Case of Deep Vein Thrombosis After Recovery From COVID-19 and Its Association With Elevated D-dimers.

The coronavirus disease 2019 (COVID-19) continues to be a devastating disease for the elderly population, especially in long-term care facilities, and it presents with varying clinical presentations. We have ample evidence that COVID-19 can predispose to deep vein thrombosis (DVT) and pulmonary embolism (PE) during an active infection. Still, very few cases of DVT have been reported after recovery from COVID-19. The imbalance of the coagulation cascade and the increased release of certain coagulation factors play an essential role in promoting hypercoagulability and vascular endothelial dysfunction. It leads to a rise in the level of fibrin degradation products, D-dimers, which can remain elevated for up to several weeks, even after recovery. It has been suggested that the risk of DVT occurring after recovering from COVID-19 remains high for up to three months. We report a case of a 77-year-old long-term care female resident at a nursing facility, ambulatory at baseline, who was noted to be COVID-19 positive upon routine facility-wide testing per department of health guidelines. She was asymptomatic during her 10-day quarantine period. D-dimer levels during routine labs were high (initial D-dimer level of 1.87 mg/L FEU {normal value: 0.19-0.52 mg/L FEU}), but the patient had no clinical signs and symptoms of DVT. Ultrasound of the bilateral legs was not performed due to low clinical suspicion. The patient received an enoxaparin DVT prophylaxis dose during the quarantine period. Follow-up D-dimer levels were done at frequent intervals after recovery, but D-dimer levels continued to remain elevated up till six weeks after her 10-day quarantine period ended. Based on previous experience with other long-term care residents who suffered from COVID-19, bilateral lower extremity ultrasound was performed, which showed bilateral DVT. Elevated D-dimer levels are a predictor of hypercoagulation complications in COVID-19. Patients with persistently elevated D-dimer levels after recovery from COVID-19 should be screened for thromboembolic complications, even if they are asymptomatic. DVT can occur up to three months post-recovery from COVID-19 infection.

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants.

For the primary prevention of coronavirus disease 2019 (COVID-19), there are currently four different vaccines available in the USA. These are Pfizer (messenger RNA [mRNA]), Moderna (mRNA), Novavax (recombinant protein), and Jansen/Johnson & Johnson (adenoviral vector). All individuals should get vaccinated, and the Centers for Disease Control and Prevention (CDC) has provided comprehensive guidelines on recommended doses, their frequency by age group, and vaccine types, all discussed in detail in this article. Vaccines are a critical and cost-effective tool for preventing the disease. Prior to receiving a vaccine, patients should get adequate counseling regarding any potential adverse effects post vaccination. Appropriate safety precautions must be taken for those more likely to experience adverse consequences. Healthcare professionals should be aware of the symptoms, indicators, and treatment of any adverse event post-vaccination. We have provided a comprehensive review of the different characteristics of COVID-19 vaccines available in the United States, including their effectiveness against various variants, adverse effects, and precautions necessary for healthcare professionals and the general population. This article also briefly covers COVID-19 vaccines available worldwide, specifically their mode of action and effectiveness.

Uncommon Side Effects of COVID-19 Vaccination in the Pediatric Population.

Introduction The rapid development of vaccines followed the Coronavirus disease 2019 (COVID-19) pandemic. There is still significant vaccine hesitancy, especially among parents. Large-scale pediatric population-based studies or reviews about vaccine side effects are limited. Data sources and methods The Centers for Disease Control and Prevention (CDC) recommends recipients or their providers notify possible adverse events to the Vaccine Adverse Event Reporting System (VAERS). We evaluated Delaware state data from the VAERS system for the pediatric age group. Results A total of 111 reports were reviewed, with summaries of the reported key side effects discussed, including seizures, myocarditis, stroke, multisystem inflammatory syndrome in children (MIS-C), chest pain, hematuria, menstrual disorder, appendicitis, behavioral and otological side effects, etc. Conclusions We noted the approximate prevalence of reported adverse events to be <0.2%. Further studies with larger sample sizes or those focused on each key side effect are needed to evaluate these side effects in detail. An open discussion about the possible side effects and reinforcing the individual, family, and community benefits are key to promoting COVID-19 vaccine acceptance.

COVID-19 Encephalopathy: Delayed Onset in Unvaccinated Patients.

COVID-19 infections have a broad spectrum of severity, with more severe symptoms observed in elderly patients, patients with underlying comorbidities, and patients with unvaccinated status. This case series aims to highlight two cases of unvaccinated patients who developed COVID-19 encephalopathy, contrasted with a vaccinated patient with similar risk factors. This article highlights the unique characteristics of COVID-19 encephalopathy to guide clinicians while approaching the broad diagnosis of acute encephalopathy or altered mental state in hospitalized patients. Current literature was reviewed and summarized the information available regarding encephalopathy separate from the more complex encephalitis and encephalomyelitis.

Monkeypox - An emerging pandemic.

Monkeypox-a zoonotic disease caused by the monkeypox virus, an orthopoxviruses family member. Recently monkeypox cases are increasing at an alarming rate in the US and worldwide. Health care professionals should keep a high index of suspicion for the disease in anyone with new onset fever, a vesicular or pustular rash with central umbilication, and lymphadenopathy. Such patients should be isolated at home or the hospital to prevent secondary transmission. The cases are typically self-limited, and most people only need home supportive care. However, as recommended by CDC, immunocompromised patients, pregnant patients, and children younger than eight years should be offered pre- or post-exposure prophylaxis with vaccines. The current outbreak explicitly targets a cohort of homosexual and gay patients. The role of sexual transmission of the virus needs to be explored further. Patients with severe symptoms or respiratory complications can also be treated with antivirals such as tecovirimat (TPOXX) and brincidofovir or with intravenous vaccinia immune globulin (VIGIV).

Prevention and Treatment of Monkeypox: A Step-by-Step Guide for Healthcare Professionals and General Population.

The World Health Organization (WHO) recently declared the monkeypox virus a Public Health Emergency of International Concern (PHEIC). As the cases of the COVID-19 pandemic start to get under control, we have seen the monkeypox virus, found predominantly in Africa, spread in non-endemic countries worldwide. In the 1970s, after the smallpox virus eradication and the vaccine's discontinuation, the monkeypox virus infection started to gain attention. The first United States outbreak happened in 2003; since then, more sporadic cases of monkeypox have gained media attention. With cases spreading worldwide, without epidemiological links with outbreaks among men who have sex with men (MSM), it warrants urgent public health control measures to contain the spread of the monkeypox virus and investigate the underlying pathophysiology, including genetic modification of the virus. This review highlights the epidemiology, transmission, pathogenesis, clinical manifestation, diagnosis, prevention, and management of the current human monkeypox virus infection.

Novel Presentation of Parechovirus Encephalitis in Children: Two Unique Cases.

Human Parechovirus encephalitis is an uncommon infection. Very few of the cases have been reported in the literature so far. These reports are mainly about neonatal encephalitis, primarily affecting preterm neonates. Parechovirus encephalitis in otherwise healthy pediatric populations is a rare entity. Here, we present two unique pediatric cases secondary to Parechovirus infection, one with hemidystonia and another with acute onset of altered mental status, confusion, and headache.

Small Bowel Obstruction and Appendicitis in Patient With Fitz-Hughes-Curtis Syndrome.

Fitz-Hughs-Curtis syndrome is a manifestation of pelvic inflammatory disease (PID) which begins with sexually transmitted organisms such as Chlamydia trachomatis (C. trachomatis) and, less commonly Neisseria gonorrhoeae. The infection is hypothesized to disseminate into the peritoneum via lymphatic, hematogenous, or ascending spread of the organisms. Progression of the disease can result in liver capsule inflammation (perihepatitis) and adhesion formation between organs. This case presentation illustrates a female who presented with symptomology consistent with small bowel obstruction (SBO) and acute appendicitis. The patient was incidentally found to have Fitz-Hugh-Curtis syndrome during laparoscopic surgery, as noted by adhesions on peritoneal organs. These findings prompted a sexually transmitted infection (STI) screening which confirmed a C. trachomatis infection, completing the clinical picture for Fitz-Hugh-Curtis syndrome. This case report highlights the need for an increased index of suspicion for Fitz-Hugh-Curtis syndrome in a young female who presents with right upper quadrant (RUQ) pain in order to prevent future complications of PID, including infertility.

Possible COVID-19 Maternal-to-Neonate Vertical Transmission in a Case of Early Neonatal Infection.

Coronavirus disease 2019 (COVID-19) is a disease caused by a novel strain of coronavirus and has resulted in a global pandemic. Information regarding the COVID-19 pathophysiology and its long-term impacts on humans is yet to be found. The knowledge about the COVID -19 infection's effects on the fetus is limited. The maternal to fetal transmission during various trimesters is not adequately studied. We present a case concerning maternal-to-fetal vertical transmission focusing on congenital infection.

Parainfluenza Bronchiolitis Mimicking Recurrent Lobar Pneumonia.

Human parainfluenza viruses (HPIVs) are the second most common cause of hospitalization in children, causing upper respiratory tract illness (URTI) and lower respiratory tract illness (LRTIs) in infants and young children. Common presentations include common cold, laryngotracheobronchitis (croup), bronchitis, and pneumonia. In immunocompetent adults, their effect is usually limited to mild upper respiratory tract illness with spontaneous recovery. However, elderly and immunocompromised adults are at risk for severe infection manifesting as epiglottitis, bronchiolitis, pneumonia, and on rare occasions, acute respiratory distress syndrome (ARDS). We describe a case of a 73-year-old female who developed recurrent respiratory distress and acute hypoxemic respiratory failure and was treated for bacterial pneumonia but was eventually diagnosed with severe parainfluenza bronchitis, causing mucus plug obstruction and lobar lung collapse.

A Review of National Level Guidelines for Risk Management of Cardiovascular and Diabetic Disease.

Cardiovascular diseases and diabetes are among the leading preventable causes of morbidity and mortality. Cardiovascular disease risk reduction aimed to address the significant modifiable risk factors, including lifestyle-related risk factors, hypertension, hyperlipidemia, and diabetes. Given the severity and disease burden, many insurances, including Medicare, cover the annual counseling for risk reduction of cardiovascular disease. Although numerous national-level guidelines are available for managing these conditions, most of them focus on disease management. Given the broad areas covered in these recommendations, a concise review summarizing the measures addressing the preventive approach in these conditions is not readily available. Herewith, we review and outline the currently available guidelines from national-level publications with principal attention to the primary prevention measures to provide a broad overview and assist providers with the risk reduction counseling.

Ivermectin-Induced Acute Psychosis in Patients Infected With COVID-19 Pneumonia.

Coronavirus disease 2019 (COVID-19) pneumonia is an infection of the lungs that causes severe inflammation in the lungs' alveoli. It causes alveoli to fill with fluid, blood clots, and sometimes even pus. Patients who are infected with COVID-19 pneumonia experience severe cough, shortness of breath, fever, fatigue, chest pain, night sweats, chills, loss of appetite, etc. During the initial phase of the COVID-19 pneumonia pandemic, it was thought that ivermectin might be helpful in patients infected with COVID-19 pneumonia, but this was later proven to be false due to its severe risks/side effects. Infectious Disease Society of America (IDSA) suggests against the use of ivermectin for COVID-19 pneumonia. However, some providers continue to use ivermectin as one of the treatments for patients infected with COVID-19 infection. In this case report, we will discuss ivermectin causing acute psychosis in healthy 45- and 51-year-old patients with no known history of any mental health illness.