Manifestations Of COVID-19 Disease Research Articles

Children and young adults hospitalized for severe COVID-19 exhibit thrombotic coagulopathy.

We report the clinical and laboratory coagulation characteristics of 27 pediatric and young adult patients (2 months to 21 years) treated for symptomatic COVID‐19 at a children's hospital in the Bronx, New York, between March 1 and May 31, 2020. D‐Dimer was > 0.5 μg/mL (upper limit of normal) in 25 (93%) patients at admission; 11 (41%) developed peak D‐dimer > 5 μg/mL during admission. Seven (26%) patients developed venous thromboembolism: three with deep vein thrombosis and four with pulmonary embolism. Requirement of increased ventilatory support was a risk factor for thrombosis (P = 0.006). Three of eight (38%) patients on prophylactic anticoagulation developed thrombosis; however, no patients developed VTE on low‐molecular‐weight heparin prophylaxis titrated to anti‐Xa level. Manifestation of COVID‐19 disease was severe or critical in 16 (59%) patients. Four (15%) patients died of COVID‐19 complications: all had comorbidities. Elevated D‐dimer and increased VTE rate were observed in this young cohort, particularly in those with severe respiratory complications, suggesting thrombotic coagulopathy. More data are needed to guide thromboprophylaxis in this age group.

Neurologic Manifestations of COVID-19 Disease in Children and Adults

SARS-CoV-2 has kept the world on tenterhooks for half a year. In this short time, millions of data and clinical findings have been collected, the amount of which astonishes even the scientific community. But the majority of them concern adult patients. Knowledge about the clinical course, complications and therapy of COVID-19 in children and adolescents, on the other hand, has been limited to date [2]. And the data that have been collected internationally illustrate once again that "children are not small adults." This is because the incidence of infection in this age group appears to differ, in some cases markedly, from that of elderly and senior patients.

Retinal manifestations of COVID-19 disease - A review of available information

Ocular signs and symptoms have been reported in COVID-19 patients, and there is a surge of information about corneal, uveal, retinal, and neuro-ophthalmological involvement in COVID-19 infection. This review attempts to determine from various researches published during the time of the pandemic, the retinal manifestations of COVID-19 infection, and its significance and correlation to severity of systemic disease. An extensive search strategy was employed using keywords “novel corona virus”, “COVID-19”, “SARS CoV2,” or “retina,” either singly or variably combined, to retrieve the articles of retinal manifestations of COVID-19 published from January 2020 till date. Retinal manifestations are ubiquitous and include microangiopathy, occlusive vascular conditions, alterations in vascular caliber, and capillary density, among others. They seem to correlate with disease severity and reflect on similar changes in other parts of the body as well. Newer studies are bringing out more and more evidence of hitherto unknown retinal manifestations of COVID-19 disease.

Diabetic Ketoacidosis and COVID-19: Two Case Reports

Background: COVID-19 is a viral infection that causes pneumonia with dyspnea, cough, and fever. Its outcomes are more severe in patients with diabetes, hypertension, and other disorders than in healthy people. New-onset diabetes and diabetic ketoacidosis (DKA) have been reported as the complications of COVID-19 in several studies. It seems that the prevalence of DKA due to Covid-19 is increasing. Therefore, two cases of individuals with DKA due to COVID-19 are presented in this study to inform other researchers about the details of this phenomenon. Material and Methods: Demographic characteristics, medical histories, physical examinations, laboratory investigations, real-time RT-PCR tests, computed tomography (CT) imaging studies, given treatments, clinical courses, and management outcomes were documented prospectively. Results: In the present experience, the manifestation of COVID-19 disease in the second case with a history of diabetes was more severe than in the first case. In the second case, with underlying diabetes and COVID-19, the DKA manifestation was associated with consciousness loss, severe restlessness, and respiratory distress;however, in the first case, with COVID-19 without diabetes, the DKA manifestation was associated with anorexia, weight loss, and lack of respiratory distress, which were milder symptoms than the second case. Conclusion: Due to the high prevalence of diabetes mellitus and COVID-19 in Iran, it is recommended to raise awareness of DKA symptoms among health professionals. © The Author(s) 2021;All rights reserved. Published by Rafsanjan University of Medical Sciences Press.

Dermatological Manifestations Associated with COVID-19 Infection.

The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) causing the 2019 coronavirus disease (COVID-19) has infected millions in recent years and is a major public health concern. Various cutaneous manifestations of the COVID-19 disease have been identified. Skin is a mirror to internal disease and can be the presenting sign of COVID-19 disease. Several cutaneous manifestations can indicate severe COVID-19 disease. In the present scenario, physicians should know the various cutaneous manifestations of COVID-19 disease for early diagnosis and proper management of the disease.

An Observational Study of Mucocutaneous Manifestations among SARS-CoV-2 Patients from Three COVID-19 Dedicated Tertiary Care Centers.

Introduction:Ever since the outbreak of COVID-19, the respiratory system has been the chief focus of researches, however, understanding the impact of this disease on the integumentary system is just as essential.Objectives:We aimed at collecting data on any cutaneous manifestation arising in patients with active and recovering COVID-19 infection, or a direct consequence of the infection's treatment, and correlating these findings with systemic disease severity and duration.Materials and Methods:A prospective observational study was conducted in three tertiary care centers from Rajasthan, India, to acquire data of laboratory-confirmed cases of COVID-19 presenting with any mucocutaneous manifestation.Results:Eight predominant patterns of dermatological involvement were seen, namely, maculopapular (14.59%), urticarial (13.17%), perniotic (12.1%), pityriasis rosea (11.74%), acral erythema/edema (10.3%), petechial (4.63%), vesicular (2.49%), and livedo (1.78%). Rare findings included eruptive pseudoangioma, eruptive hypomelanosis, alopecia parvimaculata, geographic tongue, chikungunya-like hyperpigmentation, and nail changes. On correlating these findings with the gradient of the disease, livedo, vasculitis, exfoliation, and erythroderma were associated with severe disease, whereas perniosis and eruptive pseudoangioma were seen in mild illness.Conclusion:We reported a few previously unpublished skin manifestations of COVID-19, namely, geographic tongue, chikungunya-like pigmentation, eruptive hypomelanosis, and alopecia parvimaculata. This study provides a visual description of the muco-cutaneous manifestations of COVID-19 disease which could aid a dermatologist or physician in early diagnosis of this novel infection, especially in a resource-poor setting.

COVID‐19, microthromboses, inflammation, and platelet activating factor

Recent articles report elevated markers of coagulation, endothelial injury, and microthromboses in lungs from deceased COVID-19 patients. However, there has been no discussion of what may induce intravascular coagulation. Platelets are critical in the formation of thrombi and their most potent trigger is platelet activating factor (PAF), first characterized by Demopoulos and colleagues in 1979. PAF is produced by cells involved in host defense and its biological actions bear similarities with COVID-19 disease manifestations. PAF can also stimulate perivascular mast cell activation, leading to inflammation implicated in severe acute respiratory syndrome (SARS). Mast cells are plentiful in the lungs and are a rich source of PAF and of inflammatory cytokines, such as IL-1β and IL-6, which may contribute to COVID-19 and especially SARS. The histamine-1 receptor antagonist rupatadine was developed to have anti-PAF activity, and also inhibits activation of human mast cells in response to PAF. Rupatadine could be repurposed for COVID-19 prophylaxis alone or together with other PAF-inhibitors of natural origin such as the flavonoids quercetin and luteolin, which have antiviral, anti-inflammatory, and anti-PAF actions.

Clinically Improvement in a Case of COVID-19 with Gastrointestinal Manifestations through Using Natural Therapy based on Persian Medicine: A Case Report

In addition to respiratory symptoms as the most common manifestations of COVID-19, GI tract symptoms may occur in some patients, as well. These symptoms could be disabling and annoying and supportive treatments are required to control them. Some natural remedies based on Persian medicine could be effective to fast control of GI manifestations of COVID-19 disease through Food modification and using some medicinal plants and Life style correction. This paper reports a case of COVID-19 patient with GI complications which has been treated by using Persian Medicine recommendations.

FATAL INTRACEREBRAL HEMORRHAGE IN A PATIENT WITH SEVERE COVID-19 INFECTION

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Stroke like lesions has been documented in COVID-19 patients. Although the exact stroke-incidence is unknown, it was reported to be around 5 % in a hospitalized cohort in Wuhan and 1.1 % in a study in New York City. CASE PRESENTATION: A 73-year-old male with a past medical history of hypertension and hyperlipidemia presents to ER with fever, cough, myalgia, increasing shortness of breath, and confusion for one day. His daughter is known COVID-19 positive. The patient was noted to be febrile, tachypneic, and hypoxic to 90% at room air. Chest X-ray showed bilateral infiltrates and the COVID-19 test was positive. The patient was immediately intubated due to his significant acute respiratory distress. Inflammatory markers were significantly elevated: Troponin T: 5.86, Lactate dehydrogenase: 542, CRP: 350 mg/l, Ferritin: 1878, D-dimer: >20, fibrinogen: 1094, Total Creatinine kinase: 2260 and creatinine: 5.7. His course was complicated by septic shock requiring three vasopressors; acute kidney injury requiring hemodialysis; Enterococcus Faecalis bacteremia treated with Ampicillin, and Klebsiella pneumonia sensitive to ceftriaxone. EKGs showed new onset of atrial fibrillation without ST changes. Echocardiogram showed normal ejection fraction without wall motion abnormalities. His significant troponin elevation was likely due to myonecrosis related to COVID-19 infection and he was started on heparin drip. The patient respiratory status continued to improve however he remained obtunded. Head CT showed acute right frontal hemorrhage and focal hyperdense foci in the left frontal lobe and basal ganglia. Brain MRI showed a 2.8 x 2.4 cm lesion situated in the right sub-frontal region with appearances of abscess versus necrotic tissue and extensive bilateral scattered deep white matter infarcts. Neurosurgery didn’t recommend any intervention due to poor prognosis. After 27 days of intubation, the family requested comfort measures, and the patient was terminally extubated. DISCUSSION: ‘Sepsis-induced coagulopathy’ is one of the hallmarks of severe COVID-19, usually manifests as a high D-dimer and elevated fibrinogen. It induces a systemic inflammatory response with endothelial dysfunction and microthrombosis predisposing to acute strokes. The risk of developing a cerebrovascular disease is multifactorial and includes cardiovascular risk factors, old age, and severe COVID-19 disease manifestations with sings of hypercoagulability. In this case, the stroke like-lesions could be related to septic emboli with the conversation to hemorrhage due to heparin use in the setting of severe COVID-19 infection. CONCLUSIONS: Ischemic and hemorrhagic stroke has been reported as a complication of severe COVID-19 infection. The definite mechanism is unknown, but these findings can indicate poor prognosis with potential neurological sequelae and increased mortality. Reference #1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202903/ Reference #2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236667/ Reference #3: https://jamanetwork.com/journals/jamaneurology/fullarticle/2766766 DISCLOSURES: No relevant relationships by Karim Anis, source=Web Response No relevant relationships by Anastasia Maltseva, source=Web Response No relevant relationships by Lady Sanchez Fernandez, source=Web Response

COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series

IntroductionCovid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic.MethodThis observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test.ResultsA significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to “Italian general population” (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various “connective tissue diseases” compared to “inflammatory arthritis group” (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011).ConclusionsThe finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases.Key Points• Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients’ increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement.• The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing.• Patients with “connective tissue diseases” show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to “inflammatory arthritis group”.• Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19.

Coronavirus 2019, Microthromboses, and Platelet Activating Factor

Recent articles have reported elevated markers of coagulation, endothelial injury, and microthromboses in lungs from deceased patients with coronavirus 2019 (COVID-19). Platelets are critical in the formation of thrombi, and their most potent trigger is platelet activating factor (PAF). PAF is produced by cells involved in host defense, and its biological actions bear similarities with COVID-19 disease manifestations, including pulmonary microthromboses and inflammation, possibly via activation of mast cells. The histamine1 receptor antagonist rupatadine was developed to have anti-PAF activity and inhibits activation of human mast cells in response to PAF. Rupatadine could be repurposed for COVID-19 prophylaxis.

Cutaneous manifestations in hospitalized patients diagnosed as COVID ‐19

Cutaneous manifestations of COVID‐19 disease have not yet been fully described. To describe cutaneous manifestations of COVID‐19 disease in hospitalized patients. We examined the cutaneous manifestations of 210 hospitalized patients. Cutaneous findings were observed during COVID‐19 infection in 52 of the patients. Lesions may be classified as erythematous scaly rash (32.7%), maculopapular rash (23%), urticarial lesions (13.5%), petechial purpuric rash (7.7%), necrosis (7.7%), enanthema and apthous stomatitis (5.8%), vesicular rash (5.8%), pernio (1.9%), and pruritus (1.9%). Cutaneous manifestations were observed statistically significantly more in certain age groups: patients of 55 to 64 and 65 to 74 years of age complained of more cutaneous manifestations than the other age groups. As for gender, there was no significant difference between male and female patients in terms of cutaneus findings. The relationship between comorbidity and dermatological finding status was statistically significant. The relationship increases linearly according to the comorbidities. According to the statistical results, the patients who were hospitalized in the intensive care unit had a higher risk of having cutaneous findings due to COVID‐19 infection. With this study, we may highlight the importance of overlooked dermatological findings in patients that are hospitalized.

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.

SummaryBackgroundThe cutaneous manifestations of COVID‐19 disease are poorly characterized.ObjectivesTo describe the cutaneous manifestations of COVID‐19 disease and to relate them to other clinical findings.MethodsWe carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis.ResultsThe lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo‐chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID‐19. The severity of COVID‐19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo‐chilblain and vesicular).ConclusionsWe provide a description of the cutaneous manifestations associated with COVID‐19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID‐19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID‐19, using a consensus method to define morphological patterns associated with COVID‐19.We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition. Linked Editorial: Hay et al. Br J Dermatol 2020; 183:3–4.

Radiological manifestations of COVID-19: key points for the physician.

The emergence of the SARS-CoV-2 virus at the end of 2019 has led to unprecedented demand on healthcare systems around the world. Healthcare workers, including doctors, have found themselves having to work in unfamiliar environments in the effort to control this pandemic. This article gives the hospital physician an overview of the radiological manifestations of COVID-19 disease, to improve knowledge and increase familiarity when reviewing radiographic images.

COVID-19 in children: a case series from Nigeria

IntroductionThe global spread of COVID-19 remains unabated in the past few months with a rise in the number of available literature on the novel virus. There are very few paediatric studies and are mainly from developed countries with a paucity of information on the clinical manifestation of COVID-19 disease in African children, including Nigeria.MethodsWe described the clinical presentation, laboratory findings, treatment and outcome in a group of five Nigerian children managed at a COVID-19 isolation and treatment centre in Nigeria.ResultsWe managed a total of five children with an age range of 3 months to 8 years in the last four weeks (16th April to 15th May 2020). Three of the five children were males. All the children had close contact with family members that tested positive for COVID-19. Out of the five children, one had moderate disease, three had mild symptomatic disease, and one was asymptomatic. Two out of the five children had lymphocytosis. Out of the four children who had chest radiograph, two had features of pneumonia.ConclusionCOVID-19 is not uncommon in Nigerian children, and all had a confirmed family member with COVID-19. Besides, contrary to leucopaenia with lymphopaenia observed in the adult’s population, we found lymphocytosis in this cohort and about 50.0% had pneumonic changes on chest radiograph.

Ocular manifestations of COVID-19 disease

The highly contagious novel coronavirus 2019-nCoV is a new strain not previously identified in humans. Also known as coronavirus 2 (SARS-CoV-2), this virus causes a severe acute respiratory syndrome and has had widespread impact gaining pandemic status by the World Health Organization. There have been reports on the ocular manifestations of infection with this virus and this article provides a mini review of the published data.