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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Unusual Presentation of Kawasaki Disease MESHD with Multisystem Inflammation MESHD and Antibodies SERO Against Severe Acute Respiratory Syndrome MESHD Coronavirus 2: A Case Report

    Authors: Haena Kim; Jung Yeon Shim; Jae-Hoon Ko; Aram Yang; Jae Won Shim; Deok Soo Kim; Hye Lim Jung; Ji Hee Kwak; In Suk Sol

    doi:10.21203/rs.3.rs-41276/v1 Date: 2020-07-12 Source: ResearchSquare

    Background: Since mid-April 2020, cases of multisystem inflammatory syndrome MESHD in children TRANS (MIS-C) associated with coronavirus disease MESHD (COVID-19) that mimic Kawasaki disease MESHD ( KD MESHD) have been reported in Europe and North America. However, no cases have been in East Asia, where KD MESHD is more prevalent.Case presentation: A previously healthy 11-year-old boy was admitted with a 4-day history of fever HP fever MESHD and abdominal pain HP abdominal pain MESHD. He had no contact history to any patient with COVID-19. Blood SERO acute inflammatory markers were highly elevated. He was treated with antibiotics for suspected bacterial enteritis MESHD, but he suddenly developed hypotension HP hypotension MESHD. Inotropics and intravenous immunoglobulin were administered to manage septic shock MESHD shock HP. On hospitalization day 6, he developed signs and symptoms of KD MESHD (conjunctival injection, strawberry tongue HP, cracked lip MESHD, and coronary artery dilatation MESHD dilatation HP) in addition to pleural/pericardial effusion MESHD pericardial effusion HP and mesenteric lymphadenitis HP lymphadenitis MESHD. The results of microbiologic tests, including reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), were negative. Fluorescent immunoassay SERO and enzyme-linked immunosorbent assay SERO revealed abundant IgG antibodies SERO against SARS-CoV-2 in his serum SERO, but no IgM antibodies SERO. He was discharged successfully on day 13.Conclusion: MIS-C may occur in children TRANS with a previously asymptomatic TRANS COVID-19 infection MESHD. A high index of suspicion is required for this novel syndrome in unusual cases of KD MESHD or KD shock syndrome MESHD shock HP syndrome with multisystem inflammation MESHD, even when there is no clear history of contact or symptoms of COVID-19.

    Life-threatening cardiogenic shock HP cardiogenic shock MESHD in a pediatric patient with SARS-CoV-2-associated myocarditis HP myocarditis MESHD treated with remdesivir: a case description and report of similar cases from the Literature

    Authors: Silvia Molinari; Lucia M.D. Colasanto; Maria L. Melzi; Alessandro Cattoni; Roberto Panceri; Michela Bombino; Giuseppe Lapadula; Andrea Biondi

    doi:10.21203/rs.3.rs-34802/v1 Date: 2020-06-12 Source: ResearchSquare

    BackgroundChildren are relatively spared from Coronavirus disease MESHD 2019 (COVID-19), but some severe cases have been reported. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD in children TRANS may affect the cardiovascular system. We hereby report about a case of myocarditis HP myocarditis MESHD evolving to cardiogenic shock HP cardiogenic shock MESHD in a SARS-CoV-2 positive child TRANS.Case presentationAn otherwise healthy 12-year-old patient was admitted with fever HP fever MESHD, vomiting HP vomiting MESHD, diarrhoea and drowsiness MESHD drowsiness HP, without any respiratory symptoms. He was diagnosed with COVID-19 on nasopharyngeal swab. He developed hypotension HP hypotension MESHD and cardiogenic shock HP cardiogenic shock MESHD. Bedside echocardiography revealed left ventricular impairment MESHD with an ejection fraction (LVEF) below 25%. Plasmatic markers of myocardial injury MESHD were remarkably raised, as well as inflammatory biomarkers, including procalcitonin (highest recorded value: 66 ng/mL) and interleukin-6 (8209 pg/mL). The child TRANS was transferred to Intensive Care Unit and he was treated with catecholamine support, mechanical ventilation and empiric anti-infectious therapy, including broad spectrum antibiotics and the antiviral agent remdesivir. All additional microbiological investigations yielded negative results. We observed a gradual improvement of LVEF within 5 days. A cardiac magnetic resonance confirmed the suspicion of myocarditis HP myocarditis MESHD. After 21 days of hospitalisation, the child TRANS was discharged without sequelae.ConclusionsOur hypothesis is that the child TRANS suffered from SARS-CoV-2-induced fulminant myocarditis HP myocarditis MESHD, probably in the setting of cytokine release syndrome (CRS). The peculiarity of this SARS-CoV-2 infection MESHD is the presence of cardiac failure MESHD in a previously healthy child TRANS without a respiratory illness MESHD. The positive outcome is in line with published Literature about the overall better prognosis of COVID-19 children TRANS compared to adults TRANS. Remdesivir, an investigational antiviral therapy, may have played a role on the clinical improvement of the child TRANS.

    Early prediction for severe COVID-19 with  hypertension MESHD and intervention

    Authors: Denggao Peng; Yanzhang Gao; Zhenyu Zhou; Huan Wang; Anjue Tang

    doi:10.21203/rs.3.rs-31888/v1 Date: 2020-05-28 Source: ResearchSquare

    Background To identify the early predictors of severe coronavirus disease MESHD 2019 (COVID-19) with hypertension HP hypertension MESHD,explore antihypertensive drugs with potential therapeutic effects, and provide a basis for clinical prediction and treatment decisions.Method: A retrospective study was performed on all included cases.Results A total of 68 COVID-19 patients with hypertension HP hypertension MESHD were included,27 (39.7%) was severe and 41 (60.3%) was non-severe. Between the non-severe group (n = 41) and the severe group (n = 27),number of elevated B-type natriuretic peptide (BNP) and abnormal renal function MESHD,and albumin,lactate dehydrogenase,ultrasensitive troponin I,PH Value,arterial carbon dioxide partial pressure,sodium,osmotic pressure (OP), blood SERO sugar (BS) and oxygenation index (OI) are significantly different.While age TRANS, male TRANS gender TRANS,comorbidities with diabetes MESHD or atherosclerotic cardiovascular disease MESHD,smoking history,number of abnormal liver function MESHD,heart rate,respiratory rate, blood SERO pressure,white blood SERO cell count,hematocrit,potassium and lactic acid are statistically insignificant.Four independent predictors of BNP (P = .026),OP (P = .004),BS (P = .017) and OI (P = .001) are obtained through multivariate binary logistic regression model.The area under curve (AUC) of receiver operating characteristic (ROC) of model is 0.904 ([95%CI] [0.832–0.976];P = .000),with excellent performance SERO.Compared with blank control group (n = 27) and other antihypertensive drugs group (n = 20),OP ([287.3 ± 5.7] vs [283.5 ± 6.1];P = .045) ([287.3 ± 5.7] vs [281.9 ± 5.4];P = .007) in renin-angiotensin-aldosterone system (RAS) inhibitors group (n = 21) have increased significantly.Compared with controlled blood SERO pressure group (n = 30),OP ([285.7 ± 6.2] vs [282.2 ± 5.2];P = .012) of uncontrolled group (n = 38) increased significantly.Conclusion Decreased OP MESHD and OI, increased BNP and BS are early predictors for severe COVID-19 patients with hypertension HP hypertension MESHD.For poorly controlled blood SERO pressure,targeting RAS MESHD and OP,early use of RAS inhibitors or combination with loop diuretics may be an effective treatment.

    An insertion unique to SARS-CoV-2 exhibits superantigenic character strengthened by recent mutations

    Authors: Mary Hongying Cheng; She Zhang; Rebecca A. Porritt; Moshe Arditi; Ivet Bahar

    doi:10.1101/2020.05.21.109272 Date: 2020-05-21 Source: bioRxiv

    Multisystem Inflammatory Syndrome in Children TRANS (MIS-C) associated with Coronavirus Disease MESHD 2019 (COVID-19) is a newly recognized condition in which children TRANS with recent SARS-CoV-2 infection MESHD present with a constellation of symptoms including hypotension HP hypotension MESHD, multiorgan involvement, and elevated inflammatory markers. These symptoms and the associated laboratory values strongly resemble toxic shock syndrome MESHD shock HP syndrome, an escalation of the cytotoxic adaptive immune response triggered upon the binding of pathogenic superantigens to MHCII molecules and T cell receptors (TCRs). Here, we used structure-based computational models to demonstrate that the SARS-CoV-2 spike (S) exhibits a high-affinity motif for binding TCR, interacting closely with both the - and {beta}-chains variable domains complementarity-determining regions. The binding epitope on S harbors a sequence motif unique to SARS-CoV-2 (not present in any other SARS coronavirus), which is highly similar in both sequence and structure to bacterial superantigens. Further examination revealed that this interaction between the virus and human T cells is strengthened in the context of a recently reported rare mutation (D839Y/N/E) from a European strain of SARS-CoV-2. Furthermore, the interfacial region includes selected residues from a motif shared between the SARS viruses from the 2003 and 2019 pandemics, which has intracellular adhesion molecule (ICAM)-like character. These data suggest that the SARS-CoV-2 S may act as a superantigen to drive the development of MIS-C as well as cytokine storm in adult TRANS COVID-19 patients, with important implications for the development of therapeutic approaches. SignificanceAlthough children TRANS have been largely spared from severe COVID-19 disease, a rare hyperinflammatory syndrome has been described in Europe and the East Coast of the United States, termed Multisystem Inflammatory Syndrome in Children TRANS (MISC). The symptoms and diagnostic lab values of MIS-C resemble those of toxic shock HP, typically caused by pathogenic superantigens stimulating excessive activation of the adaptive immune system. We show that SARS-CoV-2 spike has a sequence and structure motif highly similar to those of bacterial superantigens, and may directly bind to the T cell receptors. This sequence motif, not present in other coronaviruses, may explain the unique potential for SARS-CoV-2 to cause both MIS-C and the cytokine storm observed in adult TRANS COVID-19 patients.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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