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MeSH Disease

Human Phenotype

Transmission

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Seroprevalence
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    Acutely Altered Mental Status as the Main Clinical Presentation of Multiple Strokes MESHD Strokes HP in Critically Ill Patients With COVID-19.

    Authors: Carolina Díaz-Pérez; Carmen Ramos; Alberto López-Cruz; José Muñoz Olmedo; Jimena Lázaro González; Enrique de Vega-Ríos; Carmen González-Ávila; Carlos Hervás; Santiago Trillo; José Vivancos

    doi:10.21203/rs.3.rs-31769/v1 Date: 2020-05-26 Source: ResearchSquare

    Background and aims: Cerebral infarction MESHD in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes MESHD strokes HP.Methods:Clinical presentation and diagnostic work-up of the patients.Results:Two patients in their sixties were hospitalized with a bilateral pneumonia MESHD pneumonia HP COVID-19. They developed respiratory failure HP and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia MESHD lymphopenia HP and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia HP and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism MESHD pulmonary embolism HP. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (Case 1: affecting the left frontal and temporal lobes and both occipital lobes; Case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome MESHD were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes MESHD strokes HP.Conclusion:Acutely altered mental status might be the main manifestation of multiple brain infarctions MESHD in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.

    SARS-CoV-2 Infection MESHD Associated Hemophagocytic Lymphohistiocytosis MESHD: An autopsy series with clinical and laboratory correlation.

    Authors: Andrey Prilutskiy; Michael Kritselis; Artem Shevtsov; Ilyas Yambayev; Charitha Vadlamudi; Qing Zhao; Yachana Kataria; Shayna Sarosiek; Adam Lerner; John Mark Sloan; Karen Quillen; Eric Burks

    doi:10.1101/2020.05.07.20094888 Date: 2020-05-12 Source: medRxiv

    Background: A subset of COVID-19 patients exhibit clinical features of cytokine storm. However, clinicopathologic features diagnostic of hemophagocytic lymphohistiocytosis MESHD (HLH) have not been reported. Pathologic studies to date have largely focused on the pulmonary finding of diffuse alveolar damage (DAD). To this aim, we study the reticuloendothelial organs of four consecutive patients dying of COVID-19 and correlate with clinical and laboratory parameters to detect HLH. Methods: Autopsies restricted to chest and abdomen were performed on four patients who succumbed to COVID-19. Spleen, liver, and multiple pulmonary hilar/mediastinal lymph nodes were sampled in all cases. Bone marrow was obtained by rib squeeze in a subset of cases. Routine H&E staining as well as immunohistochemical staining for CD163 was performed to detect hemophagocytosis HP. Clinical and laboratory results from pre-mortem blood SERO samples were used to calculate H-scores. Findings: All four cases demonstrated DAD within the lungs. Three of the four cases had histologic evidence of hemophagocytosis HP within pulmonary hilar/mediastinal lymph nodes. One case showed hemophagocytosis HP in the spleen but none showed hemophagocytosis HP in liver or bone marrow. Lymphophagocytosis was the predominant form of hemophagocytosis HP observed. One patient showed diagnostic features of HLH with an H-score of 217 while a second patient was likely HLH with a partial H-score of 145 due to missing triglyceride level. Both patients exhibited high fever MESHD fever HP and early onset rise in serum SERO ferritin; however, neither bicytopenia, pancytopenia MESHD pancytopenia HP, nor hypofibrinogenemia HP were observed in either. The remaining two patients had H-scores of 131 and 96. Interpretation: This is the first report of SARS-CoV-2 associated HLH. Identification of HLH in a subset of patients with severe COVID-19 will inform clinical trials of therapeutic strategies.

The ZB MED preprint Viewer preVIEW includes all COVID-19 related preprints from medRxiv and bioRxiv, from ChemRxiv, from ResearchSquare, from arXiv and from Preprints.org and is updated on a daily basis (7am CET/CEST).

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MeSH Disease
Human Phenotype
Transmission
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