COVID-19 Publications

30

Jul, 2020

SARS-CoV-2 Infection in Febrile Neonates

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Abstract Most severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in pediatric patients are mild or asymptomatic. However, infants have emerged at higher risk of hospitalization and severe outcomes in pediatric coronavirus disease 2019 (COVID-19). We report a case series of 4 full-term neonates hospitalized with fever and found to have SARS-CoV-2 infection with a spectrum of illness severities. Two neonates required admission to the intensive care unit for respiratory insufficiency and end organ involvement. Half of the patients were found to have a coinfection. One neonate received antiviral therapy with remdesivir and is, to our knowledge, the youngest patient to receive this drug for COVID-19. All neonates had favorable outcomes.

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21

Jun, 2020

SARS‐CoV‐2 infection in two pediatric patients with immune cytopenias: A single institution experience during the pandemic

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In pediatrics, viral infections precede approximately 60% of cases of immune thrombocytopenia (ITP) and 15% of cases of autoimmune hemolytic anemia (AIHA). Here, we describe two previously healthy children, each diagnosed with an autoimmune cytopenia associated temporarily with SARS‐CoV‐2 viral infection, one with acute ITP and one with AIHA.

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7

Jun, 2020

Cardiac MRI of children with Multisystem Inflammatory Syndrome (MIS-C) associated with COVID-19: case series

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Abstract This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to COVID-19. Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis/conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. SARS-CoV-2 RT-PCR was negative on nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2-STIR sequences and native-T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor post-infectious myocarditis in children and adolescents with COVID-19.

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7

Jun, 2020

Fulminant COVID 19 related myocarditis in an infant

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A 2-year-old, otherwise healthy boy with a history of COVID-19-positive patient contact was hospitalized with nausea, vomiting, and poor oral intake. Physical examination was normal. Chest X-ray (CXR) demonstrated bilateral interstitial infiltration. Investigations including acute phase reactants were in the normal range. Multiplex PCR for viruses was negative and no bacterial infection was found. Real-time reverse transcription–polymerase chain reaction (RT–PCR) was negative for SARS-COV-2. He swiftly developed respiratory distress with filiform pulse, unmeasurable blood pressure, lethargy, and hepatomegaly on the second day, and was transferred to the paediatric intensive care unit, and promptly intubated. Acute phase reactants remained low with a 30 times elevated troponin T.

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7

Jun, 2020

Varying presentations of COVID-19 in young heart transplant recipients: a case series

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Background Immunosuppression is considered a risk factor for more severe clinical presentation of COVID-19. Limited data regarding clinical outcome exist in adults, whereas very little is known about the spectrum of the disease in pediatric heart transplant recipients.

Methods We retrospectively reviewed the charts of young heart transplant patients from our tertiary care center during the coronavirus pandemic in New York City and identified patients infected with SARS-CoV-2.

Results We present four cases with COVID-19 disease and elaborate on their presentation and clinical course.

Conclusions Although far from conclusive and limited by the small sample size and selection bias, these cases demonstrate mild and self-limited disease despite immunosuppressive therapy and various comorbidities that are expected to increase the severity of the clinical picture based on extrapolation from the adult experience with this novel disease.

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6

Jun, 2020

A case of an infant with SARS-CoV-2 hepatitis early after liver transplantation

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We present a case of a pediatric liver transplant recipient diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection four days after receiving a living donor liver allograft from her mother. The recipient was a 6-month-old with end-stage liver disease due to biliary atresia and failed Kasai. The infant had an uncomplicated implantation, excellent graft function and down-trending liver enzymes until developing fevers, diarrhea, and moderate respiratory distress requiring non-invasive respiratory support. SARS-CoV-2 testing (nasal swab Polymerase Chain Reaction) was positive on post-operative day (POD) 4. Liver enzymes peaked ~1000 U/L (5-fold higher than the previous day) on POD 6. Histology demonstrated a mixed picture of moderate acute hepatitis and classical elements of mild to moderate acute cellular rejection. Her hepatitis and respiratory symptoms improved coincident with completing treatment with hydroxychloroquine, reduced immunosuppression, and intravenous gamma globulin (IVIG).

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6

Jun, 2020

Infant with SARS-CoV-2 infection causing severe lung disease treated with Remdesivir

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We describe an ex-premature infant presenting with SARS-CoV-2 infection in the 5th week of life. Current reports indicate that acute symptomatic SARS-CoV-2 infection is relatively rare and much less severe than in adults. This case highlights that infection can be associated with life threatening pulmonary disease in young infants and that infection can follow a similar disease course to that described in adults. We provide first data on the use of the novel antiviral remdesivir in a young child and an innovative approach to expedited approval from a multidisciplinary clinical team and bioethics committee for compassionate access to the drug.

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6

Jun, 2020

A 3-month-old child with COVID-19: A case report.

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Introduction Coronavirus disease 2019 (COVID-19) is pandemic and is a medical issue. However, children account for a small portion of those with the disease, and there are few published reports of COVID-19 in children. The patient reported in this case report is the youngest case reported in Chengdu, China to date.

Patient concerns A 3-month-old male infant presented with cough and rhinorrhea.

Diagnosis Family members from Wuhan, the epicenter of the epidemic came to stay in the patient’s home 16 days before the onset of his disease, and his mother had been diagnosed with COVID-19. He was diagnosed with COVID-19 based on a history of exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), detected using reverse transcription polymerase chain reaction (RT-PCR).

Interventions The patient was admitted to hospital and treated symptomatically with oral medication.

Outcomes The patient recovered completely and was discharged after one month of hospitalization. He tested negative for SARS-CoV-2 using RT-PCR and a chest CT performed 4 weeks after admission showed marked improvement prior to discharge.

Conclusion Clinicians must be aware of the presentation of COVID-19 in children because it differs from that in adults.

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6

Jun, 2020

SARS‐CoV‐2 endothelial infection causes COVID‐19 chilblains: histopathological, immunohistochemical and ultraestructural study of 7 paediatric cases

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Background Chilblains (“COVID toes”) are being seen with increasing frequency in children and young adults during the COVID-19 pandemic. Detailed histopathological descriptions of COVID-19 chilblains have not been reported, and causality of SARS-CoV-2 has not been established yet.

Objective To describe histopathological features of Covid-19 chilblains and explore the presence of SARS-CoV-2 in the tissue.

Methods We examined skin biopsies from 7 paediatric patients presenting with chilblains during the COVID-19 pandemic. Immunohistochemistry for SARS-CoV-2 was performed in all cases and electron microscopy in one.

Results Histopathology showed variable degrees of lymphocytic vasculitis ranging from endothelial swelling and endothelialitis to fibrinoid necrosis and thrombosis. Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were also seen. SARS-CoV-2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of endothelial cells on electron microscopy.

Conclusions Although the clinical and histopathological features were similar to other forms of chilblains, the presence of viral particles in the endothelium and the histological evidence of vascular damage, support a causal relation of the lesions with SARS-CoV-2. Endothelial damage induced by the virus could be the key mechanism in the pathogenesis of COVID-19 chilblains and perhaps also in a group of patients severely affected by COVID-19 presenting with features of microangiopathic damage.

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6

Jun, 2020

Benign course of SARS‐CoV‐2 infection in a series of pediatric oncology patients

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Limited studies have shown that patients with cancer infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have more severe disease than the general population, with higher rates of serious illness and death in this population and other immunocompromised populations. Children are susceptible to SARS‐CoV‐2 infection, but clinical severity of the infection is significantly less than in adults. However, there is a paucity of data describing SARS‐CoV‐2 infection in pediatric patients with cancer. Here we report our experience with six pediatric oncology patients at our institution who tested positive for SARS‐CoV‐2 infection.

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