ABSTRACT
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found initially in Wuhan, China in early December 2019. The pandemic has spread to 216 countries and regions, infecting more than 23310 000 people and causing over 800 000 deaths globally by Aug. 24, 2020, according to World Health Organization (https://www.who.int/emergencies/diseases/ novel-coronavirus-2019). Fever, cough, and dyspnea are the three common symptoms of the condition, whereas the conventional transmission route for SARS-CoV-2 is through droplets entering the respiratory tract. To date, infection control measures for COVID-19 have been focusing on the involvement of the respiratory system. However, ignoring potential faecal transmission and the gastrointestinal involvement of SARS-CoV-2 may result in mistakes in attempts to control the pandemic.
Subject(s)
Humans , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Coronavirus Infections/virology , Environmental Microbiology , Feces/virology , Gastrointestinal Diseases/virology , Models, Biological , Pandemics , Pneumonia, Viral/virology , RNA, Viral/genetics , SARS-CoV-2 , Virus SheddingABSTRACT
Objective To investigate the clinical features of Kawasaki disease shock syndrome(KDSS)in children by comparing the clinical and laboratory characteristics with those of non-shock Kawasaki disease(KD)pa-tients. Methods Consecutive hospitalized patients diagnosed as KD were included,who had been admitted into the Children′s Hospital of Nanjing Medical University between January 1 and December 31,2015. There were 11 cases complicated with shock (KDSS group)and 61 cases without shock (non-shock KD group). The demographic,clinical and laboratory data were collected from all these 72 patients and comparisons were made between the KDSS group and the non-shock KD group. The parameters correlated with KDSS were evaluated by Logistic regression analysis. Results Of the 72 patients with KD,males accounted for 77. 8％ (56 / 72 cases),and 11 cases (15. 3％,11 / 72 ca-ses)met the diagnosis of KDSS. All the patients with KDSS received fluid resuscitation and vasoactive drug,and 2 cases (18. 2％,2 / 11 cases)showed resistance to intravenous immunoglobulin. There were 2 cases (18. 2％,2 / 11 cases)in the KDSS group and 10 cases (16. 4％,10 / 61 cases)in the non-shock KD group presented as incomplete KD on ad-mission. Ten cases (90. 9％,10 / 11 cases)showed abnormal echocardiography (coronary artery dilation and mitral re-gurgitation were mostly observed)in the KDSS group,otherwise 11 cases (18. 0％,11 / 61 cases)in the non-shock KD group,and there was a significant difference(P = 0. 000). Two cases (18. 2％,10 / 11 cases)had an acute gastrointesti-nal bleeding in the KDSS group,while none in the non-shock KD,and there was a significant difference(P = 0. 001). The patients with vomiting were significantly more in the KDSS group[54. 5％(6 / 11 cases)]than the non-shock KD group [16. 4％(10 / 61 cases)],and there was a significant difference(P = 0. 005). The significant differences in most laboratory indexes between the KDSS group and the non-shock KD group were as follows:(131. 91 ± 3. 86)mmol/ L vs. (136. 02 ± 4. 23)mmol/ L in sodium concentration (P = 0. 000),(834. 91 ± 1411. 48)ng/ L vs. (128. 28 ± 98. 92) ng/ L in B-type natriuretic peptide (P = 0. 000),(0. 72 ± 2. 19)μg/ L vs. (0. 00 ± 0. 01)μg/ L in troponin I (P =0. 010),(25. 44 ± 34. 06)μg/ L vs. (1. 18 ± 1. 97)μg/ L in procalcitonin (P = 0. 000). Also,immunological status of these patients with KDSS and non-shock KD varied as follows:(44. 39 ± 11. 86)％ vs. (59. 69 ± 10. 86)％ in CD3 + T lymphocytes (P = 0. 000),(25. 17 ± 8. 78)％ vs. (35. 77 ± 11. 24)％ in CD4 + T lymphocytes (P = 0. 005), (9. 93 ± 5. 63)％ vs. (5. 41 ± 0. 63)％ in natural killer(NK)cells (P = 0. 000),(40. 93 ± 13. 74)％ vs. (29. 18 ± 9. 53)％ in B cells (P = 0. 000). Logistic regression analysis showed that troponin I[odds ratio(OR)= 4. 173,Wald =56. 967,P < 0. 001],PCT(OR = 0. 378,Wald = 14. 738,P = 0. 007),and NK cells (OR = 0. 053,Wald = 6. 656,P =0. 008)were the factors associated with KDSS. Conclusions The abnormalities of gastrointestinal tract and echocardio-graphy in KDSS were significantly higher than those of the non-shock KD. Although multifactor analysis results just showed that troponin I,PCT,NK cells were associated with KDSS. If KD patients have hyponatremia,abnormal elevation of B-type natriuretic peptide and dysfunction of cellular immunity,KDSS might be considered.
ABSTRACT
Objective To summarize the clinical characteristics of Beh?et's disease (BD) in children with gastrointestinal involvement. Methods We retrospectively analyze the children BD with gastrointestinal involvement who were diagnosed in our hospital in recent 10 years. Results Twenty-two children were identified. The average age of onset was(6.1±4.0) years. The time from disease onset to clinical diagnosis was (1.2±2.1) years on average. Fifteen children had abdominal pain, diarrhea and hematochezia. Seven cases had positive endoscopic findings without any gastrointestinal symptoms. Twenty cases received corticosteroids therapy, 13 cases of them were treated with Cyclophosphamide/Methotrexate (CTX/MTX), 3 refractory cases were treated with biologics. Patients were followed up for (28±32) month on average. Eight patients' condition was stable, 7 patients were refractory, 3 patients died, 4 patients were lost to follow-up. At the same term, 5 patients without gastrointestinal involvement who received corticosteroids and CTX/MTX therapy were stable. Conclusion It is difficult to diagnose children BD at early stage. Gastrointestinal involvement may not be found, while the gastrointestinal endoscopy is of great importance in the diagnosis of the disease. Gluco-corticoid combined with immunosuppressive agents are effective. As to refractory patients, biological agent might be used although the recurrence is common. Compared with BD without gastrointestinal involvement, children BD with gastrointestinal involvement have serious condition and poor prognosis.
ABSTRACT
Systemic sclerosis is an intractable clinical subset characterized by diffuse fibrosis, vasculopathy, and immune abnormalities. Diffuse cutaneous systemic sclerosis has a variety of symptoms depending on the internal organs involved, such as the lungs, heart, kidneys, and gastrointestinal system. Gastrointestinal involvement is frequent and one of the major cause of morbidity and mortality. There is no sustained, effective therapy for treating the active gastrointestinal involvement of systemic sclerosis. Although immunoglobulin is commonly used in the treatment of other autoimmune diseases, its effects in the treatment of the gastrointestinal involvement in systemic sclerosis are unclear. Here, we report a patient with a severe cough caused by uncontrolled gastrointestinal involvement in diffuse cutaneous systemic sclerosis treated with immunoglobulin.
Subject(s)
Humans , Autoimmune Diseases , Cough , Fibrosis , Heart , Immunoglobulins , Kidney , Lung , Mortality , Scleroderma, Diffuse , Scleroderma, SystemicABSTRACT
Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that is based on the presence of non-caseating granulomas. Sarcoidosis commonly involves the lungs, skin, and eyes. Gastrointestinal tract involvement in sarcoidosis is uncommon. Gastrointestinal tract sarcoidosis commonly occurs subclinically, with clinical manifestations present in only 0.1-0.9% of patients with the disease. There are rare case reports of an individual with symptomatic gastrointestinal sarcoidosis. In Korea, gastrointestinal sarcoidosis without pulmonary involvement has not been reported previously. Here, we describe a case of gastrointestinal sarcoidosis in a 37-year-old male with symptoms of weight loss, fever, and abdominal pain. He was diagnosed based on the presence of non-caseating epithelioid granulomas in the stomach, duodenum, and colon by multiple biopsies.
Subject(s)
Adult , Humans , Male , Abdominal Pain , Biopsy , Colon , Duodenum , Fever , Gastrointestinal Tract , Granuloma , Korea , Lung , Sarcoidosis , Skin , Stomach , Weight LossABSTRACT
Existen pocos pacientes inmunodeprimidos o no, con implicación del tracto gastrointestinal por Cryptococcus neoformans, tanto en su manifestación local como enfermedad aislada y diseminada tipo criptococcemia. Reportamos un caso de criptococosis con compromiso esofágico, gástrico y duodenal en un paciente diagnosticado con SIDA C3. Según nuestro conocimiento, y búsqueda en la literatura, ha sido el único caso reportado en Colombia y América Latina.
There are very few patients, whether they are immunocompromised or not, with their gastrointestinal tracts compromised by Cryptococcus neoformans. This is true for both local manifestations as an isolated disease and for the disseminated disease of cryptococcoma. We report a case of cryptococcosis with esophageal, gastric and duodenal compromise in a patient diagnosed with Category 3 AIDS. To our knowledge after a search of the literature, this is the only reported case in Colombia and Latin America.
Subject(s)
Humans , Male , Adult , Acquired Immunodeficiency Syndrome , Cryptococcosis , Cryptococcus neoformans , HIVABSTRACT
Systemic lupus erythematosus(SLE) is an autoimmune inflammatory disease,virtually every system and organ can be affected.Gastrointestinal manifestations of SLE attract far less attention than the other major organ involvements.Gastrointestinal manifestations of these diseases often can't be diagnosed early and correctly,because the clinical manifestation varies and often nonspecific,and often confused with the side effect of medicine.But SLE related gastrointestinal involvement is clinically important because some cases can be life-threatening if not treated promptly.This paper reviews the common SLE gastrointestinal involvements,including the diagnosis and treatment of esophageal and gastric involvement,lupus mesenteric vasculitis,lupus pancreatitis,lupus peritonitis,pseudo-obstruction,proteinlosing gastroenteropathy,and hepatic involvement,to improve the recognition of gastrointestinal manifestations,and make an early and accurate diagnosis so that appropriate treatment along with prognosis can be made.
ABSTRACT
Behcet's disease is a chronic, relapsing vasculitis of unknown origin that affects nearly all organs. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal lesion and the colon. The lesions are typically resistant to medical treatment and frequently recur with surgical treatment. We describe a patient who had intestinal Behcet's disease complicated perforation and enterocutanous fistula with a good response to infliximab.