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1.
Pediatr Infect Dis J ; 39(8): e206-e207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32639461

RESUMO

Pediatric inflammatory multisystem syndromes associated with Severe Acute Respiratory Syndrome Coronavirus 2 are emerging in recent reports. We describe a patient with critical illness consistent with atypical Kawasaki disease with cardiac dysfunction and abdominal involvement presenting weeks after Severe Acute Respiratory Syndrome Coronavirus 2 infection. Our patient showed unique central nervous system involvement with small vessel vasculitis and profound hypocomplementemia, both not previously reported in case descriptions and may hint at possible disease mechanisms.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Adolescente , Betacoronavirus , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Glomerulonefrite Membranoproliferativa , Hemossiderose/diagnóstico por imagem , Hospitalização , Humanos , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Sistema Nervoso , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/terapia
4.
S D Med ; 73(6): 246-251, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32580256

RESUMO

Coronavirus infectious disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was deemed a worldwide pandemic by the World Health Organization in February 2020. The U.S. began seeing epidemic levels of cases in early March 2020. South Dakota case numbers dramatically increased in late March/early April, 2020 due to a large meat processing facility outbreak. Although COVID-19 infections in adults more severely involve the lungs and heart with multiple organ-system dysfunction, pediatric patients have largely been spared. In May 2020, a syndrome resembling severe Kawasaki disease with shock in children was reported from European groups. We report a case that presented to and was managed in our Sioux Falls pediatric intensive care unit in April 2020 that fits the description, course, and successful treatment described by our European colleagues. Our case fulfils the case definition of paediatric multisystem inflammatory syndrome temporally associated with COVID-19 described by the Royal College of Paediatrics and Child Health on April 27, 2020. We will review and discuss the European and US case definitions of this syndrome and similarities, and differences with Kawasaki disease and treatment options.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/virologia , Betacoronavirus , Criança , Humanos , Pandemias , South Dakota
5.
Rev Esp Enferm Dig ; 112(7): 584-585, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32579014

RESUMO

We thank Dr. Cienfuegos and colleagues for their comments on our recent publication "COVID-19, Coronavirus, SARS-CoV-2 and the small bowel". Cienfuegos et al. have treated several COVID-19 patients with thromboembolic complications, including bowel ischemia. The authors correctly highlight the importance of this complication in COVID-19 patients, which has also been documented in autopsy studies.


Assuntos
Infecções por Coronavirus , Coronavirus , Microbioma Gastrointestinal , Pandemias , Pneumonia Viral , Vírus da SARS , Trombose , Betacoronavirus , Humanos , Síndrome de Resposta Inflamatória Sistêmica
6.
Ann Rheum Dis ; 79(8): 999-1006, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32527868

RESUMO

BACKGROUND: Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities. METHODS: Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator. RESULTS: Sixteen patients were included (sex ratio=1, median age 10 years IQR (4·7 to 12.5)). SARS-CoV-2 was detected in 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 µg/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004). CONCLUSION: Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Síndrome de Linfonodos Mucocutâneos/virologia , Pandemias , Paris/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia
7.
N Engl J Med ; 383(4): 347-358, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32598830

RESUMO

BACKGROUND: A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. METHODS: Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020. RESULTS: As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days. CONCLUSIONS: The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adolescente , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Síndrome de Linfonodos Mucocutâneos/virologia , New York/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Adulto Jovem
8.
N Engl J Med ; 383(4): 334-346, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32598831

RESUMO

BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.).


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adolescente , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunomodulação , Inflamação , Tempo de Internação , Masculino , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Síndrome de Linfonodos Mucocutâneos/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Prospectivos , Respiração Artificial , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/terapia , Estados Unidos
9.
Int J Infect Dis ; 97: 371-373, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32553716

RESUMO

Recently, an increasing number of SARS-CoV-2 patients with COVID-19 syndrome, which overlaps with Kawasaki Disease (KD), have been reported, supporting the suggestion that infection is one of the triggers of KD. We summarized the reports of simultaneous familial KD cases to better understand the etiopathogenesis of both KD and Multisystem Inflammatory Syndrome in Children (MIS-C) related to COVID-19. Here we discuss the etiology of these syndromes from the point of view of infection and genetic susceptibility.


Assuntos
Infecções por Coronavirus/complicações , Síndrome de Linfonodos Mucocutâneos/genética , Síndrome de Linfonodos Mucocutâneos/patologia , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/genética , Síndrome de Resposta Inflamatória Sistêmica/patologia , Adulto , Betacoronavirus , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias
10.
Anaesth Crit Care Pain Med ; 39(3): 393-394, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32562808
11.
Int J Med Sci ; 17(9): 1281-1292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32547323

RESUMO

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20µg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.


Assuntos
Betacoronavirus/isolamento & purificação , Causas de Morte , Infecções por Coronavirus/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Idoso , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/virologia , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oximetria , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Pró-Calcitonina/sangue , Prognóstico , Curva ROC , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/virologia
12.
Med Clin North Am ; 104(4): 573-585, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505253

RESUMO

Sepsis and septic shock are major causes of mortality among hospitalized patients. The sepsis state is due to dysregulated host response to infection, leading to inflammatory damage to nearly every organ system. Early recognition of sepsis and appropriate treatment with antibiotics, fluids, and vasopressors is essential to reducing organ system injury and mortality. This review summarizes the current understanding of the epidemiology, pathophysiology, diagnosis, and treatment of sepsis and septic shock.


Assuntos
Tomada de Decisão Clínica , Escores de Disfunção Orgânica , Sepse/diagnóstico , Choque Séptico/diagnóstico , Pressão Sanguínea/efeitos dos fármacos , Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Humanos , Classificação Internacional de Doenças , Taxa Respiratória , Sensibilidade e Especificidade , Sepse/fisiopatologia , Sepse/terapia , Choque Séptico/fisiopatologia , Choque Séptico/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Terminologia como Assunto , Vasoconstritores/uso terapêutico
14.
BMC Infect Dis ; 20(1): 396, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503442

RESUMO

BACKGROUND: Delayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients. METHODS: A matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia. RESULTS: The 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p <  0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421-3.217, p <  0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719-0.890, p < 0.001), with a sensitivity and specificity of 72.9 and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group. CONCLUSIONS: DNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.


Assuntos
Candidemia/diagnóstico , Neutrófilos/citologia , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Candida/isolamento & purificação , Candidemia/complicações , Candidemia/microbiologia , Candidemia/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
15.
BMJ ; 369: m2094, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493739

RESUMO

OBJECTIVES: To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN: Prospective observational study. SETTING: General paediatric department of a university hospital in Paris, France. PARTICIPANTS: 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020. MAIN OUTCOME MEASURES: The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus. RESULTS: 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home. CONCLUSIONS: The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adolescente , Corticosteroides/uso terapêutico , Betacoronavirus/genética , Betacoronavirus/imunologia , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Nasofaringe/virologia , Pandemias , Paris , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Estudos Prospectivos , RNA Viral/genética , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/etiologia
16.
Euro Surveill ; 25(22)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32524957

RESUMO

End of April 2020, French clinicians observed an increase in cases presenting with paediatric inflammatory multisystem syndrome (PIMS). Nationwide surveillance was set up and demonstrated temporospatial association with the coronavirus disease (COVID-19) epidemic for 156 reported cases as at 17 May: 108 were classified as confirmed (n = 79), probable (n = 16) or possible (n = 13) post-COVID-19 PIMS cases. A continuum of clinical features from Kawasaki-like disease to myocarditis was observed, requiring intensive care in 67% of cases.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Pneumonia Viral/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Surtos de Doenças , Feminino , França/epidemiologia , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia
17.
Sci Adv ; 6(23): eaaz5466, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32548259

RESUMO

Uncontrolled inflammatory processes are at the root of numerous pathologies. Most recently, studies on confirmed COVID-19 cases have suggested that mortality might be due to virally induced hyperinflammation. Uncontrolled pro-inflammatory states are often driven by continuous positive feedback loops between pro-inflammatory signaling and oxidative stress, which cannot be resolved in a targeted manner. Here, we report on the development of multidrug nanoparticles for the mitigation of uncontrolled inflammation. The nanoparticles are made by conjugating squalene, a natural lipid, to adenosine, an endogenous immunomodulator, and then encapsulating α-tocopherol, as antioxidant. This resulted in high drug loading, biocompatible, multidrug nanoparticles. By exploiting the endothelial dysfunction at sites of acute inflammation, these multidrug nanoparticles delivered the therapeutic agents in a targeted manner, conferring survival advantage to treated animals in models of endotoxemia. Selectively delivering adenosine and antioxidants together could serve as a novel therapeutic approach for safe treatment of acute paradoxal inflammation.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Endotoxemia/tratamento farmacológico , Nanopartículas/química , Esqualeno/química , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Adenosina/administração & dosagem , Adenosina/química , Animais , Antioxidantes/administração & dosagem , Antioxidantes/química , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Modelos Animais de Doenças , Endotoxemia/induzido quimicamente , Feminino , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/química , Lipopolissacarídeos/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Nanopartículas/administração & dosagem , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Esqualeno/administração & dosagem , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente , Resultado do Tratamento , alfa-Tocoferol/administração & dosagem , alfa-Tocoferol/química
20.
BMC Infect Dis ; 20(1): 385, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471385

RESUMO

BACKGROUND: The seasonal influenza epidemic is an important public health issue worldwide. Early predictive identification of patients with potentially worse outcome is important in the emergency department (ED). Similarly as with bacterial infection, influenza can cause sepsis. This study was conducted to investigate the effectiveness of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score as prognostic predictors for ED patients with influenza. METHODS: This single-center, retrospective cohort study investigated data that was retrieved from a hospital-based research database. Adult ED patients (age ≥ 18 at admission) with laboratory-proven influenza from 2010 to 2016 were included for data analysis. The initial SIRS and qSOFA scores were both collected. The primary outcome was the utility of each score in the prediction of in-hospital mortality. RESULTS: For the study period, 3561 patients met the study inclusion criteria. The overall in-hospital mortality was 2.7% (95 patients). When the qSOFA scores were 0, 1, 2, and 3, the percentages of in-hospital mortality were 0.6, 7.2, 15.9, and 25%, respectively. Accordingly, the odds ratios (ORs) were 7.72, 11.92, and 22.46, respectively. The sensitivity and specificity was 24 and 96.2%, respectively, when the qSOFA score was ≥2. However, the SIRS criteria showed no significant associations with the primary outcome. The area under the receiver operating characteristic curve (AUC) was 0.864, which is significantly higher than that with SIRS, where the AUC was 0.786 (P < 0.01). CONCLUSIONS: The qSOFA score potentially is a useful prognostic predictor for influenza and could be applied in the ED as a risk stratification tool. However, qSOFA may not be a good screening tool for triage because of its poor sensitivity. The SIRS criteria showed poor predictive performance in influenza for mortality as an outcome. Further research is needed to determine the role of these predictive tools in influenza and in other viral infections.


Assuntos
Serviço Hospitalar de Emergência , Epidemias , Mortalidade Hospitalar , Vírus da Influenza A/genética , Influenza Humana/mortalidade , Escores de Disfunção Orgânica , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adulto , Idoso , Feminino , Hospitalização , Humanos , Influenza Humana/complicações , Influenza Humana/virologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Sepse/diagnóstico , Sepse/etiologia , Triagem
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