RESUMEN
Mpox (monkeypox) is a zoonotic disease that has been endemic in African countries for decades, with a recent global outbreak in countries around the world. A 39-year-old male with human immunodeficiency virus (HIV)-hepatitis B virus (HBV) coinfection and poor adherence to antiretroviral treatment, who was severely immunocompromised and had a concurrent diagnosis of Mpox, presented to our hospital with disseminated skin lesions (over 350 lesions), perianal ulcers, odynophagia, oral intolerance, diarrhea, and soft-tissue bacterial superinfection of the lower extremities. Laboratory results were consistent with HBV infection, with an absolute CD4 cell count of 40 cells/uL and a positive PCR result for monkeypox virus. An abdominopelvic CT scan showed evidence of severe proctitis and perineal soft-tissue infection. Sixty-five days after a positive monkeypox virus PCR, new lesions in the vesicular stage continued to appear, eventually developing hemodynamic instability and sepsis, resulting in a fatal outcome. Our case highlights the importance of intentionally looking for risk factors such as HIV/HBV coinfection and evaluating immune status (CD4 cell count) in patients with severe Mpox because it could be related to higher mortality.
RESUMEN
Background: The severity of coronavirus disease 2019 (COVID-19) is related to several factors, including age, sex, and comorbidities (obesity, type 2 diabetes, and hypertension). However, systemic inflammation plays a fundamental role in COVID-19 pathophysiology. Several studies have described this association employing specific biomarkers that are not routinely used in clinical practice. On the other hand, very few reports in the literature focused on the analysis of the routine laboratory biomarkers to predict the outcome of severe COVID-19 patients. Objective: We aimed to analyze the dynamic inflammatory response using routine laboratory biomarkers to predict in-hospital mortality in Mexican patients with severe COVID-19. Methods: This is a cohort study including patients with severe COVID-19. Demographic characteristics were retrieved from medical charts and biochemical parameters were measured at hospital admission and subsequently on days 3, 5, 7, 10, 14, and 21 during the hospital stay; measurements were stopped when patients were discharged from the hospital (alive or death). Results: A total of 250 patients were included in the study, 40.8% of patients died. The analyzed routine laboratory parameters, such as serum levels of neutrophil-to-lymphocyte ratio, C-reactive protein, and D-dimer remained elevated in hospitalized patients who did not survive, whereas eosinophil and platelets were maintained at lower levels. In the multivariate analysis, leukocytes, and neutrophils were the best biomarkers for predicting mortality risk and were independent of age, gender, or comorbidities. Conclusion: Our results support the use of routine laboratory biomarkers as predictors of mortality in Mexican hospitalized patients with severe COVID-19.
RESUMEN
Coronavirus disease 2019 (COVID-19), caused by the new coronavirus SARSCoV-2, is an infectious disease that has caused an increase in hospitalizations for pneumonia; the spectrum of clinical presentation is variable. One such presentation, pneumomediastinum (PM), is defined as the presence of air or some other gas in the mediastinum. It is a rare condition, usually benign and self-limited; it has been seen in patients with COVID-19. Although most cases are, as explained above, self limited and in addition, can be managed conservatively, close monitoring is recommended, as PM can cause life-threatening hemodynamic and respiratory disturbances. We present a case series of 4 patients with SARS CoV-2 infection, in whom PM was found, and who were admitted to the Regional Hospital of High Specialty of the Yucatan Peninsula during the period of May 2020 through August 2020.
