RESUMEN
OBJECTIVES: To characterize the clinical course and outcomes of children 12-18 years of age who developed probable myopericarditis after vaccination with the Pfizer-BioNTech (BNT162b2) coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccine. STUDY DESIGN: A cross-sectional study of 25 children, aged 12-18 years, diagnosed with probable myopericarditis after COVID-19 mRNA vaccination as per the Centers for Disease Control and Prevention criteria for myopericarditis at 8 US centers between May 10, 2021, and June 20, 2021. We retrospectively collected the following data: demographics, severe acute respiratory syndrome coronavirus 2 virus detection or serologic testing, clinical manifestations, laboratory test results, imaging study results, treatment, and time to resolutions of symptoms. RESULTS: Most (88%) cases followed the second dose of vaccine, and chest pain (100%) was the most common presenting symptom. Patients came to medical attention a median of 2 days (range, <1-20 days) after receipt of Pfizer mRNA COVID-19 vaccination. All adolescents had an elevated plasma troponin concentration. Echocardiographic abnormalities were infrequent, and 92% showed normal cardiac function at presentation. However, cardiac magnetic resonance imaging, obtained in 16 patients (64%), revealed that 15 (94%) had late gadolinium enhancement consistent with myopericarditis. Most were treated with ibuprofen or an equivalent nonsteroidal anti-inflammatory drug for symptomatic relief. One patient was given a corticosteroid orally after the initial administration of ibuprofen or an nonsteroidal anti-inflammatory drug; 2 patients also received intravenous immune globulin. Symptom resolution was observed within 7 days in all patients. CONCLUSIONS: Our data suggest that symptoms owing to myopericarditis after the mRNA COVID-19 vaccination tend to be mild and transient. Approximately two-thirds of patients underwent cardiac magnetic resonance imaging, which revealed evidence of myocardial inflammation despite a lack of echocardiographic abnormalities.
Asunto(s)
Vacunas contra la COVID-19/genética , COVID-19/prevención & control , Imagen por Resonancia Cinemagnética/métodos , Miocarditis/etiología , SARS-CoV-2/inmunología , Vacunación/efectos adversos , Vacunas Sintéticas/efectos adversos , Adolescente , COVID-19/epidemiología , COVID-19/genética , Vacunas contra la COVID-19/efectos adversos , Niño , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Miocarditis/diagnóstico , Miocarditis/epidemiología , Pandemias , Estudios Retrospectivos , Estados Unidos/epidemiología , Vacunas de ARNmAsunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias , Neumonía Viral , Atención Posnatal , Complicaciones Infecciosas del Embarazo , Adulto , Enfermedades Asintomáticas/epidemiología , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Masculino , Madres/estadística & datos numéricos , Ciudad de Nueva York/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Atención Posnatal/métodos , Atención Posnatal/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Medición de Riesgo , SARS-CoV-2 , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , TelemedicinaRESUMEN
Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections disproportionately affect children, but there are few pediatric reports of pericarditis and mediastinitis caused by CA-MRSA in previously healthy children. Here we report a severe case of CA-MRSA pericarditis with extension to the mediastinum and carotid sheath in a previously healthy 8-month-old infant who was successfully treated with surgical interventions and with a combination of daptomycin and vancomycin. The relatively indolent clinical course in this patient was notable given the significant extent of infection. This case highlights the potential virulence of CA-MRSA in previously healthy children and the importance of early diagnosis, prompt drainage, and appropriate antibiotic coverage.