Severe Infection

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Severe Infection

23  articles in this collection
Written by Mathias Castonguay, Camille Blouin, Noémie Desgagnés, Anne-Marie Lavigne, 

The Use of Corticosteroids in Adrenal Insufficiency

The World Health Organization has recently advised against corticosteroids use in COVID-19 patients, unless indicated for another reason, as in adrenal insufficiency (AI). Indeed, both patients with primary or secondary AI are at higher risk of developing infections, precipitating an adrenal crisis. No specific protocol has been studied for AI patients in the context of […]

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06/05/2020

Thrombotic occlusive vasculopathy

Llamas-Velasco M. et al. described a 61-year-old male with ischemic digits and retiform purpura and livedoid lesions. Nasopharyngeal swab was positive for SARS-CoV-2 infection. The patient was admitted to the intensive care unit. The lesions involve hands and feet. Laboratory results revealed leucopenia, increased fibrinogen, increased D-dimer and a heterozygous Factor V Leiden mutation. Histopathological […]

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05/25/2020

Potential Effect of Complement Pathways in Thrombotic Microvascular Injury

Based on pulmonary and cutaneous biopsy and autopsy samples, some critically ill patients present a generalized thrombotic microvascular injury. Cutaneous manifestation consistent with a thrombotic microvascular injury included retiform purpura or livedo racemose. Histological findings suggest that some of the severe cases of COVID-19 would have thrombotic injuries mediated by a systemic activation of the […]

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05/22/2020

Management of autoimmune bullous diseases

Recommendations for AIBD patients undergoing immunosuppressive therapy during the pandemic :  Immunomodulatory therapy should be maintained when necessary since unjustified withdrawal could lead to uncontrolled AIBD activity.  Adhere to standard precautions including social distancing and hand washing.  What if AIBD patients are SARS-CoV-2 infected ?  Evaluate the risk for each patient.  May be stopped during […]

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04/30/2020

Is Obesity a Risk Factor for Severity?

In the 2009 H1N1 pandemic, obesity was identified as a risk factor for fatal and critical complications of influenza.1,3,4 Obesity appears to be an independent risk factor for severe COVID-19 infection: 5 The need for invasive mechanical ventilation increases with body mass categories, reaching nearly 90% in ICU patients with a BMI > 35 kg/m2. […]

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05/10/2020

Pediatric Multi-System Inflammatory Syndrome: A New Clinical Presentation in Children

The United States (including New York City) and the United Kingdom have recently reported cases of multi-system inflammatory syndrome in children and adolescents potentially associated with COVID-19. The NYC Health Department reported 15 patients hospitalized between April 17 and May 1 with symptoms consistent with this syndrome. The presentation varies between a typical Kawasaki disease, […]

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05/17/2020

Treatment Options for Pregnant Women

Confirmed cases should be treated in a negative pressure isolation room when available. Critically ill patients should be placed in left lateral decubitus. Treatment options include oxygen therapy, hydration, and empirical antibiotic therapy. The use of antiretroviral therapy and chloroquine is under investigation. Target saturation is ≥ 95%.   Is hydroxychloroquine safe in pregnancy? Some […]

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04/15/2020

Neurologic Manifestations in Severely Ill Patients

36.4% of patients had neurological symptoms, most frequently headache, dizziness and impaired consciousness. About 5% of patients reported either hypogeusia or hyposmia. Severely ill patients were more likely to develop acute cerebrovascular diseases, impaired consciousness and skeletal muscle injury.   This data comes from a non-peer reviewed retrospective case series conducted in three hospitals of […]

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04/19/2020

Coagulopathy: What We Know So Far

About coagulation and inflammation biochemical parameters: Markedly decreased fibrinogen, high FDP (fibrin degradation product), high D-dimers and increased PT/PTT are observed in COVID-19 non survivors.1,2,3,4,5,6 Rapidly rising FDP may be correlated with disease progression and may be a better surrogate marker than D-dimers.1,4,5 Plasminogen levels tend to be higher in severe disease and may play […]

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05/03/2020

Reviewing CVD and Acute Cardiovascular Complications

CVD (cardiovascular disease): Pre-existing cardiovascular and metabolic disease are common in COVID-19 patients and they increase the risk of morbidity and mortality1. These comorbidities (hypertension, cardiovascular/cerebrovascular disease and diabetes) are associated with a greater risk of ICU hospitalisation2. Patients with CVD appear more susceptible to COVID-19–induced cardiac injury3.   Acute cardiovascular complications: Acute cardiac injury is […]

Written by and
04/05/2020

Youngsters’ Cases Characteristics

Longer incubation period was seen in children, thus reinforcing usage of preventive control interventions in time; Majority of positive patients had a confirmed case in their family members; Asymptomatic infections are more frequent than in adults; The most common finding in chest computed tomography (CT scan) was bilateral ground-glass opacity; Patients with pre-existing comorbidities could […]

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05/04/2020

Considerations in the Management of Diabetes in the Pandemic Context

Diabetes is an important risk factor for poorer outcomes in COVID-19. Mechanistic hypotheses include the effect of acute and chronic hyperglycemia on angiotensin-converting-enzyme-2 receptor, impaired immune response and confounding population characteristics such as age and cardiovascular comorbidities. Prevention: Patients at risk of metabolic disease who have contracted the infection should be monitored to prevent new […]

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05/04/2020

Reverse Tako-Tsubo Syndrome in a Patient with Acute Myocarditis

SARS-CoV-2-related acute myocarditis may present as a reverse Tako-Tsubo syndrome. Endomyocardial biopsy revealed diffuse T-lymphocytic inflammatory infiltrates with important interstitial oedema and limited foci of necrosis; no replacement fibrosis was detected, suggesting an acute inflammatory process. Molecular analysis showed absence of the SARS-CoV-2 genome within the myocardium.   This case report highlights an atypical presentation […]

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04/17/2020

A Case of Immune Thrombocytopenic Purpura (ITP)

COVID-19 may potentially represent a novel etiology for ITP, although we cannot exclude other causes of thrombocytopenia in this case (e.g. thrombocytopenia related to amoxicillin–clavulanic acid exposure).   A 65-year-old woman with hypertension and autoimmune hypothyroidism was admitted with COVID-19 pneumonia in Strasbourg, France. Laboratory tests performed at admission showed a normal full blood count […]

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04/27/2020

Presentation and Outcomes in Pregnant Women

Clinical manifestations : Clinical manifestations in pregnant women were comparable to those seen in infected non-pregnant adults.  Initial normal body temperature was seen more commonly in pregnant women, thus rendering early detection of the virus more difficult in this population.  It has not been shown that pregnancy is a risk factor for more severe infection. […]

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04/05/2020

Immunosuppressants Use in Dermatology during the Outbreak

There is currently no data about the benefits or the risks of stopping immunomodulators/immunosuppressants during the COVID-19 outbreak.  Pre-coronavirus pivotal trials for psoriasis show that patients under biologic therapies had respiratory infection rates similar to placebo.  Price et al recommend:  Consider stopping classic immunosuppressants and rituximab  when viral symptoms present, especially with known or potential […]

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04/10/2020

A First Presumptive Case Report of Acute Necrotizing Hemorrhagic Encephalopathy

Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storms. A female airline worker in her late fifties is the first reported case of acute necrotizing hemorrhagic encephalopathy associated with SARS-CoV-2. Hemorrhagic bithalamic lesions were demonstrated by CT and MRI imagery. However, detection […]

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04/17/2020

Rationale of Favipiravir Against New Pandemic

Before COVID-19: Favipiravir is approved in Japan and China for treating severe influenza virus, as well as a promising prophylaxis and treatment of Ebola virus and treatment of Fever with Thrombocytopenia Syndrome.1   It was shown to be safe in several human clinical trials for influenza.1  It is renowned for its broad anti-RNA virus action1, and […]

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04/12/2020

DIC a Prognostic Factor of Mortality

DIC (Disseminated Intravascular Coagulation) is highly associated with death, as the majority of patients (71%) who died from NCP (novel coronavirus pneumoniae) met the criteria for DIC (with median time of four days after admission) compared to few survivor (0.6% developing DIC). Coagulation parameters (mainly D-dimers) should be done at baseline and followed throughout the […]

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03/27/2020

Hematologic Parameters and Need of ICU Care

Lymphopenia is frequent1,2 and severe lymphopenia may be useful to identify patients that will need ICU care1,2,3. Patients requiring ICU tend to have higher LDH (lactate dehydrogenase) and higher ANC (absolute neutrophil count)1,2,3. Thrombocytopenia is frequent2,3, but does not seem to correlate the need of ICU care.1,2,3. Hemoglobin, monocyte, prothrombin time, activated partial thromboplastin time […]

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04/01/2020

Kidney Function and Mortality

AKI (acute kidney injury) is independently strongly associated with increased mortality and morbidity and is dependent on its severity (Stage 1 HR = 3.51, Stage 2 HR = 6.24, Stage 3 HR = 9.81)1 CKD (chronic kidney disease) is associated with enhanced risk of severe COVID-19 infection (OR 3.03)2 and a greater in-hospital mortality (HR […]

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04/01/2020

Lymphopenia as a Classification and Prediction Tool

The LYM% (blood lymphocyte percentage) can be used as a reliable indicator to classify the infection as moderate, severe and critical independently of any other auxiliary indicators. TML (Time-LYM%-model) is a tool of classification and prognosis prediction. TML-1 is defined as the LYM% at day 10-12 after symptom onset and TML-2 is the LYM% at […]

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04/01/2020

Prophylactic Anticoagulation in Sepsis Induced Coagulopathy

LMWH (low molecular weight heparin) at a prophylactic dose may reduce mortality in patient with markedly elevated D-dimers (6 upper limit normal) or  a SIC (sepsis-induced-coagulopathy criteria) ≥4, as 28-day mortality rates were statistically lower for patients meeting these criterias. Higher doses should be considered in patient with a high body mass index.  Rationale of […]

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04/07/2020