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      Acute Encephalopathy in a Child with COVID-19 Infection

      case-report

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          A bstract

          Coronavirus disease-2019 (COVID-19) is a global health crisis. Children account for 1–5% of diagnosed COVID-19 cases with relatively mild presentation and less mortality compared to adults. While patients typically present with fever, shortness of breath, and cough, neurologic manifestations have been reported, mainly in adults. We report a case of COVID-19-associated encephalopathy in an 11-year-old child who presented with altered sensorium and seizures.

          How to cite this article: Kinikar A, Kulkarni R, Rajput U, et al. Acute Encephalopathy in a Child with COVID-19 Infection. Pediatr Inf Dis 2020;2(2):62–63.

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          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
          Article 0 comments Cited 10786 times – based on 0 reviews     Review now
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            COVID-19: consider cytokine storm syndromes and immunosuppression

            Puja Mehta, Daniel McAuley, Michael Brown … (2020)
            As of March 12, 2020, coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%, 1 compared with a mortality rate of less than 1% from influenza. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality. Current management of COVID-19 is supportive, and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality. 2 Secondary haemophagocytic lymphohistiocytosis (sHLH) is an under-recognised, hyperinflammatory syndrome characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is most commonly triggered by viral infections 3 and occurs in 3·7–4·3% of sepsis cases. 4 Cardinal features of sHLH include unremitting fever, cytopenias, and hyperferritinaemia; pulmonary involvement (including ARDS) occurs in approximately 50% of patients. 5 A cytokine profile resembling sHLH is associated with COVID-19 disease severity, characterised by increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α. 6 Predictors of fatality from a recent retrospective, multicentre study of 150 confirmed COVID-19 cases in Wuhan, China, included elevated ferritin (mean 1297·6 ng/ml in non-survivors vs 614·0 ng/ml in survivors; p 39·4°C 49 Organomegaly None 0 Hepatomegaly or splenomegaly 23 Hepatomegaly and splenomegaly 38 Number of cytopenias * One lineage 0 Two lineages 24 Three lineages 34 Triglycerides (mmol/L) 4·0 mmol/L 64 Fibrinogen (g/L) >2·5 g/L 0 ≤2·5 g/L 30 Ferritin ng/ml 6000 ng/ml 50 Serum aspartate aminotransferase <30 IU/L 0 ≥30 IU/L 19 Haemophagocytosis on bone marrow aspirate No 0 Yes 35 Known immunosuppression † No 0 Yes 18 The Hscore 11 generates a probability for the presence of secondary HLH. HScores greater than 169 are 93% sensitive and 86% specific for HLH. Note that bone marrow haemophagocytosis is not mandatory for a diagnosis of HLH. HScores can be calculated using an online HScore calculator. 11 HLH=haemophagocytic lymphohistiocytosis. * Defined as either haemoglobin concentration of 9·2 g/dL or less (≤5·71 mmol/L), a white blood cell count of 5000 white blood cells per mm3 or less, or platelet count of 110 000 platelets per mm3 or less, or all of these criteria combined. † HIV positive or receiving longterm immunosuppressive therapy (ie, glucocorticoids, cyclosporine, azathioprine).
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              Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

              Yan Yan Zhang, Meng Xiao, Shulan Zhang … (2020)
              Coagulopathy in Critical Illness with Covid-19 The authors describe a 69-year-old man with Covid-19 diagnosed in January 2020 in Wuhan, China, along with two other critically ill patients with Covid-19 who were also seen in the same intensive care unit. Coagulopathy and antiphospholipid antibodies were seen in all three patients.
              Article 0 comments Cited 1153 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher): PID
                Title: Pediatric Infectious Disease
                Abbreviated Title: PID
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Electronic): 2582-4988
                Publication date (Print): April-June 2020
                Volume: 2
                Issue: 2
                Pages: 62-63
                Affiliations
                [1-3 ]Department of Pediatrics, BJ Government Medical College, Pune, Maharashtra, India
                [4 ]Department of Microbiology, BJ Government Medical College, Pune, Maharashtra, India
                Author notes
                Rajesh Kulkarni, Department of Pediatrics, BJ Government Medical College, Pune, Maharashtra, India, Phone: +91 9224799523, e-mail: docrajesh75@yahoo.com
                Article
                DOI: 10.5005/jp-journals-10081-1244
                SO-VID: 0ce535dc-32c8-41b3-84d1-099d82b1a522
                Copyright © Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.
                License:

                © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Subject: CASE REPORT
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                file-pdf pid-2020-2-62.pdf

                ScienceOpen disciplines: General medicine,Immunology,Health & Social care,Public health,Infectious disease & Microbiology,Microbiology & Virology
                Keywords: Atypical,COVID-19,SARS-CoV-2,Children,Encephalopathy
                Data availability:
                ScienceOpen disciplines: General medicine, Immunology, Health & Social care, Public health, Infectious disease & Microbiology, Microbiology & Virology
                Keywords: Atypical, COVID-19, SARS-CoV-2, Children, Encephalopathy

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