1
|
Nyasulu PS, Tamuzi JL. Epidemiology, clinical profiles, and prognostic value of COVID-19-related cutaneous manifestations in African populations: a rapid narrative review. Int J Dermatol 2024; 63:10-22. [PMID: 37965793 DOI: 10.1111/ijd.16872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Skin manifestations' true prognostic value, and clinical and epidemiological pictures in SARS-CoV-2 infection in African populations are poorly described and understudied. More familiarity with COVID-19 cutaneous manifestations may aid in early clinical diagnosis or guide prognosis. METHODS In this literature review, we looked for potential studies published from December 2019 to March 2023 on COVID-19 cutaneous lesions in African populations. Our key questions were focused on the prognostic values of cutaneous manifestations related to COVID-19. RESULTS Our findings show that cutaneous manifestations of COVID-19 vary by country and severity of COVID-19, primarily multisystem inflammatory syndrome (MIS). Significant differences were also found between various dermatological lesions, primarily MIS, erythema multiforme-like, livedoid, vesicular, or varicella-like rashes, urticarial, maculopapular or morbilliform rashes, and chilblain-like or pernio-like rashes. There were 47.5% (115/242) of MIS cases reported in nine published African studies. Our findings also revealed that MIS may be diagnosed in 2-7 days due to early onset rash. Advanced age, obesity, diabetes, cardiovascular disease, HIV, tuberculosis, asthma, atopic disease, underweight, malnutrition, and malignancy were found to be associated with COVID-19 cutaneous manifestations in African populations. CONCLUSIONS COVID-19-related skin manifestations in African populations are important as a driving force in COVID-19 prognosis.
Collapse
Affiliation(s)
- Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
2
|
Elgohary MA, Mohamed ME, Hamada MM, Fahim JS, El‐Masry TA, Ibrahim AM, Taha AG, Seadawy MG, Alexiou A, Papadakis M, Batiha GE, El‐Bouseary MM. First confirmed case of multisystem inflammatory syndrome in adult in Egypt. Clin Case Rep 2023; 11:e7382. [PMID: 37273670 PMCID: PMC10233214 DOI: 10.1002/ccr3.7382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023] Open
Abstract
Key Clinical Message Our case report demonstrates extremely uncommon data associated with MIS-A, such as cholestatic jaundice, anemia, and quickly progressing pneumonia. IVIG and pulse steroid medications are the best treatments for improving clinical outcomes. Abstract We report a case of multiple organ dysfunctions due to MIS-A in an adult with a history of suspected COVID-19. Our case demonstrates extremely uncommon data associated with MIS-A, such as cholestatic jaundice, anemia, and quickly progressing pneumonia. IVIG and pulse steroid medications are the best treatments for improving clinical outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Thanaa A. El‐Masry
- Department of Pharmacology and Toxicology, Faculty of PharmacyTanta UniversityTantaEgypt
| | | | - Ahmad Gad Taha
- Virology Laboratory DepartmentCentral Military LaboratoriesCairoEgypt
| | | | - Athanasios Alexiou
- Department of Science and EngineeringNovel Global Community Educational FoundationHebershamNew South WalesAustralia
- AFNP MedWienAustria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten‐Herdecke, Heusnerstrasse 40University of Witten‐HerdeckeWuppertalGermany
| | - Gaber El‐Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary MedicineDamanhour UniversityDamanhourEgypt
| | - Maisra M. El‐Bouseary
- Department of Pharmaceutical Microbiology, Faculty of PharmacyTanta UniversityTantaEgypt
| |
Collapse
|
3
|
Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection in KwaZulu-Natal, South Africa. Pediatr Infect Dis J 2023; 42:e9-e14. [PMID: 36476527 PMCID: PMC9725742 DOI: 10.1097/inf.0000000000003759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa. OBJECTIVE To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal. METHODS Retrospective multicenter study of children (0-13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C. RESULTS Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP (P = 0.01), ferritin (P < 0.001), troponin-T (P = 0.02), B-type natriuretic peptide (BNP) (P = 0.01), and lower platelets (P = 0.01). Acute kidney injury (P = 0.01), cardiac involvement (P = 0.02), and altered levels of consciousness (P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7-19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069-1650) ng/mL versus 540 (IQR 181-1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7-191.5; P = 0.005). CONCLUSIONS Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation.
Collapse
|
4
|
Abstract
Severe complications related to COVID-19 occur infrequently in children and adolescents. these life-threatening complications are mainly acute respiratory failure from acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). MIS-C is a postinfectious complication occurring approximately 3 to 6 weeks mostly after an asymptomatic or mild SARS-CoV-2 infection. For both types of complications, supportive ICU care is often required. For MIS-C critical illness, immunomodulation is prescribed to reverse hyperinflammation and its cardiac and other sequelae.
Collapse
Affiliation(s)
- Allison M Blatz
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care, Boston Children's Hospital, 300 Longwood Avenue, Bader 634, Boston, MA 02115, USA; Department of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
5
|
Mohammad KO, Rodriguez JBC, Urey MA. Coronavirus disease 2019 and the cardiologist. Curr Opin Cardiol 2022; 37:335-342. [PMID: 35731679 DOI: 10.1097/hco.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.
Collapse
Affiliation(s)
- Khan O Mohammad
- Department of Internal Medicine, Dell Medical School at the University of Texas, Austin, Texas
| | - Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Marcus A Urey
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| |
Collapse
|
6
|
Balkaran S, Surdut SP, Rose DM, Freercks R. Multisystem inflammatory syndrome in an adult (MIS-A) due to SARS-CoV-2 infection presenting to a South African hospital. BMJ Case Rep 2022; 15:15/2/e246587. [PMID: 35135793 PMCID: PMC8830159 DOI: 10.1136/bcr-2021-246587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Kawasaki-like multisystem inflammatory syndrome related to SARS-CoV-2 infection is a well-described condition in children and adolescents (MIS-C) and now also in adults (MIS-A). We report a case of MIS-A in a previously well woman in her mid-30s who presented with vasopressor-dependent shock 2 weeks after initial recovery from suspected SARS-CoV-2 infection, accompanied by fever, vomiting, diarrhoea, weakness, arthralgia, rash, cough and headache. Examination was notable for fever, tachycardia, hypotension, cervical lymphadenopathy, mucocutaneous involvement, neck stiffness, pansystolic murmur and bilateral crepitations. Inflammatory markers were elevated. Echocardiogram showed mitral regurgitation with preserved ejection fraction. She was treated with vasopressors, admitted to the intensive care unit and subsequently required invasive mechanical ventilation. Both PCR and antibodies for SARS-CoV-2 were positive. Treatment with intravenous methylprednisolone and intravenous immunoglobulin was initiated with rapid improvement in clinical condition and inflammatory markers. She has since made a full recovery with normal echocardiogram 8 months later.
Collapse
Affiliation(s)
- Sarvesh Balkaran
- Department of Medicine, Walter Sisulu University Faculty of Health Sciences, Gqeberha, South Africa
| | | | - David Morris Rose
- Intensive Care Unit, Livingstone Tertiary Hospital, Gqeberha, South Africa
| | - Robert Freercks
- Department of Medicine, Division of Nephrology and Hypertension, University of Cape Town, Gqeberha, South Africa
| |
Collapse
|
7
|
Al Bishawi A, Ali M, Al‐Zubaidi K, Abdelhadi H. Beware of the ambiguous enemy of multisystem inflammatory syndrome in adult (MIS-A) following Covid-19 infection or vaccination. Clin Case Rep 2021; 9:e05138. [PMID: 34868588 PMCID: PMC8626603 DOI: 10.1002/ccr3.5138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/01/2022] Open
Abstract
Multisystem Inflammatory Syndrome is a rare and novel clinical presentation described during the evolving COVID-19 pandemic. The condition is usually presenting as a sepsis-like syndrome leading to secondary multi-organ dysfunction post-COVID-19 infection. Although the syndrome has been mainly described in children, rare adults' form has been similarly described. We are describing a 37-year-old female patient presented with fever and neck pain after 1 month of a mild SARS-CoV-2 infection course and 10 days post her second COVID-19 vaccine. Examination demonstrated fever, hypotension, and hypoxemia, in addition to multiple tender cervical lymph nodes. Initial laboratory workup showed evidence of significant inflammation with raised markers, including C-reactive protein, ferritin, and interleukin-6. Extensive evaluation to rule out active infection was done, and all return negative, including repeat SARS-CoV-2 test. Furthermore, cardiac evaluation showed moderately reduced systolic ventricular function. Despite all negative test and supportive measures, the patient continued to deteriorate requiring critical care admission for ionotropic support, non-invasive ventilation in addition to presumptive broad-spectrum antimicrobial management. There was no significant improvement with supportive care until the presentation of multisystem involvement on in the context of a recent history of COVID 19 and negative infective screen was raised. The diagnosis of multisystem inflammatory syndrome-adult form (MIS-A) was embraced, and the patient was commenced on methylprednisolone leading to a dramatic resolution of symptoms both clinically and biochemically with stabilization of vital functions allowing for safe outcomes.
Collapse
Affiliation(s)
- Ahmad Al Bishawi
- Infectious Diseases DivisionDepartment of Internal MedicineCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| | - Maisa Ali
- Infectious Diseases DivisionDepartment of Internal MedicineCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| | - Khaled Al‐Zubaidi
- Department of PaediatricsPaediatric Infectious DiseaseHamad Medical CorporationDohaQatar
| | - Hamad Abdelhadi
- Infectious Diseases DivisionDepartment of Internal MedicineCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| |
Collapse
|
8
|
Miqdhaadh A, Imad HA, Fazeena A, Ngamprasertchai T, Nguitragool W, Nakayama EE, Shioda T. Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives. Trop Med Infect Dis 2021; 6:tropicalmed6040187. [PMID: 34698279 PMCID: PMC8544693 DOI: 10.3390/tropicalmed6040187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022] Open
Abstract
The multisystem inflammatory syndrome in adults (MIS-A) is a novel syndrome observed during COVID-19 outbreaks. This hyper-inflammatory syndrome is seen predominantly in children and adolescents. The case of an adult from the Maldives who had asymptomatic SARS-CoV-2 infection three weeks before presenting to the hospital with fever, rash, and shock is presented. De-identified clinical data were retrospectively collected to summarize the clinical progression and treatment during hospitalization and the six-month follow-up. SARS-CoV-2 infection was confirmed by RT-PCR. Other laboratory findings included anemia (hemoglobin: 9.8 g/dL), leukocytosis (leukocytes: 20,900/µL), neutrophilia (neutrophils: 18,580/µL) and lymphopenia (lymphocytes: 5067/µL), and elevated inflammatory markers, including C-reactive protein (34.8 mg/dL) and ferritin (2716.0 ng/dL). The electrocardiogram had low-voltage complexes, and the echocardiogram showed hypokinesia, ventricular dysfunction, and a pericardial effusion suggestive of myocardial dysfunction compromising hemodynamics and causing circulatory shock. These findings fulfilled the diagnostic criteria of MIS-A. The case was managed in the intensive care unit and required non-invasive positive pressure ventilation, inotropes, and steroids. With the new surges of COVID-19 cases, more cases of MIS-A that require the management of organ failure and long-term follow-up to recovery are anticipated. Clinicians should therefore be vigilant in identifying cases of MIS-A during the pandemic.
Collapse
Affiliation(s)
- Ahmed Miqdhaadh
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.M.); (A.F.)
| | - Hisham Ahmed Imad
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (E.E.N.); (T.S.)
- Correspondence: or ; Tel.: +66-631501402
| | - Aminath Fazeena
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.M.); (A.F.)
| | - Thundon Ngamprasertchai
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Wang Nguitragool
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Emi E. Nakayama
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (E.E.N.); (T.S.)
| | - Tatsuo Shioda
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (E.E.N.); (T.S.)
| |
Collapse
|