1
|
Fiordelisi A, Soldovieri S, Pagnini I, Marrani E, Simonini G, Indolfi G, Trapani S. Acute hemorrhagic edema of infancy: 20-year experience from an Italian tertiary referral center. Pediatr Dermatol 2024; 41:825-830. [PMID: 39022801 DOI: 10.1111/pde.15707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Data on acute hemorrhagic edema of infancy (AHEI) are derived from small case series or case reports. We report a 20-year experience at a national referral center. METHODS We performed a single-center retrospective study including patients who were diagnosed with AHEI from January 1, 2004, to June 30, 2023. RESULTS We identified 21 patients (57.1% females) with a median age of 18 months (range 7-33 months). Thirteen (61.9%) patients were admitted to the pediatric ward, the remaining eight (38.1%) presented to the emergency department and were discharged for outpatient management. The median length of hospitalization was 5 days (range 3-9 days). Twenty patients (95.2%) had prodromal symptoms. The most common cutaneous findings were targetoid purpuric plaques. The lesions were most localized on the face (13, 61.9%) and on the upper limbs (18 patients, 85.7%). Sixteen (76%) patients presented with nonpitting and tender edema, localized on the feet (9/16, 56%) and hands (6/16, 37.5%). Systemic involvement was rare, and no patients experienced complications or sequelae. Twelve (57.1%) patients underwent infectious disease investigations, with positive results in only four (33.3%). None of the patients diagnosed after the SARS-CoV-2 outbreak (March 2020) had positive nasopharyngeal swabs for the virus. For the 13 patients who were admitted to the pediatric ward, the median length of hospitalization was five days (3-9 days). CONCLUSIONS The 21-patient single-center cohort of children affected by AHEI confirmed a generally benign course of AHEI, despite a 62% rate of hospitalization.
Collapse
Affiliation(s)
- Adele Fiordelisi
- Residency School of Pediatrics, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Sara Soldovieri
- Residency School of Pediatrics, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Firenze, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, University of Florence, Firenze, Italy
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| |
Collapse
|
2
|
Huynh T, Sanchez-Flores X, Yau J, Huang JT. Cutaneous Manifestations of SARS-CoV-2 Infection. Am J Clin Dermatol 2022; 23:277-286. [PMID: 35247198 PMCID: PMC8897723 DOI: 10.1007/s40257-022-00675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus disease 2019 (COVID-19) pandemic, affecting people worldwide. SARS-CoV-2 infection is a multisystem disease with potential for detrimental effects on various systemic organs. It affects people of all ages with varying degrees of disease severity. Patients with SARS-CoV-2 infection commonly present with dry cough, fever, and fatigue. A clinical spectrum of skin findings secondary to SARS-CoV-2 has also been reported. The most common cutaneous patterns associated with COVID-19 are chilblain-like lesions (CBLL), maculopapular lesions, urticarial lesions, vesicular lesions, and livedoid lesions. Other skin findings secondary to SARS-COV-2 infection are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely multisystem inflammatory syndrome in adults (MIS-A). Physician awareness of skin manifestations of SARS-CoV-2 infection can help with early identification and treatment. This narrative review provides an update of various skin manifestations reported with SARS-CoV-2 infection, including clinical presentation, proposed pathogenesis, histopathology, prognosis, and treatment options.
Collapse
Affiliation(s)
- Thy Huynh
- Dermatology Section, Boston Children's Hospital, 300 Longwood Avenue, Fegan 6, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Xavier Sanchez-Flores
- Dermatology Section, Boston Children's Hospital, 300 Longwood Avenue, Fegan 6, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Judy Yau
- Tufts University School of Medicine, Boston, MA, USA
| | - Jennifer T Huang
- Dermatology Section, Boston Children's Hospital, 300 Longwood Avenue, Fegan 6, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
3
|
Coronavirus Disease 2019 and Acute Hemorrhagic Edema of Infancy. Case Rep Infect Dis 2022; 2022:7610402. [PMID: 35127185 PMCID: PMC8812376 DOI: 10.1155/2022/7610402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute hemorrhagic edema of infancy (AHEI) is a small-vessel leukocytoclastic vasculitis, presented with low-grade fever and edema in the face and upper and lower limbs, as well as purpuric/ecchymotic lesions in these regions. AHEI was also reported after viral infections, including herpes simplex virus, rotavirus, and adenovirus. Case Presentation. Herein, we reported a case of a 20-month-old boy presented with low-grade fever. Additionally, mild cough and progressive purpuric/ecchymotic lesions were observed in some independent regions and extremity swelling. Laboratory testing showed leukopenia, lymphopenia, and the elevation of both C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Thereafter, the result of the reverse-transcriptase polymerase chain reaction (RT-PCR) test on the obtained specimen samples, including nasopharyngeal swab for COVID-19, was positive. The patient was treated with supportive care, and two weeks later, the serology test for COVID-19 resulted positive. Conclusion We should think about children infected with COVID-19, particularly those with skin manifestations.
Collapse
|
4
|
Young EM. Perinatal/maternal-fetal-infant dermatologic manifestations of SARS-CoV-2. An Overview and Implications for diagnosis, treatment, and prognosis. Front Pediatr 2022; 10:1071839. [PMID: 36533244 PMCID: PMC9755859 DOI: 10.3389/fped.2022.1071839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
Early identification of the dermatologic manifestations of SARS-CoV-2 in perinatal and maternal-fetal-infant populations is essential for early intervention in the diagnosis, treatment, and prevention of short and long term sequelae. Although cutaneous signs of SARS-CoV-2 are less common in pregnant women, neonates, and infants, the recognition of related skin lesions with regard to timing, location, duration, and pattern can lead to determining disease severity. While many pediatric patients may be asymptomatic with negative SARS-CoV-2 testing, skin lesions may be the only clue of infection. SARS-CoV-2 infection in pregnancy can lead to severe life threatening illness and by understanding the cutaneous manifestations associated with SARS-CoV-2 infection, early diagnosis can be made with improved maternal-fetal outcomes. A wide array of dermatologic presentations associated with SARS-CoV-2 are reported in the literature. This review explores the expanding reports in the literature of the dermatologic presentations of skin lesions related to SARS-CoV-2 specifically in perinatal and maternal-fetal-infant health and the implications for management. The collaboration of the specialties of dermatology, pediatrics, obstetrics/gynecology, and infectious disease in the approach to SARS-CoV-2 disease can lead to a better understanding of the scope and presentation of this disease.
Collapse
Affiliation(s)
- Elaine M Young
- Adult and Pediatric Dermatology, Private Practice, Huntington, WV, United States.,Department of Internal Medicine, Joan C. Edwards School of Medicine, Huntington, WV, United States
| |
Collapse
|
5
|
Sadeghzadeh‐Bazargan A, Rezai M, Najar Nobari N, Mozafarpoor S, Goodarzi A. Skin manifestations as potential symptoms of diffuse vascular injury in critical COVID-19 patients. J Cutan Pathol 2021; 48:1266-1276. [PMID: 33978234 PMCID: PMC8239514 DOI: 10.1111/cup.14059] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
As a respiratory viral infection caused by a novel coronavirus, COVID-19 became rapidly pandemic within a few months. Despite the wide range of manifestations and organ involvement in COVID-19 patients, the exact pathogenesis of severe and fatal types of COVID-19 and causes involved with the individual base of the disease is not yet understood. Several studies have reported clinical, laboratory, and histopathological data in favor of vascular injury in multiple organs of critically ill patients with COVID-19 as a result of hyperactive immune response, inflammation, and cytokine storm. Also, both clinical and histopathological evidence points to such vascular involvements in the skin. Given the ease of clinical examinations and skin biopsy and the lower risks of transmission of COVID-19 to healthcare workers, the present review article was conducted to investigate the vascular skin manifestations of COVID-19 patients clinically and/or histopathologically as helpful clues for better understanding the pathogenesis and predicting the prognosis of the disease, especially in severe cases.
Collapse
Affiliation(s)
| | - Mahdi Rezai
- Department of Emergency Medicine Management Research Center, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Samaneh Mozafarpoor
- Dermatologist, Skin Disease and Leishmaniasis Research Center, Department of DermatologyIsfahan University of Medical SciencesIsfahanIran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| |
Collapse
|
6
|
Bronz G, Rinoldi PO, Lavagno C, Bianchetti MG, Lava SA, Vanoni F, Milani GP, Terrani I, Ferrarini A. Skin Eruptions in Acute Hemorrhagic Edema of Young Children: Systematic Review of the Literature. Dermatology 2021; 238:397-403. [PMID: 34551420 PMCID: PMC9153327 DOI: 10.1159/000519009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute hemorrhagic edema is a skin-limited small-vessel leukocytoclastic vasculitis, which affects infants 4 weeks to 2 years of age and remits within 3 weeks. The diagnosis is made clinically in not-ill appearing children with acute onset of raised annular or nummular eruptions and edema. In this vasculitis, type, distribution, and evolution of the rash have never been systemically investigated. To address this issue, we employed the data contained in the Acute Hemorrhagic Edema Bibliographic Database, which incorporates all reports on acute hemorrhagic edema. SUMMARY Key features of rash were documented in 383 children. Annular eruptions in a strict sense, usually targetoid, were reported in 375 (98%) cases (many children also presented polycyclic or arciform eruptions). Nummular eruptions were also very common (n = 358; 93%). Purpuric eruptions and ecchymoses were reported in the vast majority of cases. Macules and wheals were described in a minority of cases. Edema, detected in all cases, was mostly painful, indurated and nonpitting. The following regions were affected, in decreasing order, by annular or nummular eruptions: legs, feet, face, arms, ears, trunk, and genitals. With the exception of feet, which were very often affected, the same distribution was reported for edema. The initial eruption was often a wheal or a macule that evolved into a nummular or an annular eruption. Nummular eruptions successively evolved into annular ones. KEY MESSAGE This study carefully characterizes type, distribution, and evolution of skin eruption in acute hemorrhagic edema. The data help physicians to rapidly and noninvasively make the clinical diagnosis of this vasculitis.
Collapse
Affiliation(s)
- Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro O. Rinoldi
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Camilla Lavagno
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Mario G. Bianchetti
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sebastiano A.G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Federica Vanoni
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Isabella Terrani
- Department of Dermatology, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | |
Collapse
|
7
|
Palomo-Pérez JC, Vega-Memije ME, Aguilar-Blancas D, González-Martínez E, Rangel-Gamboa L. Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature. SAGE Open Med Case Rep 2021; 9:2050313X21997194. [PMID: 33747514 PMCID: PMC7905726 DOI: 10.1177/2050313x21997194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.
Collapse
Affiliation(s)
- Juan Carlos Palomo-Pérez
- External Consultation Division, General Hospital Dr. Manuel Gea González, Ciudad de México, México.,Tláhuac General Hospital, Ciudad de México, México
| | | | | | - Erik González-Martínez
- Ecology of Pathogenic Agents Deparment, Researcher Division, General Hospital Dr. Manuel Gea González, Ciudad de México, México
| | - Lucia Rangel-Gamboa
- Ecology of Pathogenic Agents Deparment, Researcher Division, General Hospital Dr. Manuel Gea González, Ciudad de México, México.,Private Practice, Luminox Skin Centre, Ciudad de México, México
| |
Collapse
|
8
|
Jamshidi P, Hajikhani B, Mirsaeidi M, Vahidnezhad H, Dadashi M, Nasiri MJ. Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review. Front Med (Lausanne) 2021; 8:634208. [PMID: 33665200 PMCID: PMC7921489 DOI: 10.3389/fmed.2021.634208] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19. Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: "SARS-CoV-2" or "COVID-19" or "new coronavirus" or "Wuhan Coronavirus" or "coronavirus disease 2019" and "skin disease" or "skin manifestation" or "cutaneous manifestation." Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%). Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.
Collapse
Affiliation(s)
- Parnian Jamshidi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
AlGhoozi DA, AlKhayyat HM. A child with Henoch-Schonlein purpura secondary to a COVID-19 infection. BMJ Case Rep 2021; 14:e239910. [PMID: 33408113 PMCID: PMC10577763 DOI: 10.1136/bcr-2020-239910] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/04/2022] Open
Abstract
Henoch-Schonlein purpura (HSP) is a common IgA-mediated small vessel vasculitis of childhood that affects several systems. It is characterised by a tetrad of dermatological, abdominal, joint and renal manifestations. HSP can occur secondary to upper respiratory tract infections, medications, vaccinations and malignancies. COVID-19 is caused by SARS-CoV-2, a single-stranded RNA virus from the Beta-Coronaviridae family, and often presents as a respiratory infection with symptoms ranging from a mild common cold-like illness to severe pneumonia. It has also been reported to exhibit extrapulmonary manifestations, including but not limited to cardiac, thrombotic, hepatocellular and dermatological complications. We report a case of a 4-year-old boy who presented with clinical features of HSP, with detailed history that revealed a recent recovery from a COVID-19 upper respiratory tract infection, indicating a possible correlation between the two.
Collapse
|
10
|
Abstract
Background/aim Sars-CoV-2 virus infection (COVID-19) was observed in China in the last months of 2019. In the period following, this infection spread all over the world. In March 2020 the World Health Organization announced the existence of a pandemic. The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents. Materials and methods In PubMed, Google Scholar databases, skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects are searched in detail. Results Pressure injury, contact dermatitis, itching, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. Skin problems related to personal hygiene measures could include itching, dryness, and contact dermatitis. Skin findings may also be observed in SARS-CoV-2 virus infections. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc. are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin findings. However, in asymptomatic or presymptomatic COVID-19 patients in particular, skin lesions can lead to the diagnosis of COVID-19. In addition, skin lesions may occur due to COVID-19 treatment agents. Conclusion Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in this pandemic period.
Collapse
Affiliation(s)
- Ülker GÜL
- Department of Dermatology, Gülhane Faculty of Medicine, Health Sciences University, İstanbulTurkey
| |
Collapse
|
11
|
González-Arnay E, Martín-Olivera R, Quintero-Quintero YC, Hernández-Guerra AI. Proposal for a harmonized protocol for COVID-19 screening and necropsy in forensic sciences facilities. J Forensic Leg Med 2020; 76:102067. [PMID: 33032204 PMCID: PMC7834631 DOI: 10.1016/j.jflm.2020.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/13/2020] [Accepted: 09/26/2020] [Indexed: 02/06/2023]
Abstract
On 31 December 2019, health authorities in the People's Republic of China informed the World Health Organization of a then limited outbreak of interstitial viral pneumonia, identified at a laboratory in the city of Wuhan. In mid-April 2020 this outbreak of COVID-19 (as the disease has been called) has aggravated and spread worldwide, causing more than 200,000 deaths and affecting especially the United States, Spain, Italy, France and the United Kingdom. Despite the severity of the outbreak, the pathological findings have not been described in detail and there are very few guidelines or protocols for conducting autopsy studies on patients who have died from COVID-19. There are currently very few histopathological case series studies on this disease. In addition, some of these studies have been performed on biopsies or surgical resection pieces from patients in whom disease was subsequently demonstrated or through minimally invasive autopsy protocols. None of the studies offer a detailed necropsy protocol. This document proposes a protocol of action for the institutes of Forensic Medicine facing the current SARS-CoV2 pandemic, which combines protection of worker safety with optimization of tissue collection.
Collapse
Affiliation(s)
- Emilio González-Arnay
- Applied Anatomy Laboratory. Department of Anatomy, Histology and Neuroscience. Autonomous University of Madrid, Calle Arzobispo Morcillo, 4, 28029, Madrid, Spain; Division of Pathology, Canary Islands University Hospital, La Laguna, Canary Islands, Spain.
| | - Raquel Martín-Olivera
- Institute for Legal Medicine and Forensic Sciences. Santa Cruz de Tenerife, Canary Islands, Spain
| | - Yamilet C Quintero-Quintero
- Division of Histopathology of the National Institute of Toxicology and Forensic Sciences (Canary Islands Section), Santa Cruz de Tenerife, Canary Islands, Spain
| | - Ana I Hernández-Guerra
- Division of Histopathology of the National Institute of Toxicology and Forensic Sciences (Canary Islands Section), Santa Cruz de Tenerife, Canary Islands, Spain
| |
Collapse
|
12
|
Navaeifar MR, Poudineh Ghazaghi M, Shahbaznejad L, Rouhanizadeh H, Abutalebi M, Ranjbar Varandi M, Rezai MS. Fever with Rash is One of the First Presentations of COVID-19 in Children: A Case Report. Int Med Case Rep J 2020; 13:335-340. [PMID: 32821174 PMCID: PMC7425085 DOI: 10.2147/imcrj.s262935] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/10/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Clinical presentations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vary among patients, which make a confusing challenge for clinicians to diagnose the disease. While the disease is not rare, but the symptoms may be atypical in children. CASE PRESENTATION A 12-month-old boy with fever and rash without respiratory complaints at the onset of the disease presented to the hospital. His illness was then accompanied by severe anemia, hypoalbuminemia, hypoxemia, and pleural effusion. The nasopharyngeal swab polymerase chain reaction test was positive for the novel coronavirus. Despite primary normal lung imaging, the second imaging was typical for the disease on the third day of admission. DISCUSSION Dermatologic manifestations of the novel coronavirus infection are not rare during the illness but rarely occur at the onset of the disease. Information about the cutaneous manifestations of SARS-CoV-2 and its time interval from the onset of the disease in children are not clear yet. Severe anemia, hypoalbuminemia, and pleural effusion are not reported as classic findings of the novel SARS-CoV-2. They may be considered as a consequence of the hyperinflammatory response or direct effect of the virus. CONCLUSION As a different manifestation of SARS-CoV-2, infected children may initially present fever and rash. More studies are needed to discover the cause of these complications. The correct answer may lead to better insight and more effective treatment.
Collapse
Affiliation(s)
- Mohammad Reza Navaeifar
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Leila Shahbaznejad
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamed Rouhanizadeh
- Pediatric Department, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahnush Abutalebi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
13
|
Estébanez A, Pérez-Santiago L, Silva E, Guillen-Climent S, García-Vázquez A, Ramón MD. Cutaneous manifestations in COVID-19: a new contribution. J Eur Acad Dermatol Venereol 2020; 34:e250-e251. [PMID: 32294264 PMCID: PMC7262266 DOI: 10.1111/jdv.16474] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Affiliation(s)
- A Estébanez
- Department of Dermatology, Clinical University Hospital, University of Valencia, Valencia, Spain
| | - L Pérez-Santiago
- Department of Surgery, Clinical University Hospital, University of Valencia, Valencia, Spain
| | - E Silva
- Department of Dermatology, Clinical University Hospital, University of Valencia, Valencia, Spain
| | - S Guillen-Climent
- Department of Dermatology, Clinical University Hospital, University of Valencia, Valencia, Spain
| | - A García-Vázquez
- Department of Dermatology, Clinical University Hospital, University of Valencia, Valencia, Spain
| | - M D Ramón
- Department of Dermatology, Clinical University Hospital, University of Valencia, Valencia, Spain
| |
Collapse
|
14
|
AbdelMassih AF, AbdelAzeam AS, Ayad A, Kamel AY, Khalil A, Kotb B, Waheed D, Menshawey E, Sefein F, Taha F, Ismail HA, Osman I, Iskander J, El Wakil L, Rashad L, Arsanyous MB, El Shershaby M, Mansour M, Ashraf M, Hafez N, Abuzeid NM, AbdElSalam NMN, Hafez NG, Youssef N, Hozaien R, Saeed R, Kamel D, AbdelHameed MA, Ali S. Unleashing the mysterious link between COVID-19 and a famous childhood vasculitis: Kawasaki disease. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [PMCID: PMC7358563 DOI: 10.1186/s43054-020-00029-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) emerged as a small outbreak in Wuhan rapidly progressing into the deadliest pandemic since the Spanish flu of 1918. The disease was deemed trivial in children, until the reporting, few days ago, of an emerging pediatric multi-inflammatory syndrome mimicking Kawasaki disease (KD). Main body This report reveals that coronaviridae were implicated in induction of several post-infectious vasculitides, namely, KD, AHEI, and HSP. This occurs in genetically susceptible individuals to vascular inflammation. Shared genetic susceptibilities between KD and CoV include genes encoding for CD 40, HLAB-15:03, and ACE. This leads to augmented inflammation with hypersecretion of cytokines especially IL-6. Conclusion The revealed relationships between KD and CoV can help to predict the risk of KD in COVID-19 patients through screening levels of upregulated cytokines. It might also signify that classic treatment of KD with IVIG might need to be replaced with anti-cytokine therapy in COVID-19 patients.
Collapse
|
15
|
Landa N, Mendieta-Eckert M, Fonda-Pascual P, Aguirre T. Chilblain-like lesions on feet and hands during the COVID-19 Pandemic. Int J Dermatol 2020; 59:739-743. [PMID: 32329897 PMCID: PMC7264591 DOI: 10.1111/ijd.14937] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Nerea Landa
- Department of Dermatology, Dermitek Clinic - Grupo stop, Bilbao, Spain
| | | | | | - Teresa Aguirre
- Primary Care Physician, Centro Bombero Echaniz, Bilbao, Spain
| |
Collapse
|
16
|
Reply to: "Various forms of skin rash in COVID-19: Petechial rash in a patient with COVID-19 infection". J Am Acad Dermatol 2020; 83:e143. [PMID: 32283235 PMCID: PMC7151475 DOI: 10.1016/j.jaad.2020.04.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
|