1
|
Pizzo F, Marino A, Di Nora A, Spampinato S, Cacciaguerra G, Costanza G, Scarlata F, Biasco A, Consentino MC, Lubrano R, Cacopardo B, Nunnari G, Ruggieri M, Pavone P. Urea/Creatinine Ratio's Correlation with Creatine Kinase Normalization in Pediatric COVID-19 Patients with Myositis: Evaluating Prognostic and Predictive Value. Infect Dis Rep 2023; 16:13-25. [PMID: 38247974 PMCID: PMC10801615 DOI: 10.3390/idr16010002] [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: 11/04/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been chiefly linked with substantial respiratory complications. However, emerging studies have brought attention to the occurrence of severe muscle inflammation (myositis) related to COVID-19, potentially leading to multi-organ failure and increased mortality. Myositis is generally characterized by heightened serum creatine kinase (CK) levels. Acute myositis is characterized by an infiltration of viruses into calf muscle fibers, which may cause a subsequent inflammatory response leading to calf muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. While the association between myositis and severe outcomes has been recognized in adults, it remains less understood in the pediatric population. The current retrospective study, conducted at Policlinico San Marco University Hospital in Catania, aimed to analyze clinical and laboratory factors associated with myositis in pediatric patients with SARS-CoV-2 infection. Between January 2022 and January 2023, ten pediatric patients diagnosed with myositis and SARS-CoV-2 infection were evaluated. The study highlighted clinical manifestations such as fever, calf muscle pain, and abnormal gait. Lab results showed elevated CK levels among other findings. All patients underwent treatment, with the majority recovering without complications. A notable correlation was observed between CK levels, blood urea nitrogen (BUN), and the urea/creatinine ratio (UCR). The study also discusses potential pathophysiological mechanisms behind SARS-CoV-2's impact on skeletal muscles, emphasizing an indirect inflammatory response. Our findings underscore that while myositis in children with SARS-CoV-2 infection appears to follow a benign and self-limiting trajectory, it is crucial to monitor specific markers for early intervention and management. Further research is warranted to elucidate the underlying mechanisms and improve clinical outcomes.
Collapse
Affiliation(s)
- Francesco Pizzo
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Andrea Marino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy; (B.C.); (G.N.)
| | - Alessandra Di Nora
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Serena Spampinato
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Giovanni Cacciaguerra
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Giuseppe Costanza
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Federica Scarlata
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Arturo Biasco
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Maria Chiara Consentino
- Postgraduate Training Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (F.P.); (A.D.N.); (G.C.); (G.C.); (F.S.); (A.B.); (M.C.C.)
| | - Riccardo Lubrano
- Department of Paediatrics, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy;
| | - Bruno Cacopardo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy; (B.C.); (G.N.)
| | - Giuseppe Nunnari
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy; (B.C.); (G.N.)
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital “Policlinico G. Rodolico”, 95125 Catania, Italy;
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital “Policlinico G. Rodolico”, 95125 Catania, Italy;
| |
Collapse
|
2
|
Nashwan AJ, Alassaf A, Abujaber AA, Al Wraidat M, Ananthegowda DC, Al-Kaabi SK, Othman M, Ahmad MK, Al Maslamani M, Khatib M. Rhabdomyolysis in Critically Ill Patients With COVID-19: A Retrospective Study. Cureus 2023; 15:e37333. [PMID: 37181981 PMCID: PMC10168594 DOI: 10.7759/cureus.37333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION The total number of ICU admissions for COVID-19 patients has increased steadily. Based on the research team's clinical observations, many patients developed rhabdomyolysis, but few cases were reported in the literature. This study explores the incidence of rhabdomyolysis and its outcomes, like mortality, the need for intubation, acute kidney injury, and the need for renal replacement therapy (RRT). METHODS We retrospectively reviewed the characteristics and outcomes of patients admitted to the ICU at a COVID-19-designated hospital in Qatar between March and July 2020. Logistic regression analysis was used to determine factors associated with mortality. RESULTS 1079 patients with COVID-19 were admitted to the ICU, and 146 developed rhabdomyolysis. Overall, 30.1% died (n = 44), and 40.4% developed Acute Kidney Injury (AKI) (n = 59), with only 19 cases (13%) recovering from the AKI. AKI was significantly associated with increased mortality rates among rhabdomyolysis patients. Moreover, significant differences were found between groups regarding the subject's age, calcium level, phosphorus level, and urine output. However, the AKI was the best predictor of mortality for those who got the COVID-19 infection and rhabdomyolysis. CONCLUSION Rhabdomyolysis increases the risk of death in COVID-19 patients admitted to the ICU. The strongest predictor of a fatal outcome was acute kidney injury. The findings of this study emphasize the importance of early identification and prompt treatment of rhabdomyolysis in patients with severe COVID-19.
Collapse
Affiliation(s)
| | - Anood Alassaf
- Pediatrics Department, Hamad Medical Corporation, Doha, QAT
| | | | | | | | | | | | | | | | - Mohamad Khatib
- Critical Care Medicine, Hamad Medical Corporation, Doha, QAT
| |
Collapse
|
3
|
Geeting D, Alibrahim O, Patel M, Kumar R, Mallory P. COVID-19 and Severe Rhabdomyolysis Causing Acute Kidney Injury and Life-Threatening Hyperkalemia in a Pediatric Patient: a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:121. [PMID: 37073177 PMCID: PMC10090753 DOI: 10.1007/s42399-023-01453-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
Though initially believed to primarily be a respiratory pathogen, the SARS-CoV-2 virus has manifested as a virus that has the potential to affect multiple organ systems causing a wide variety of disease and symptomatology. Children have been largely spared in comparison to adult morbidity and mortality; however, acute pediatric illness secondary to COVID-19 infection has become both more common and more serious. Here, we present a teenager with acute COVID-19 who presented to the hospital with profound weakness and oliguria and was discovered to have severe rhabdomyolysis causing life-threatening hyperkalemia and acute kidney injury. He required treatment with emergent renal replacement therapy in the intensive care unit. His initial CK was 584,886 U/L. Creatinine was 14.1 mg/dL and potassium was 9.9 mmol/L. He was successfully treated with CRRT and was discharged on hospital day 13 with normal kidney function on follow-up. Rhabdomyolysis and acute kidney injury are increasingly recognized as complications of acute SARS-CoV-2 infection and require vigilance given the potentially fatal complications and long-standing morbidity associated with these conditions.
Collapse
Affiliation(s)
- Danielle Geeting
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Omar Alibrahim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Mital Patel
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Reeti Kumar
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| | - Palen Mallory
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital and Health System, Durham, NC USA
| |
Collapse
|
4
|
Rhabdomyolysis in Pediatric Patients with SARS-CoV-2 Infection. CHILDREN 2022; 9:children9101441. [PMID: 36291377 PMCID: PMC9600903 DOI: 10.3390/children9101441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 02/06/2023]
Abstract
Background: Rhabdomyolysis is a rare but severe complication in adult patients with Coronavirus disease 2019 (COVID-19), which can result in acute kidney injury and death; however, it is rarely reported in pediatric patients. Methods: In this study, we retrospectively reviewed the clinical features and outcomes of rhabdomyolysis in pediatric patients aged 0–18 years with COVID-19 who were hospitalized at Taipei Tzu Chi Hospital, an epicenter of COVID-19 in northern Taiwan. Results: We treated eight patients with rhabdomyolysis during the omicron variant-Severe acute respiratory syndrome coronavirus 2 (omicron variant-SARS-CoV-2) community outbreak and none during the alpha variant endemic. These eight patients shared stereotypical presentations, including the presence of bilateral calf pain after defervescence. The creatinine kinase (CK) levels were between 1346 and 6937 U/L on admission, and clinical course was uneventful after aggressive saline hydration. Conclusion: Rhabdomyolysis is not a rare complication in pediatric patients with the omicron-SARS-CoV-2 infection, and reassurance of a good prognosis is important to alleviate family anxiety.
Collapse
|
5
|
Kermond R, Cavazzoni E, Kilo T, Britton PN, Durkan A. COVID-19-associated rhabdomyolysis in a paediatric patient with sickle cell trait. J Paediatr Child Health 2022; 58:1664-1665. [PMID: 34964528 DOI: 10.1111/jpc.15867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/08/2021] [Indexed: 01/04/2023]
Affiliation(s)
- Rachael Kermond
- Department of Nephrology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Elena Cavazzoni
- Department of Paediatric Intensive Care, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Tatjana Kilo
- Department of Haematology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Phillip N Britton
- Department of Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anne Durkan
- Department of Nephrology, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Kontou M, Kakleas K, Kimioni V, Georgiadi D, Spoulou V, Michos A. Rhabdomyolysis and coronavirus disease-2019 in children: A case report and review of the literature. Pediatr Investig 2022; 6:135-139. [PMID: 35774521 PMCID: PMC9218973 DOI: 10.1002/ped4.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Coronavirus disease-2019 (COVID-19) presents with a variety of symptoms, but rhabdomyolysis has rarely been reported in children. Case presentation We report a 10-year-old girl who presented with fever, myalgia, and limping. The patient was tested positive for severe acute respiratory syndrome coronavirus-2. On admission, creatine kinase (CK) level was 13 147 units per liter and the patient was diagnosed with rhabdomyolysis. She was treated with intravenous fluids, which resulted in CK levels decrease. There are currently seven case reports of children with rhabdomyolysis associated with acute COVID-19 infection and two reports with the multisystemic inflammatory syndrome. Conclusion Children presenting with muscle pain and weakness in the acute phase or following COVID-19 infection, should alert physicians of the possibility of rhabdomyolysis.
Collapse
Affiliation(s)
- Maria Kontou
- First Department of PediatricsInfectious Diseases and Chemotherapy Research LaboratoryMedical School“Aghia Sophia” Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Konstantinos Kakleas
- First Department of PediatricsInfectious Diseases and Chemotherapy Research LaboratoryMedical School“Aghia Sophia” Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Vaso Kimioni
- First Department of PediatricsInfectious Diseases and Chemotherapy Research LaboratoryMedical School“Aghia Sophia” Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Dimitra Georgiadi
- First Department of PediatricsInfectious Diseases and Chemotherapy Research LaboratoryMedical School“Aghia Sophia” Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Vasiliki Spoulou
- First Department of PediatricsInfectious Diseases and Chemotherapy Research LaboratoryMedical School“Aghia Sophia” Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Athanasios Michos
- First Department of PediatricsInfectious Diseases and Chemotherapy Research LaboratoryMedical School“Aghia Sophia” Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| |
Collapse
|
7
|
Silva J, Patricio F, Patricio-Martínez A, Santos-López G, Cedillo L, Tizabi Y, Limón ID. Neuropathological Aspects of SARS-CoV-2 Infection: Significance for Both Alzheimer's and Parkinson's Disease. Front Neurosci 2022; 16:867825. [PMID: 35592266 PMCID: PMC9111171 DOI: 10.3389/fnins.2022.867825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/14/2022] [Indexed: 01/08/2023] Open
Abstract
Evidence suggests that SARS-CoV-2 entry into the central nervous system can result in neurological and/or neurodegenerative diseases. In this review, routes of SARS-Cov-2 entry into the brain via neuroinvasive pathways such as transcribrial, ocular surface or hematogenous system are discussed. It is argued that SARS-Cov-2-induced cytokine storm, neuroinflammation and oxidative stress increase the risk of developing neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. Further studies on the effects of SARS-CoV-2 and its variants on protein aggregation, glia or microglia activation, and blood-brain barrier are warranted.
Collapse
Affiliation(s)
- Jaime Silva
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Felipe Patricio
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Aleidy Patricio-Martínez
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- Facultad de Ciencias Biológicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Gerardo Santos-López
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Mexico
| | - Lilia Cedillo
- Centro de Detección Biomolecular, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, United States
| | - Ilhuicamina Daniel Limón
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| |
Collapse
|
8
|
A Comprehensive Review of Neuromuscular Manifestations of COVID-19 and Management of Pre-Existing Neuromuscular Disorders in Children. J Clin Med 2022; 11:jcm11040934. [PMID: 35207206 PMCID: PMC8876161 DOI: 10.3390/jcm11040934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Since the emergence of SARS-CoV-2, several studies have been published describing neuromuscular manifestations of the disease, as well as management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic. These disorders include muscular dystrophies, myasthenic syndromes, peripheral nerve disorders, and spinal muscular atrophy. Such patients are a vulnerable population due to frequent complications such as scoliosis, cardiomyopathy, and restrictive lung disease that put them at risk of severe complications of COVID-19. In this review, neuromuscular manifestations of COVID-19 in children and the management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic are discussed. We also review strategies to alleviate pandemic-associated disruptions in clinical care and research, including the emerging role of telemedicine and telerehabilitation to address the continued special needs of these patients.
Collapse
|
9
|
Severe Rhabdomyolysis in a Child With Multisystem Inflammatory Syndrome: An Autoimmune Mechanism? Pediatr Neurol 2021; 124:11-12. [PMID: 34507248 PMCID: PMC8349362 DOI: 10.1016/j.pediatrneurol.2021.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/02/2021] [Accepted: 07/31/2021] [Indexed: 01/01/2023]
|
10
|
Finsterer J, Scorza F. SARS-CoV-2 associated rhabdomyolysis in 32 patients. Turk J Med Sci 2021; 51:1598-1601. [PMID: 33576584 PMCID: PMC8283436 DOI: 10.3906/sag-2012-327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background/aim This mini-review aims at summarising and discussing previous and recent findings concerning the clinical manifestations, therapeutic management, and outcome of SARS-CoV-2 associated rhabdomyolysis. Materials and methods Literature search in the PubMed database by applying appropriate search terms. Results A total of 26 articles reporting SARS-CoV-2 associated rhabdomyolysis in 32 patients were identified. Age ranged from 16 to 80 years. Four patients were female and 25 were male. Onset of rhabdomyolysis was prior to onset of COVID-19 in 7 patients, and after onset of COVID-19 in the remaining patients. Exposure to myotoxic medication was identified in 18 patients. Myotoxic drugs these patients were taking at the time rhabdomyolysis included azithromycin, hydroxy-chloroquine, placitaxel, propofol, imastinib, piperacillin and meropenem, hydrochlorothiazide, and acetaminophen. Peak creatine-kinase values ranged from 328 to >427656 U/l. The outcome was unreported in 8 cases, favourable in 15 partial, incomplete in 3 cases, and lethal in 6 cases. Conclusion SARS-CoV-2 associated rhabdomyolysis is rare, may be most frequently due to the side effects of myotoxic anti-COVID-19 drugs, and only rarely due to virus myositis, and may have a favourable outcome in most patients.
Collapse
Affiliation(s)
- Josef Finsterer
- Department of Neurology, Klinik Landstrasse, Messerli Institute, Vienna, Austria
| | - Fulvio Scorza
- Department of Neuroscience. Federal University of São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| |
Collapse
|