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Valente-Acosta B, Moreno-Sánchez F, Neme-Yunes Y, López-Rueda S, Hoyo-Ulloa I, Garcia-Gutierrez M. Concomitant Cytomegalovirus Viraemia in Multisystem Inflammatory Syndrome in Adults (MIS-A) following COVID-19. Case Rep Infect Dis 2024; 2024:8852063. [PMID: 38590710 PMCID: PMC11001470 DOI: 10.1155/2024/8852063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is recognised as an infrequent complication of coronavirus disease 2019 (COVID-19). This syndrome occurs following COVID-19 infection in some individuals and is characterised by inflammation of multiple organ systems, such as the heart, liver, bowel, and lymph nodes. Cytomegalovirus (CMV) viraemia is associated primarily with immunosuppression. In COVID-19 patients, it has been reported in severe and critical cases. We present a case of an adult patient diagnosed with MIS-A and concomitant CMV viraemia.
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Affiliation(s)
- Benjamin Valente-Acosta
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Francisco Moreno-Sánchez
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Yvette Neme-Yunes
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Sara López-Rueda
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Irma Hoyo-Ulloa
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
| | - Mónica Garcia-Gutierrez
- The American British Cowdray Medical Center, Sur 136 116, Alvaro Obregon, Mexico City 01120, Mexico
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Bohmwald K, Diethelm-Varela B, Rodríguez-Guilarte L, Rivera T, Riedel CA, González PA, Kalergis AM. Pathophysiological, immunological, and inflammatory features of long COVID. Front Immunol 2024; 15:1341600. [PMID: 38482000 PMCID: PMC10932978 DOI: 10.3389/fimmu.2024.1341600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/09/2024] [Indexed: 04/12/2024] Open
Abstract
The COVID-19 pandemic continues to cause severe global disruption, resulting in significant excess mortality, overwhelming healthcare systems, and imposing substantial social and economic burdens on nations. While most of the attention and therapeutic efforts have concentrated on the acute phase of the disease, a notable proportion of survivors experience persistent symptoms post-infection clearance. This diverse set of symptoms, loosely categorized as long COVID, presents a potential additional public health crisis. It is estimated that 1 in 5 COVID-19 survivors exhibit clinical manifestations consistent with long COVID. Despite this prevalence, the mechanisms and pathophysiology of long COVID remain poorly understood. Alarmingly, evidence suggests that a significant proportion of cases within this clinical condition develop debilitating or disabling symptoms. Hence, urgent priority should be given to further studies on this condition to equip global public health systems for its management. This review provides an overview of available information on this emerging clinical condition, focusing on the affected individuals' epidemiology, pathophysiological mechanisms, and immunological and inflammatory profiles.
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Affiliation(s)
- Karen Bohmwald
- Millennium Institute on Immunology and Immunotherapy. Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Benjamín Diethelm-Varela
- Millennium Institute on Immunology and Immunotherapy. Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Linmar Rodríguez-Guilarte
- Millennium Institute on Immunology and Immunotherapy. Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Thomas Rivera
- Millennium Institute on Immunology and Immunotherapy. Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Pablo A. González
- Millennium Institute on Immunology and Immunotherapy. Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy. Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Huang J, Guo Z, Duan J, Zou Y, Chen K, Huang H, Zhang S, Zhou Y. Tissue expression of the SARS-CoV-2 cell receptor gene ACE2 in children. J Trop Pediatr 2023; 69:fmad027. [PMID: 37674390 DOI: 10.1093/tropej/fmad027] [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] [Indexed: 09/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has become a significant global public health problem. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes the disease, utilizes angiotensin-converting enzyme II (ACE2) as a major functional receptor to enter host cells. No study has systematically assessed ACE2 expression in multiple tissues in children. This study investigated ACE2 expression and ACE2 protein's histological distribution in various organs in paediatric patients (the small intestine, thymus, heart and lungs). Our study revealed that ACE2 was highly expressed in enterocytes of the small intestine and widely expressed in the myocardium of heart tissues. The most notable finding was the positive staining of ACE2 in the Hassall's corpuscles epithelial cells. Negligible ACE2 expression in the lung tissues may contribute to a lower risk of infection and fewer symptoms of pneumonia in children than in adults with COVID-19 infection. These findings provide initial evidence for understanding SARS-CoV-2 pathogenesis and prevention strategies in paediatric clinical practice, which should be applicable for all children worldwide.
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Affiliation(s)
- Jiyi Huang
- Central Laboratory, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Zhibin Guo
- Central Laboratory, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Junkai Duan
- Pediatric Heart Disease Treatment Center, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Yong Zou
- Pediatric Heart Disease Treatment Center, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Kuai Chen
- Department of Neonatal Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Hui Huang
- Department of Pathology, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Sheng Zhang
- Pediatric Heart Disease Treatment Center, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
| | - Yunguo Zhou
- Pediatric Heart Disease Treatment Center, Jiangxi Provincial Children's Hospital, Nanchang 330006, China
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Buonsenso D, Martino L, Morello R, Mariani F, Fearnley K, Valentini P. Viral persistence in children infected with SARS-CoV-2: current evidence and future research strategies. THE LANCET. MICROBE 2023; 4:e745-e756. [PMID: 37385286 PMCID: PMC10292824 DOI: 10.1016/s2666-5247(23)00115-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 07/01/2023]
Abstract
In this Personal View, we discuss current knowledge on SARS-CoV-2 RNA or antigen persistence in children infected with SARS-CoV-2. Based on the evidence that the virus can persist in adults, we have done a literature review and analysed studies that looked for SARS-CoV-2 RNA or antigens in children undergoing autopsy, biopsy, or surgery for either death from COVID-19 or multisystem inflammatory syndrome, or assessments for long COVID-19 or other conditions. Our analysis suggests that in children, independent from disease severity, SARS-CoV-2 can spread systemically and persist for weeks to months. We discuss what is known about the biological effects of viral persistence for other viral infections and highlight new scenarios for clinical, pharmacological, and basic research exploration. Such an approach will improve the understanding and management of post-viral syndromes.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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Alhumaid S, Alabdulqader M, Al Dossary N, Al Alawi Z, Alnaim AA, Al Mutared KM, Al Noaim K, Al Ghamdi MA, Albahrani SJ, Alahmari AA, Al Hajji Mohammed SM, Almatawah YA, Bayameen OM, Alismaeel AA, Alzamil SK, Alturki SA, Albrahim ZR, Al Bagshi NA, Alshawareb HY, Alhudar JA, Algurairy QA, Alghadeer SM, Alhadab HA, Aljubran TN, Alabdulaly YA, Al Mutair A, Rabaan AA. Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7110380. [PMID: 36422931 PMCID: PMC9698370 DOI: 10.3390/tropicalmed7110380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. Objectives: To identify the type and proportion of coinfections with SARS-CoV-2 and bacteria, fungi, and/or respiratory viruses, and investigate the severity of COVID-19 in children. Methods: For this systematic review and meta-analysis, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus, and Nature through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies on the incidence of COVID-19 in children with bacterial, fungal, and/or respiratory coinfections, published from 1 December 2019 to 1 October 2022, with English language restriction. Results: Of the 169 papers that were identified, 130 articles were included in the systematic review (57 cohort, 52 case report, and 21 case series studies) and 34 articles (23 cohort, eight case series, and three case report studies) were included in the meta-analysis. Of the 17,588 COVID-19 children who were tested for co-pathogens, bacterial, fungal, and/or respiratory viral coinfections were reported (n = 1633, 9.3%). The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: n = 204, 59.1% compared to female gender: n = 141, 40.9%). The majority of the cases belonged to White (Caucasian) (n = 441, 53.3%), Asian (n = 205, 24.8%), Indian (n = 71, 8.6%), and Black (n = 51, 6.2%) ethnicities. The overall pooled proportions of children with laboratory-confirmed COVID-19 who had bacterial, fungal, and respiratory viral coinfections were 4.73% (95% CI 3.86 to 5.60, n = 445, 34 studies, I2 85%, p < 0.01), 0.98% (95% CI 0.13 to 1.83, n = 17, six studies, I2 49%, p < 0.08), and 5.41% (95% CI 4.48 to 6.34, n = 441, 32 studies, I2 87%, p < 0.01), respectively. Children with COVID-19 in the ICU had higher coinfections compared to ICU and non-ICU patients, as follows: respiratory viral (6.61%, 95% CI 5.06−8.17, I2 = 0% versus 5.31%, 95% CI 4.31−6.30, I2 = 88%) and fungal (1.72%, 95% CI 0.45−2.99, I2 = 0% versus 0.62%, 95% CI 0.00−1.55, I2 = 54%); however, COVID-19 children admitted to the ICU had a lower bacterial coinfection compared to the COVID-19 children in the ICU and non-ICU group (3.02%, 95% CI 1.70−4.34, I2 = 0% versus 4.91%, 95% CI 3.97−5.84, I2 = 87%). The most common identified virus and bacterium in children with COVID-19 were RSV (n = 342, 31.4%) and Mycoplasma pneumonia (n = 120, 23.1%). Conclusion: Children with COVID-19 seem to have distinctly lower rates of bacterial, fungal, and/or respiratory viral coinfections than adults. RSV and Mycoplasma pneumonia were the most common identified virus and bacterium in children infected with SARS-CoV-2. Knowledge of bacterial, fungal, and/or respiratory viral confections has potential diagnostic and treatment implications in COVID-19 children.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
- Correspondence: ; Tel.: +966-561-522-581
| | - Muneera Alabdulqader
- Pediatric Nephrology Specialty, Pediatric Department, Medical College, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Ministry of Health, Al-Ahsa 36358, Saudi Arabia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Abdulrahman A. Alnaim
- Department of Pediatrics, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Koblan M. Al Mutared
- Administration of Pharmaceutical Care, Ministry of Health, Najran 66255, Saudi Arabia
| | - Khalid Al Noaim
- Department of Pediatrics, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Mohammed A. Al Ghamdi
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Suha Jafar Albahrani
- Division of Diabetology, Family Medicine Department, College of Medicine, King Faisal University, Al-Ahsa 36364, Saudi Arabia
| | - Abdulaziz A. Alahmari
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | | | - Yameen Ali Almatawah
- Division of Infectious Diseases and Infection Control, Pediatric Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa 36422, Saudi Arabia
| | - Omar Musa Bayameen
- Public Health Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Ahmed Abdulwhab Alismaeel
- Public Health Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Sherifah Khaled Alzamil
- Public Health Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Samiah Ahmad Alturki
- Public Health Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Zahra’a Radi Albrahim
- Public Health Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Nasreen Ahmad Al Bagshi
- Public Health Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Hesham Yousef Alshawareb
- Southern Sector, Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 36421, Saudi Arabia
| | - Jaafar Abdullah Alhudar
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 36361, Saudi Arabia
| | | | - Samirah Mansour Alghadeer
- Infection Prevention and Control Administration, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 36421, Saudi Arabia
| | - Hassan Ali Alhadab
- Ambulatory Transportation Administration, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 36421, Saudi Arabia
| | | | - Yousif Ahmad Alabdulaly
- Quality Assurance and Patient Safety Administration, Directorate of Health Affairs, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia
- Department of Nursing, Prince Sultan Military College, Dhahran 34313, Saudi Arabia
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health/Nutrition, The University of Haripur, Haripur 22620, Khyber Pakhtunkhwa, Pakistan
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