Background The SARS-CoV-2 omicron variant produces more symptoms in the upper respiratory tract than in the lower respiratory tract. This form of “common cold” can cause inflammation of the oropharynx and the Eustachian tube, leading to the multiplication of bacteria such as Streptococcus pneumoniae in the oropharynx. Eustachian tube dysfunction facilitates migration of these bacteria to the middle ear, causing inflammation and infection (otitis media), which in turn could lead to further complications such as acute mastoiditis and meningitis. Case presentation In January 2022, during the rapid spread of the omicron variant of the SARS-CoV-2 virus, two patients presented to the emergency room at our hospital complaining of headache and a low level of consciousness. A few days prior to admission, the patients had been diagnosed with COVID-19 based on clinical manifestations of a cold virus, without respiratory failure. Cranial computed tomography revealed signs of bilateral invasion of the middle ear in both cases. Lumbar puncture was compatible with acute bacterial meningitis, and S. pneumoniae was isolated in cerebrospinal fluid in both patients. RT-PCR tests for SARS-CoV-2 were repeated, confirming the presence of the omicron variant in one of the patients. We were unable to confirm the variant in the second patient due to the low viral load in the nasopharyngeal sample obtained at admission. However, the time of diagnosis (i.e., during the peak spread of the omicron variant), strongly suggest the presence of the omicron variant. Both patients were admitted to the intensive care unit and both showed rapid clinical improvement after initiation of antibiotic treatment. Conclusions The omicron variant of the SARS-CoV-2 virus can promote the development of otitis media and secondary acute bacterial meningitis. S. pneumoniae is one of the main bacteria involved in this process.
Coronavirus disease 2019 (COVID-19) can cause severe acute respiratory failure requiring admission to the intensive care unit (ICU). Over time, it has become clear that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) not only affects the respiratory system, but also has an impact, directly or indirectly, on many organs in the body, including the liver. Here we present three patients diagnosed with severe COVID-19 who developed acute acalculous cholecystitis (AAC) after a prolonged ICU stay.AAC is a rare form of cholecystitis not associated with the presence of gallstones. In this case, inflammation of the gallbladder is due to hypomotility, which induces accumulation of bile with a secondary increase in intraluminal pressure that leads to inflammation, ischemia, and necrosis of the gallbladder wall [1,2]. The accumulation of bile can also promote bacterial colonization and sepsis. Numerous factors can contribute to the hypomotility that is the main stimulus that drives contraction and emptying of the gallbladder, including hemodynamic instability, dehydration, positive end-expiratory pressure in mechanically ventilated patients (by reducing hepatosplanchnic blood flow), opioid analgesics, sedation, and prolonged periods without enteral nutrition.Between March 2020 and March 2021, 126 patients with COVID-19 were admitted to our ICU; of these, 96 required invasive mechanical ventilation (IMV). Three patients developed AAC. All these critically ill patients were included in a Spanish registry of COVID-19 patients, which was approved and exempted from the requirement for patient informed consent by Ethics Committee of our Hospital (123/2020).The first case, a 73-year-old man, was admitted to the ICU for acute respiratory distress syndrome (ARDS) secondary to COVID-19. The patient required IMV for 34 days and enteral nutrition during the entire ICU stay. After 41 days in the ICU, the patient was discharged to the inpatient ward. Two days later, he developed abdominal pain and fever along with elevated C-reactive protein (CRP) levels. Abdominal ultrasound showed a hydropic gallbladder with thickened walls and incipient necrosis (Figure 1). Due to the patient's frail condition, percutaneous drainage was performed, and antibiotics were administered. The patient responded well, and there was no need for cholecystectomy.The second patient, a 42-year-old man, was similarly admitted to the ICU for ARDS secondary to COVID-19. The patient required IMV for 35 days and received enteral nutrition
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.