Cervical abscess caused by methicillin-susceptible Staphylococcus aureus in an infant infected with SARS-CoV-2: Diagnostic dilemma

Abstract

A new inflammatory disease has emerged in children after the COVID-19 disease and has been named multisystem inflammatory syndrome in children (MIS-C). We report a case of cervical abscess in an infant with COVID-19 who was first considered to have MIS-C due to persistent fever, high inflammatory markers. A 10-month-old boy was admitted to the emergency department due to a 3-day fever and cervical lymphadenopathy. SARS-CoV-2 RNA was detected by a real-time reverse transcriptase-polymerase chain reaction in the nasopharyngeal swab specimen of the patient. Regarding initial clinical and laboratory findings, the patient was diagnosed to have MIS-C and bacterial co-infection. Clindamycin and ceftriaxone treatments were initiated for bacterial co-infection. Despite treatment, his fever persisted and acute phase reactants compatible with MIS-C were elevated and intravenous immunoglobulin (IVIG) was administered. After IVIG treatment, his fever persisted and the patient developed local inflammatory signs including erythema, tenderness, fluctuation developed. Cervical ultrasonography and magnetic resonance imaging demonstrated the findings compatible with the cervical abscess. Drainage of the cervical abscess was performed by an otolaryngologist. Methicillin-susceptible Staphylococcus aureus was isolated from the abscess culture. After abscess drainage, fever and acute phase reactants declined. His nasopharyngeal swab was negative for SARS-CoV-2 on the 7th day. He was discharged on the 21st day of hospitalization with full recovery. To the best of our knowledge, no cases of COVID-19 with cervical abscess caused by Staphylococcus aureus in children had been reported previously. Bacterial co-infection should be kept in mind in children infected with SARS-CoV-2 and showing MIS-C findings.

Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis

“…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%) [6,8,10,11,[16][17][18][19][21][22][23]31,35,38,40,[45][46][47][48]52,54,57,[59][60][61]63,64,[67][68][69][70][71]74,76,77,81,90,93,95,97,104,105,107,111,113,114,117,118,121,…”

“…Only four studies were conducted within multiple countries (n = 4) [53,109,118,127]. The majority of the studies were single-center [4,6,[11][12][13][14][15][16]18,19,[21][22][23][32][33][34][35][38][39][40][41][43][44][45][46][48][49][50][51][52][55][56][57][59][60][61][62][64][65][66][67][68][69][70][72][73][74][75]…”

“…COVID-19 children coinfected with bacteria, fungi, and/or respiratory viruses were reported to have received antibiotics in 77 studies [5,8,9,[12][13][14][15][16][19][20][21][22][23]36,[38][39][40]42,45,46,[50][51][52]55,56,59,60,[63][64][65][66][67][68][69][70]72,[74][75][76][77]80,[86][87][88]90,92,93,[96][97][98]100,…”

“…Clinical treatment outcomes for the COVID-19 children who were coinfected with bacteria, fungi, and/or respiratory viruses and died was documented in 43 (4.4%) cases [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]90,96,105,116], while 931 (95.6%) of the COVID-19 cases recovered [4][5][6][7][8][9][10][11]31,[33][34][35][36]38,40,42,43,[45][46][47][48][50][51][52][54][55]…”

The value of FDG-PET/CT imaging in the assessment, monitoring, and management of COVID-19

“…Recently, MRI has shown excellent concordance with chest CT and has been proposed as a viable alternative for monitoring COVID-19 pneumonia in patients in whom exposure to ionizing radiation should be avoided such as children and pregnant patients [ 2 , 23 , 24 ]. PUS has also been proposed as an alternative technique for examining pulmonary lesions in these populations although more research is required to investigate its effectiveness in distinguishing between different stages of parenchymal infiltration compared to CT [ 25 ] . While each of these structural imaging techniques, CT, US, MRI, and conventional radiography, has been employed in the diagnosis and monitoring of COVID-19 in particular patient populations, an in-depth discussion of the merits, limitations, and disadvantages of each technique is beyond the scope of this review.…”