Pericarditis as the Main Clinical Manifestation of COVID-19 in Adolescents

Dimopoulou, Dimitra; Spyridis, Nikolaos; Dasoula, Foteini; Krepis, Panagiotis; Eleftheriou, Eirini; Liaska, Marianthi; Servos, George; Maritsi, Despoina; Τσολιά, Μαρία

doi:10.1097/inf.0000000000003096

Cited by 20 publications

(17 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mechanism of pericarditis in COVID-19 is probably due to the inflammatory process and the subsequent cytotoxic and immune-mediated effects related to SARS-COV-2 infection. In the literature, one case of acute pediatric pericarditis presenting with pericardial tamponade [13] and two cases of adolescents with acute pericardial effusion [14] have been already reported. In our cohort, 42 patients showed pericardial involvement, representing 50% of all patients and 66% of MIS-C.…”

Section: Pericarditismentioning

confidence: 99%

Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience

et al. 2021

View full text Add to dashboard Cite

Since the spread of COVID-19, pediatric patients were initially considered less affected by SARS-COV-2, but current literature reported subsets of children with multisystem inflammatory syndrome (MIS-C). This study aims to describe the cardiac manifestation of SARS-COV-2 infection in a large cohort of children admitted to two Italian pediatric referral centers. Between March 2020 and March 2021, we performed a cardiac evaluation in 294 children (mean age 9 ± 5.9 years, male 60%) with active or previous SARS-COV-2 infection. Twenty-six showed ECG abnormalities: 63 repolarization anomalies, 13 Long QTc, five premature ventricular beats, two non-sustained ventricular tachycardia, and one atrial fibrillation. In total, 146 patients underwent cardiac biomarkers: NT-proBNP was elevated in 57, troponin in 34. An echocardiogram was performed in 98, showing 54 cardiac anomalies: 27 left-ventricular dysfunction, 42 pericarditis, 16 coronaritis. MIS-C was documented in 46 patients (mean age 9 ± 4.8 years, male 61%) with cardiac manifestations in 97.8%: 27 ventricular dysfunctions, 32 pericarditis, 15 coronaritis, 3 arrhythmias. All patients recovered, and during follow-up, no cardiac anomalies were recorded. Our experience showed that cardiac involvement is not rare in children with SARS-COV-2, and occurred in almost all patients with MIS-C. However, patients’ recovery is satisfactory and no additional events were reported during FU.

show abstract

Section: Pericarditismentioning

confidence: 99%

Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Pericardial effusion has been reported in ~5% of adults with COVID-19 occurring at the time of or shortly after diagnosis [4]. There are only four cases of acute pericarditis described in the literature in children and adolescents with an active COVID-19 infection [5][6][7]. Our case differs in its unusually late and subtle presentation and to the best of our knowledge, it is the first report of a delayed presentation of pericarditis following recovery from COVID-19 infection in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Pericarditis Following Recovery From COVID-19 Infection in a 15-Year-Old Boy: A Postinflammatory Immune-Mediated Presentation or a New-Onset Autoimmune Disease

Lamprinos¹,

Ladomenou²,

Stefanaki³

et al. 2021

Cureus

View full text Add to dashboard Cite

As the COVID-19 pandemic evolves, the medical community continues to report a variety of clinical manifestations of SARS-CoV-2 in the pediatric population. Although younger age groups experience less severe disease, attention is given to the immunologic manifestations of the disease. Pericarditis is a rare cardiac complication of COVID-19 infection. We discuss the first case of delayed presentation of pericarditis following recovery from COVID-19 infection in the pediatric population. A 15-year-old male adolescent presented to the emergency department (ED) with a two-day history of left-sided, sub-sternal chest pain that worsened during inspiration and a low-grade fever. Twenty days prior to this presentation, the patient experienced fever and was tested positive for SARS-CoV-2. His family history was remarkable for Hashimoto thyroiditis and rheumatoid arthritis, with his mother having experienced 18 episodes of pericarditis during the exacerbations of her disease. RT-PCR for SARS-CoV-2 was negative on this occasion and the serology assay identified positive IgG antibodies against the virus. The ECG was suggestive for pericarditis and the diagnosis was confirmed by the presence of pericardial effusion on ECHO. The rest of the aetiological investigations for pericarditis were negative. In view of the strong family history of autoimmunity, questions were raised in the medical team of our hospital regarding the etiology of his pericarditis and on whether it represented a postinflammatory immune-mediated presentation of SARS-CoV-2 or a new-onset autoimmune disease.

show abstract

“…Interestingly, 45.6% of the patients had a mild pericardial effusion. Pericardial effusion incidence has not been thoroughly evaluated in Covid-19 [34,35]. In addition, troponin levels were elevated on ICU admission, a nding that has been linked to myocardial involvement in Covid-19 [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients

Zakynthinos¹,

Tsolaki²,

Karavidas³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background Cardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, yet causality has not been explored. Intensive Care Unit patients frequently present AF during critical illness. Sepsis is one of the main contributors of AF occurrence in ICU patients. The aim of the study was to explore if Covid-19 myocardial involvement is the only contributor for New Onset Atrial Fibrillation (NOAF) in intubated ICU patients. Methods Consecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, severity of illness and ARDS are reported. Echocardiographic findings, troponin levels and secondary infection (sepsis/septic shock) data were collected on the day of AF and compared to the preceding days’ and/or ICU admission data. Comparison was also performed between NOAF and control group (no AF) on admission. Results Among 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICU day. Seventeen patients in the NOAF group (89.5%) presented a septic secondary infection vs 25 (41.6%) in the control group (p < 0.001). In sixteen NOAF patients (84.2%), AF occurred concurrently with a secondary septic episode. Noradrenaline, lactate levels and inflammation biomarkers presented a gradual increase in the days preceding the AF day (all p < 0.05). Troponin increased compared to admission (p = 0.017). AF did not resolve or re-occurred if sepsis persisted. Upon ICU admission left ventricular ejection fraction was rather normal, yet, global longitudinal strain was equally impaired (< 16.5%) in 63% vs 78% in the NOAF and control groups, respectively. The right ventricle was mildly dilated, and 36 (45.6%) patients had pericardial effusion. Echocardiographic findings did not change on NOAF occurrence. Conclusion Secondary infections seem to be major contributors for NOAF in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.

show abstract

Pericarditis as the Main Clinical Manifestation of COVID-19 in Adolescents

Cited by 20 publications

References 10 publications

Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience

Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience

Pericarditis Following Recovery From COVID-19 Infection in a 15-Year-Old Boy: A Postinflammatory Immune-Mediated Presentation or a New-Onset Autoimmune Disease

Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients

Contact Info

Product

Resources

About