Highlights1. What is already known about this topic? SARS-CoV-2 causes asymptomatic or mild infection in about 80% of humans, while an excessive immune response has killed millions. Differential susceptibility and risk factors became a concern early in the pandemic. Several monogenic defects that involve innate viral sensors or affect interferon response pathways, as well as autoantibodies against type 1 interferons, have been identified in 14% of patients with life-threatening COVID-19. The impact of the novel betacoronavirus infection in patients with known inborn errors of immunity is less clear. Case series and reports from different countries have suggested a minor impact or even a potential protective effect of the IEI for some patients.2. What does this article add to our knowledge? We describe findings and outcomes of COVID-19 in 31 pediatric and adult patients with known IEI from Mexico, 84% of whom survived. Pediatric patients had a higher hospitalization rate. Inpatient mortality was 40%, and ICU mortality was 63%. Six patients died of secondary bacterial infection or uncontrolled systemic inflammation, but not from overwhelming viral infection. One patient with an autoinflammatory disorder under treatment with anakinra had a catastrophic clinical course. Eighty percent of patients received IVIG as part of their treatment for acute SARS-CoV-2 infection.3. How does this study impact current management guidelines? We recommend continued and/or high-dose IVIG in patients with known IEI seeking care for COVID-19. Patients with autoinflammatory disorders, especially those with inflammasome dysregulation, should probably take extreme measures to prevent exposure, while doctors taking care of SARS-CoV-2 infected patients with immune deficiencies must do everything they can to prevent secondary bacterial infections. The high survival of patients with COVID-19 in the context of inborn errors of immunity worldwide (over 80%) might be the result of patientphysician awareness and special care.
The current pandemic of the novel SARS‐CoV‐2 infection has affected over 10 million humans around the planet. The clinical manifestations of Coronavirus disease 2019 (COVID‐19) are diverse, ranging from asymptomatic or mild flu‐like symptoms to atypical pneumonia, severe respiratory distress syndrome, systemic inflammation, immune dysregulation and coagulopathy.
Background Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects patients younger than 5 years. In the absence of an available, affordable diagnostic test, detailed clinical history and physical examination are still fundamental to make a diagnosis. Methods We present five representative cases with KD‐like presentations: systemic onset juvenile idiopathic arthritis, mycoplasma‐induced rash and mucositis, staphylococcal scalded skin syndrome, BCGosis, and the recently described multisystemic inflammatory syndrome in children (MIS‐C) associated with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) virus. Results Rash, fever, and laboratory markers of inflammation can be present in several childhood diseases that may mimic KD. Conclusion The term ‘Kawasaki syndrome’ instead of ‘Kawasaki disease’ may be more appropriate. Physicians should consider an alternative diagnosis that may mimic KD, particularly considering MIS‐C during the present pandemic, as an aggressive diagnostic and therapeutic approach is needed.
Chikungunya virus infection is a disease transmitted by vectors, in which vertical transmission was described in years [2005][2006]. An infection rate up to 49% in neonates born from mothers with active viremia during labor has been observed. Perinatal infection could results in serious complications and potential cognitive impairment. Objective: To describe a newborn with Chikungunya virus infection secundary to vertical transmission. Clínical case: A female newborn is analyzed. She presented with fever and exanthema during her first week of life, elevation of transaminases and thrombocytopenia. Her mother had had symptoms compatible with chikungunya virus infection on the day of the delivery. Specific IgM antibodies against chikungunya were documented and the diagnosis was confirmed. Conclusion: Given the high perinatal transmissibility rate of chikungunya virus, this diagnosis should be considered in every newborn child of a mother with suggestive symptoms of chikungunya in the days surrounding delivery.
We present the case of an 8-year-old girl with hemophagocytic lymphohistiocytosis secondary to a Salmonella typhi infection. She received antibiotic treatment and intravenous immunoglobulin with complete resolution of the symptoms. We present a review of previously reported pediatric cases and propose a gradual approach to treatment.
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