Cerebral Infarctions in an Infant With COVID-19 Delta Variant Infection and Disseminated Tuberculosis

Fraser, Stuart; Ellsworth, Misti; Pérez, Norma; Hamilton, Hunter; Fletcher, Stephen; Brown, Deborah; Srivaths, Lakshmi

doi:10.1016/j.pediatrneurol.2021.10.014

Cited by 8 publications

(13 citation statements)

References 8 publications

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“…Notably, in many cases, both hypercoagulation and inflammation are present. MIS-C typically presents with severe systemic inflammation and hypercoagulopathy [1, 6, 9, 10, 12, 13]. Despite these associated risk factors and possible mechanisms, the full extent to which SARS-CoV-2 can be attributed to AIS in patients remains unknown [2, 6].…”

Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Multisystem Inflammatory Syndrome-Related Cerebral Infarction in a Pediatric Patient Managed with Decompressive Craniectomy

Morgan

Collins

Nagy³

2023

Pediatr Neurosurg

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Most people who are infected with the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are asymptomatic or present with mild upper respiratory symptoms. This is especially true in the pediatric population; however, rarely, a massive cytokine storm can develop causing multisystem inflammatory syndrome associated with COVID (MIS-C). Furthermore, children may also suffer from acute ischemic strokes secondary to SARS-CoV-2 infection. Here, we present a 2-year-old male who was admitted to the hospital with MIS-C and evidence of a previous SARS-CoV-2 infection. On post-admission day 2, the patient was in cardiogenic shock, had acute kidney injury (AKI), liver dysfunction, and metabolic acidosis. He had concurrent altered mental status and his CT scan showed ischemic infarcts in the territory of the right middle cerebral artery and superior cerebellar artery bilaterally. Magnetic resonance angiography (MRA) confirmed occlusion of the right middle cerebral artery and right superior cerebellar artery. He underwent an emergent decompressive craniectomy due to rapid deterioration and cerebral edema. After the procedure, he continued to improve and was discharged with moderate disability that improved during outpatient rehab. Though rare in children, SARS-CoV-2 can lead to AIS, especially in the presence of underlying risk factors such as MIS-C and hypercoagulopathy. AIS can be associated with severe mortality and morbidity; however, even in this severe case of AIS, the patient was successfully treated with a decompressive craniectomy.

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Section: Discussionmentioning

confidence: 99%

Post-COVID-19 Multisystem Inflammatory Syndrome-Related Cerebral Infarction in a Pediatric Patient Managed with Decompressive Craniectomy

Morgan

Collins

Nagy³

2023

Pediatr Neurosurg

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“…Tuberculosis has been considered a risk factor for severe COVID-19 (86) with higher COVID-19 case fatality rates observed in areas like Peru with a high TB burden (87). Also, a case report of severe COVID-19 in an infant with disseminated TB has been reported (88). On a cellular level, the FCN1 + /SPP1 + macrophage lineage is enriched in the lungs of severe COVID-19 patients.…”

Section: Me ́Nage à Trios: Covid Tb and Hiv/aidsmentioning

confidence: 99%

The COVID-19, tuberculosis and HIV/AIDS: Ménage à Trois

Udoakang

Zune²,

Tapela³

et al. 2023

Front. Immunol.

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In December 2019, a novel pneumonic condition, Coronavirus disease 2019 (COVID- 19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in China and spread globally. The presentation of COVID-19 is more severe in persons with underlying medical conditions such as Tuberculosis (TB), Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other pneumonic conditions. All three diseases are of global concern and can significantly affect the lungs with characteristic cytokine storm, immunosuppression, and respiratory failure. Co-infections of SARS-CoV-2 with HIV and Mycobacterium tuberculosis (Mtb) have been reported, which may influence their pathogenesis and disease progression. Pulmonary TB and HIV/AIDS patients could be more susceptible to SARS-CoV-2 infection leading to lethal synergy and disease severity. Therefore, the biological and epidemiological interactions of COVID-19, HIV/AIDS, and TB need to be understood holistically. While data is needed to predict the impact of the COVID-19 pandemic on these existing diseases, it is necessary to review the implications of the evolving COVID-19 management on HIV/AIDS and TB control, including therapy and funding. Also, the impact of long COVID on patients, who may have this co-infection. Thus, this review highlights the implications of COVID-19, HIV/AIDS, and TB co-infection compares disease mechanisms, addresses growing concerns, and suggests a direction for improved diagnosis and general management.

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“…In most pediatric cases, the process is benign ( 1 , 2 ).The risk factors for ischemic stroke increase against the backdrop of COVID-19 ( 3 , 4 ).While ischemic stroke is not a common complication of COVID-19, its incidence is low in adults ( 5 , 6 ) and especially rare in children ( 7 ). Ischemic stroke as a complication of COVID-19 can cause varying degrees of damage in children, ranging from hemiplegia and disability to severe cases leading to death ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, there have been reports of life-threatening COVID-19 in infants, involving cases in those as young as six months and two months old ( 8 – 10 ). Mierzewska-Schmidt et al.…”

Section: Introductionmentioning

confidence: 99%

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Case report: unprecedented case of infantile cerebral infarction following COVID-19 and favorable outcome

Zheng,

Chen,

et al. 2024

Front. Immunol.

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The 2019 novel coronavirus, SARS-CoV-2, was highly prevalent in China as of December 2022, causing a range of symptoms, predominantly affecting the respiratory tract. While SARS-CoV-2 infection in children is generally mild, severe cases, especially in infants, are rare. We present a case of a previously healthy 7-month-old infant who developed cerebral infarction and coagulation dysfunction three days after COVID-19 onset. Clinically, the infant had weakness in the left limbs and pinpoint bleeding spots. A cranial magnetic resonance imaging showed ischemic strokes in the right basal ganglia and thalamus. Laboratory tests indicated thrombocytopenia and coagulation dysfunction. Inflammatory cytokines like interleukin-10 were elevated, with increased CD3+, CD4+, and CD8+ T lymphocytes but decreased CD3- CD16+ CD56+ natural killer cells. Treatment included mannitol, dexamethasone, oral aspirin, and vitamins B1 and B6 for reducing intracranial pressure, antiinflammation, anticoagulation, and nerve support, respectively. During the recovery phase, rehabilitation therapy focused on strength training, fine motor skills, and massage therapy. The infant gradually improved and successfully recovered. While rare, such cases can lead to severe complications. These combined efforts were instrumental in achieving significant functional recovery in the patient, demonstrating that even in severe instances of pediatric cerebral infarction due to COVID-19, positive outcomes are attainable with early and comprehensive medical response.

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Cerebral Infarctions in an Infant With COVID-19 Delta Variant Infection and Disseminated Tuberculosis

Cited by 8 publications

References 8 publications

Post-COVID-19 Multisystem Inflammatory Syndrome-Related Cerebral Infarction in a Pediatric Patient Managed with Decompressive Craniectomy

Post-COVID-19 Multisystem Inflammatory Syndrome-Related Cerebral Infarction in a Pediatric Patient Managed with Decompressive Craniectomy

The COVID-19, tuberculosis and HIV/AIDS: Ménage à Trois

Case report: unprecedented case of infantile cerebral infarction following COVID-19 and favorable outcome

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