Nearly a quarter of kids with COVID or MIS-C had neurologic involvement
Among US children and teens hospitalized with COVID-19 or its related multisystem inflammatory syndrome in children (MIS-C), 22% had neurologic conditions, most of them transient but 12% of them life-threatening or fatal, according to a study today in JAMA Neurology.
A team led by researchers at Boston Children's Hospital studied 1,695 patients with COVID-19 younger than 21 years admitted to 61 hospitals, 616 (36%) of whom also had MIS-C, from Mar 15 to Dec 15, 2020. Neurologic involvement was identified in 365 (22%) of patients from 52 hospitals.
Patients with neurologic symptoms were more likely than their peers to have underlying neurologic conditions (81 of 365 [22%] vs 113 of 1,330 [8%]). But 53% had been healthy, compared with 54% of those without neurologic symptoms. Also, patients with neurologic symptoms had similar rates of MIS-C as those who didn't have neurologic symptoms (126 [35%] vs 490 [37%]).
Neurologic symptoms were transient and non–life-threatening among 322 of 365 (88%) children, while 43 (12%) developed life-threatening coronavirus-related conditions, including severe encephalopathy (brain damage or dysfunction) (15 patients, 5 with splenial lesions [on the corpus callosum in the brain]), stroke (12), central nervous system infection/demyelination (damage to the brain's protective covering) (8), Guillain-Barre syndrome/variants (4), and acute fulminant cerebral swelling (4).
Among the 43 children with life-threatening neurologic involvement, 17 survivors (40%) had new neurologic disabilities at hospital release, and 11 patients (26%) died.
Patients with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (indicating inflammation) (median, 12.2 vs 4.4) and D-dimer concentrations (indicating blood clots) (49% vs 22%). Median patient age was 9.1 years, and 54% were male. Roughly one in four children with neurologic involvement had altered awareness or confusion.
The authors said that the long-term effects on neurodevelopmental outcomes among these children are unknown. "Patients with less severe neurologic involvement could have future sequelae," they wrote. "Long-term follow-up of pediatric patients with COVID-19–related neurologic involvement is needed to evaluate effects on cognition and development."
Mar 5 JAMA Neurol study
UK trial finds azithromycin doesn't reduce time to recovery from COVID
Treatment with azithromycin had little effect on reducing the time to recovery or risk of hospitalization in patients with suspected COVID-19, according to a randomized clinical trial published yesterday in The Lancet.
In the UK-based PRINCIPLE trial, which is investigating interventions against COVID-19 in those at risk of adverse outcomes, investigators randomly assigned people 65 years and older, or 50 and older with at least one comorbidity, who had been feeling unwell with suspected COVID-19 for 14 days to receive usual care plus azithromycin for 3 days, usual care plus other interventions, or usual care alone.
Of the 2,265 participants who enrolled from May 22 to Nov 30, 2020, 2,120 were included in the final analysis, with 500 in the azithromycin plus usual care group, 797 in the usual care plus other interventions group, and 823 in the usual care alone group. Eighty percent (402 of 500) of the patients in the azithromycin plus usual care group and 77% (631 of 823) of patients in the usual care alone group reported recovery within 28 days.
Using a Bayesian primary analysis model, the investigators found little evidence of benefit from azithromycin in the time to first reported recovery compared with usual care alone (hazard ratio, 1.08; 95% Bayesian credibility interval [BCI], 0.95 to 1.23), equating to an estimated benefit in median time to first recovery of 0.94 days (95% BCI 0.56 to 2.43).
Three percent of patients in both the azithromycin group and the usual care group were hospitalized (absolute benefit in percentage, 0.3%; 95% BCI -1.7 to 2.2), and no deaths were reported in either group.
Previous trials have found that azithromycin offers little to no benefit in hospitalized COVID-19 patients, but this is the first to examine azithromycin for COVID-19 in a community setting.
"In conclusion, our findings show that azithromycin should not be used routinely to treat COVID-19 in the community in older adults, in the absence of additional indications," the study authors wrote. "These findings have important antibiotic stewardship implications during this pandemic, as inappropriate use of antibiotics leads to increased antibiotic resistance, and there is evidence that azithromycin use increased during the pandemic in the UK."
Mar 4 Lancet study
Study: Ocular swabs detect SARS-CoV-2 RNA in 57% of COVID-19 cases
Genetic evidence of SARS-CoV-2, the virus that causes COVID-19, was found on the ocular surface of 57% of Italian COVID-19 patients, according to a study published yesterday in JAMA Ophthalmology.
The study was based on patients treated in the intensive care unit of a university hospital in Lombardy, Italy, one of the first major hot spots of the COVID-19 pandemic in Europe. Doctors took conjunctival swabs from 91 patients hospitalized for COVID-19, which was clinically diagnosed by reverse-transcription polymerase chain reaction assay on nasopharyngeal swabs and by radiologic imaging, the authors said, and they also took swabs from 17 healthy volunteers who had no COVID-19 symptoms.
The investigators detected SARS-CoV-2 RNA on the ocular surface of 52 of 91 patients with COVID-19 (57.1%; 95% confidence interval, 46.3% to 67.5%). In the 17 healthy volunteers, 10 had positive ocular swabs but negative nasopharyngeal swabs.
"Because patients may have positive test results with a conjunctival swab and negative results with a nasopharyngeal swab, use of the slightly invasive conjunctival swab may be considered as a supplementary diagnostic test," the authors said.
The infectivity of ocular material could not be determined from this study, the authors said.
Mar 4 JAMA Ophthalmol study