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SARS-CoV-2 was found in the heart tissue of Brazilian children with COVID-19-related multisystem inflammatory syndrome (MIS-C), Myocarditis And died heart failure..
It is believed to be the first evidence of direct infection of cardiomyocytes by the virus. Viral particles have been identified in various cell lineages of the heart, including cardiomyocytes, endothelial cells, mesenchymal cells, and inflammatory cells.
The case is mentioned in the report Published online August 20 Lancet child and adolescent health..
“The presence of the virus in different cell types of heart tissue, as evidenced by electron microscopy, indicates that myocarditis in this case is probably a direct inflammatory response to the viral infection of the heart,” he said. The author, Marisa Dolhnikoff, MD, Department of Pathology at the University of Sao Paulo in Brazil, Medscape Medical News..
In adults, there were previous reports in adults with COVID-19 of both SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR) and virus particles by electron microscopy of heart tissue from endocardial preparations. The researchers say. In one of these reports, Tavazzi and colleaguesThey found, “Viral particles detected in cardiac macrophages of adult patients with COVID-19-related acute heart injury. No viral particles were found in cardiomyocytes or endothelial cells.
“Our case report is the first knowledge documenting the presence of viral particles in the heart tissue of children with MIS-C,” they added. “In addition, viral particles have been identified in various cell lineages of the heart, including cardiomyocytes, endothelial cells, mesenchymal cells, and inflammatory cells.”
“About” Case Report
“We are looking forward to working with you,” said Dr. C. Michael Gibson, CEO of the Baim Institute for Clinical Research in Boston, Massachusetts, Boston, Massachusetts. Medscape Medical News..
“In previous reports of COVID-19 and the heart, we found that the virus resides in an area outside the cardiomyocytes. The relative contribution of inflammatory cells invading the heart, the release of blood-derived inflammatory mediators, and myocardium. The virus inside the cells themselves leads to heart damage.”
The patient was a previously healthy, 11-year-old girl of African descent with MIS-C associated with COVID-19. She developed heart failure and died one day later in the hospital despite aggressive treatment.
SARS-CoV-2 RNA was detected in post-mortem nasopharyngeal swabs and heart and lung tissues by RT-PCR.
Dolhnikoff et al., on postmortem ultrasonography of the heart, found that “hyperechoic diffuse thickened endocardium (mean thickness 10 mm), thickened myocardium (18 mm thick in left ventricle), and small Pericardial fluid”.
Histopathological examination revealed myocarditis, Pericarditis, And endocarditis characterized by infiltration of inflammatory cells. Inflammation is predominantly interstitial and perivascular, associated with foci of cardiomyocyte necrosis, composed primarily of CD68 + macrophages, some CD45 + lymphocytes, and some neutrophils and eosinophils It was
Electron microscopy of heart tissue revealed that shape and size were consistent with spherical viral particles Coronavirus family Family within extracellular compartments and cardiomyocytes, capillary endothelial cells, endocardial endothelial cells, macrophages, neutrophils, and fibroblasts.
Autopsy also showed microthrombus in pulmonary arterioles and glomerular capillaries. SARS-CoV-2-related pneumonia was mild.
Lymphopenia and signs of hemophagocytosis were observed in the spleen and lymph nodes. Acute tubular necrosis Necrosis of the kidney and lobule of the liver and secondary to shock were also seen. Brain tissue showed microglia reactivity.
“Fortunately, MIS-C is a rare event and can be serious and life-threatening, but most children recover,” Dornikov commented.
“This case report occurs when scientists worldwide call attention to MIS-C and the pediatrics community needs to recognize it quickly and treat it. Direct viral and myocarditis Evidence of a physical relationship suggests that MIS-C is one of the possible presentation forms of COVID-19, the heart may be the target organ, and clinicians may be aware of possible cardiac sequelae in these children. I warn you,” she added.
Expert considers
Scott Aydin MD, Dean of Medicine, Pediatric Cardiac Intensive Care, New York City’s Mount Sinai Kravis Children’s Hospital Medscape Medical News The case report is “unfortunately not so surprising.”
“Since the first announcement of MIS-C a few months ago, the mechanism of direct and indirect damage to the heart muscle has been suspected. This important study suggests that COVID-19 causes disruption to the human body. It’s just the next step for a better understanding, and the choice of treatments needed to treat COVID-19 and MIS-C children.”
In these cases, myocardial biopsy was fairly invasive in these cases, “which is rare, but if at all, The pathological findings state that it is pervasive inflammation, rather than viral cell necrosis.”
“While such reports certainly produce viral tweets, it is important to understand that it is not uncommon to find widespread organ dissemination of the virus in highly ill patients. Does not mean that the organs are malfunctioning,” said Koga. Medscape Medical News..
He said the deceased girl needed a high PCR cycle threshold to isolate the virus from lung and heart samples.
“This meant that both organs had a low viral load, rather than the virus itself infecting and destroying the organs, the theory of SARS-CoV-2 is responsible for the widespread inflammatory response that causes organ inflammation. That means they were upheld as a potential trigger.”, who wasn’t associated with the case report either.
There was no specific funding for this study. The author has declared no competing interests. Aydin does not disclose the financial relationship involved. Koga disclosed the financial relationship between Boehringer Ingelheim and the Jardians.
Lancet Child Adolsk Health.. Published August 20, 2020 Online. Case report
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