It was a rash that turned Dr. Alisa Femina upside down.
Femia, director of inpatient dermatology at NYU Langone Health in New York City, was looking at the patient’s chart. The chart contained several pictures of a 45-year-old man who had been caring for his wife for the past few weeks. Ill with COVID-19.. The man had dim red circular spots on his palms and soles. His eyes were pink and his lips were terribly rough.
His body was erupting with extreme inflammation as almost pointed out Only for children At the time.
“Before I met the patient, I said:’This has not been reported yet. This must be MIS-A,'” Femia recalled.
MIS-A stands for “Adult Multiple Organ Inflammation Syndrome”.When there was a condition Identified by child Named MIS-C this spring, C means “children”.
Children developed dangerous inflammation around the heart and other organs weeks after being first infected with SARS-CoV-2, the virus that causes COVID-19.
The· Centers for Disease Control and Prevention warned doctors To MIS-C in May. As of October 1, the CDC reported 1,027 confirmed cases of MIS-C, and more are under investigation. Twenty children have died.
In some cases, children developed the rash that Femina saw in adult patients.
Femia and colleagues details the incident Lancet In July, we warn other doctors to monitor similar patients.
“The skin in front of me is right there,” Femia said. “You can’t see it.”
However, in reality, many doctors may not be aware of the adult condition. Only dozens of cases of MIS-A have been reported. And not all patients have an overt rash.
Dr. Sapna Bamrah Morris, clinical leader of the Healthcare Systems and Workers Safety Task Force, which is part of the CDC’s COVID-19 compliance, detailed 27 cases. report The agency announced last week.
“The true prevalence of MIS-A is unknown,” Morris said. “We need to make doctors aware of it. It may be rare, but we don’t know. It may be more common than we think.”
Part of the problem is that the virus circulates among humans for less than a year. Physicians around the world are still learning how SARS-CoV-2 works on patients.
Severely ill COVID-19 patients usually tend to arrive at the hospital because of respiratory problems. That was not the case with MIS-A.
Many MIS-A patients report fever, chest pain, or other heart problems. Diarrhea or other gastrointestinal problems — But I’m not short of breath. Also, the diagnostic test for COVID-19 tends to be negative.
Instead, the patient will test positive for COVID-19 antibody. This means that even if you have no symptoms, you were infected 2 to 6 weeks ago.
“Just because someone does not show respiratory symptoms as the main symptom does not mean that what they are experiencing is not the result of COVID-19,” Morris said.
Illness can be life-threatening. Patients usually have some severe dysfunction in at least one organ, such as the heart or liver.
The 10 patients in the CDC report had to be admitted to the intensive care unit. Some had to wear a ventilator. Two people have died.
In addition, the CDC report showed that members of racial and ethnic minority groups appear to be disproportionately affected. Almost all patients with MIS-A were African American or Hispanic. However, very few cases have been reported to fully understand the underlying mechanism.
Although some genetic associations may be possible, COVID-19 has been shown to “disproportionately affect undervalued minorities, probably due to socio-economic factors,” Femina said. It was solid. Underlying health conditions that increase the risk of COVID-19 complications, such as obesity and type 2 diabetes, also tend to be higher. Prevalent among members of racial and ethnic minority groups..
During the summer, Florida doctors began to see a surge in COVID-19 cases. “The vast number of people passing through our emergency departments and hospitals are very ill,” recalls Dr. Lillian Avo, Head of Infection Prevention for the Jackson Health System in Miami.
COVID-19’s most sensitive and reliable test, called the PCR test, is not always available and can take days to return. Avo turned to antibody testing and obtained an influx of patients triaged to COVID-19 units or elsewhere in the healthcare system.
People generally develop antibodies against infections within about a week or so. At least it inferred to Abo and her colleagues that COVID-19 would somehow be involved in the patient’s symptoms.
Abbo then found a subset of patients who were severely ill but had no obvious lung problems with acute infections after being infected with COVID-19.
“We were a little confused,” Abo said. “Molecular PCR tests are negative, and then antibody tests are positive.”
Further blood tests revealed a very high level of inflammation in the body.
In addition, the most severe COVID-19 patients tend to be 65 years of age or older or have multiple underlying health problems, but these patients are “young people who are expected not to get sick. “I did,” said Abo.
“That’s what caught our attention.”
There is no proven cure for MIS-A. “We need to be aware of this syndrome and develop data,” said Abo to understand which treatments are most effective.
Dr. Jill Weatherhead, an assistant professor of infectious diseases and tropical medicine at Baylor College of Medicine in Houston, said CDC case reports show doctors a variety of medications for MIS-A patients, including steroids and potential medications. It points out that it indicates that you have tried. It affects the immune system, called interleukin-6 inhibitors.
“The problem with these diseases is that we don’t know the mechanism that causes MIS-A and MIS-C,” Weatherhead said. “Until more information is available, it is difficult to know standard treatments.”
In children, MIS-C is generally treated with intravenous immunoglobulin, a blood product that contains a variety of antibodies. It can also be used by adults, but its effectiveness has been poorly proven.
Intravenous immunoglobulin (IVIG) is different from convalescent plasma, another blood-derived antibody treatment. The latter is taken from patients who have antibodies that recover from COVID-19 and specifically target the virus in the blood. IVIG, on the other hand, is a collection of antibodies that are not specific to coronavirus.
Patients with MIS-A already have COVID-19 antibody, so it is highly likely that additional convalescent plasma will be ineffective.
The current theory of MIS-A patients is that, as far as we know, the infection is gone. Dr. Hucasiere, Head of Critical Care Services at Sandra Atlas Bashard Hospital at North Shore University Hospital, which is part of Northwell, said. Health in Long Island, NY.
“It’s the antibodies produced that seem to be causing the problem,” he said.
Cassiere was part of a large team of doctors who treated a surge in COVID-19 patients in New York this spring. MIS-A was not identified at the time, but Cassiere is convinced that such patients have been around for a long time.
“We were looking at patients admitted to the ICU for organ failure,” Cassiere said. He said they were negative for COVID-19 but positive for COVID-19 antibodies, suggesting they had been previously infected.
“Looking back, I probably had this multi-organ inflammatory syndrome,” Cassière said. “I didn’t have to put everything together.”
A few months later, the puzzles are beginning to become apparent. However, identifying patients with MIS-A requires a full-scale approach.
“This should be at the forefront of the minds of all intensive care unit doctors who are examining the patient, especially if the patient has the COVID-19 antibody,” said Cassière.
Given Femina’s experience, it includes people who specialize in dermatology.
“This is really the beauty of medicine, and for this syndrome, many different professionals need to come together to make a diagnosis,” Femina said.
Doctors are worried that many MIS-A patients will not be detected and will probably not be treated.
“We don’t have enough data to explain what this could have in the long run,” Cassiere said. “This may be the tip of the iceberg. That’s what I’m worried about.”
This story was originally published NBC News..
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