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COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 28943

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Special Issue Editors

Dr. Pierpaolo Di Micco

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UOC Medicina, Fatebenefratelli Hospital of Naples, 80131 Naples, Italy
Interests: immunology; vascular medicine; cardiology; infectious disease; neurology; coagulation and clinical laboratory
Special Issues, Collections and Topics in MDPI journals

Dr. Anna Annunziata

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Pneumology, Monaldi Hospital of Naples, AO deiColli, 80131 Naples, Italy
Interests: COPD; alpha1-antitrysin deficiency; COVID-19
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nearly one year ago, the SARS-CoV-2 outbreak began, and our work has changed since. Scientific literature contributed to the knowledge of this virus and its related infectious diseases, with the number of submissions and articles around the world increasing exponentially as a result.

Each colleague contributed by sharing their working experience, and COVID-19 has thus been associated to a number of relevant clinical abnormalities per se and\or during treatment.

Immunopathological complication and thrombotic complications have been identified since the first reports from China, but the description of other complications such as liver and cardiac damages have also been associated to COVID-19.

On the other hand, since COVID-19 is a newly identified disease, little is known about post-COVID-19 clinical features that are an emerging cause of chronic disability for several patients.

Indeed, in recent months, evidence has emerged that in patients with microbiological healing from COVID-19, many residual symptoms persist. The persistence of respiratory, cardiovascular or metabolic disorders, due to persistent chronic inflammation, sequelae of organ damage, and complications from the prolonged hospitalization and social isolation results in post acute COVID-19 syndrome. Follow up is needed after COVID-19, with appropriate management of clinical sequelae.

Thus, the aim of this thematic series is to report unusual clinical presentations or complications of COVID-19 and post-COVID-19 clinical features. Scientific contributions may be submitted as original articles, reviews, or brief clinical series.

We look forward to reading about your clinical experience in the daily clinical management of COVID-19 from diagnostics to therapeutic aspects.

Dr. Pierpaolo Di Micco
Dr. Anna Annunziata
Guest Editors

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Keywords

COVID-19
SARS
immunopathological disease
venous thromboembolism
post-COVID-19

Published Papers (13 papers)

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Editorial

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2 pages, 182 KiB

Open AccessEditorial

Editorial Comment on Special Issue—COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features

by Pierpaolo Di Micco, Anna Annunziata and Giuseppe Fiorentino

Healthcare 2022, 10(9), 1715; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10091715 - 07 Sep 2022

Cited by 1 | Viewed by 801

Abstract

Beginning in 2020, the COVID-19 pandemic caused by SARS-CoV-2 remains ongoing [...] Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

Research

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13 pages, 290 KiB

Open AccessArticle

Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status

by Pasquale Moretta, Pasquale Ambrosino, Anna Lanzillo, Laura Marcuccio, Salvatore Fuschillo, Antimo Papa, Gabriella Santangelo, Luigi Trojano and Mauro Maniscalco

Healthcare 2022, 10(3), 480; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10030480 - 04 Mar 2022

Cited by 4 | Viewed by 2403

Abstract

Background. Cognitive impairment has been reported in the aftermath of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection. We investigated the possible association between cognitive impairment and the main clinical and functional status variables in a cohort of convalescent COVID-19 patients without premorbid diseases potentially affecting cognition. Methods. We consecutively screened for inclusion of convalescent COVID-19 patients referring to a post-acute care facility for pulmonary rehabilitation. All the enrolled patients were assessed for cognitive functions. We also investigated features of psychological distress (anxiety, depression, symptoms of posttraumatic stress disorder and quality of life) and cardiac and pulmonary functional status. Results. The 63 enrolled patients (mean age 59.82 ± 10.78, male gender = 47) showed a high frequency of depressive symptoms (76.2%) and anxiety (55.5%), and a high prevalence of symptoms of posttraumatic stress disorder (PTSD, 44.4%). About half of the total sample showed reduced cognitive efficiency (RCE, 44.4%) in the domains of spatial and verbal long-term memory and executive functions. Patients with RCE more frequently showed alteration of blood pressure (BP) circadian rhythm (p = 0.01), higher levels of D-Dimer (p = 0.03), had experienced a severe illness (p = 0.02), had longer disease duration (p = 0.04), more clinically relevant symptoms of PTSD (p = 0.02), more frequent cognitive complaints (p = 0.002), higher anxiety scores (p = 0.01) and lower quality of life (p = 0.02) than patients with normal cognitive efficiency. Conclusions. Our findings indicated a possible association between the RCE after COVID-19 and some cardiological variables, including some indirect measures of a residual autonomic disorder, such as the presence of an altered BP circadian rhythm. Future research studies with large samples are needed to provide valid conclusions. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

9 pages, 1238 KiB

Open AccessArticle

Clinical Study on the Efficacy and Safety of Arginine Administered Orally in Association with Other Active Ingredients for the Prevention and Treatment of Sarcopenia in Patients with COVID-19-Related Pneumonia, Hospitalized in a Sub-Intensive Care Unit

by Carolina Bologna and Eduardo Pone

Healthcare 2022, 10(1), 162; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010162 - 14 Jan 2022

Cited by 8 | Viewed by 3149

Abstract

In order to evaluate the efficacy of oral supplementation with 3 g of arginine per day associated with creatine, L-carnitine, aspartic acid, magnesium, selenium and vitamins C and E (Argivit© Aesculapius Farmaceutici) in the prevention and treatment of sarcopenia in patients with COVID-19-related pneumonia, we conducted a parallel randomized study comparing it with standard therapy alone. Forty patients on standard therapy plus supplementation were compared with a control group of 40 patients, all hospitalized at the sub-intensive care unit of the Del Mare Hospital in Naples, with a clinical diagnosis of SARS-CoV-2 infection and COVID-19 pneumonia. Muscle strength was assessed with the handgrip test and muscle ultrasound. Arginine-supplemented patients had an average grip strength of 23.5 at the end of hospitalization compared with 22.5 in the untreated group with less reduction, showing statistical significance (p < 0.001). In the same way, the thickness of the vastus lateralis quadriceps femoris muscle measured at the end of hospitalization showed less reduction on ultrasound, with a higher average value in the group receiving treatment than in the group of patients without supplementation (p < 0.001). Upon discharge there was a 58.40% reduction in ventilation days in patients with arginine supplementation compared with the control group. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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12 pages, 408 KiB

Open AccessArticle

Association of Mortality-Related Risk Factors in Patients with COVID-19: A Retrospective Cohort Study

by Shazia Rehman, Nadia Rehman, Ayesha Mumtaz and Jindong Jiang

Healthcare 2021, 9(11), 1468; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111468 - 29 Oct 2021

Cited by 14 | Viewed by 2203

Abstract

COVID-19 is a rapidly disseminating infectious disease conferred by the World Health Organization (WHO) as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics data have been identified for patients with COVID-19, but mortality-related risk factors and a comprehensive clinical course of disease in a developing country have not been specifically defined. This retrospective, single-center cohort study involved all successive inpatients having a positive COVID-19 polymerase chain reaction (PCR), with deceased or discharged clinical outcomes from 1 January to 10 May 2021. Data were extracted from electronic medical records on demographic, clinical, radiological, and laboratory findings as well as complications faced and treatment provided during follow-up, involving serial samples for viral RNA identification, and compared between the dead and survivors. To investigate the risk factors associated with in-hospital mortality, we employed the multivariate logistic regression model. In this study, 2048 patients were involved, 1458 of whom were discharged, and 590 died in hospital. More than half of patients were identified as male with old age being the potential risk factor of mortality. Exactly 94.8% of all patients presented with fever at the time of admission. Several comorbidities were present in the study population, with the most frequent comorbidity being cardiovascular diseases (1177 of 2048) and hypertension (975 of 2048) followed by cerebrovascular disease and diabetes mellitus. Mortality rates for infected patients were observed as higher in severe patients (46.3%) compared with non-severe cases (26.1%) during a follow-up. Multivariate regression analysis showed a significant association of in-hospital mortality of patients with older age, presence of hypertension and cardiovascular diseases as underlying comorbidities, increased level of cardiac troponin I and d-dimer concentration on admission, as well as septicemia and ARDS as a complication during illness. To minimize the risk of death in COVID19 patients, as well as the risk of severe complications, urgent public health measures should be properly planned and implemented on those vulnerable populations. To detect early manifestations of clinical problems, thorough and regular follow-up is warranted. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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9 pages, 884 KiB

Open AccessArticle

Remdesivir in Severe COVID-19 and Non-Invasive Ventilation: A Real-Life Experience

by Francesca Simioli, Carmine Nicoletta, Maria Rosaria Valentino, Maria Martino, Anna Annunziata, Novella Carannante, Pierpaolo Di Micco and Giuseppe Fiorentino

Healthcare 2021, 9(9), 1108; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091108 - 27 Aug 2021

Cited by 6 | Viewed by 2102

Abstract

Background: Antiviral treatment is a hot topic regarding therapy for COVID-19. Several antiviral drugs have been tested in the months since the pandemic began. Yet only Remdesivir obtained approval after first trials. The best time to administer Remdesivir is still a matter for discussion and this could also depend upon the severity of lung damage and the staging of the infection. Methods: We performed a real-life study of patients hospitalized forCOVID-19 and receiving non-invasive ventilation (NIV). In this single-center study, a 5 day course of Remdesivir was administered as compassionate use. Further therapeutic supports included antibiotics, low molecular weight heparin and steroids. Data collection included clinical signs and symptoms, gas exchange, laboratory markers of inflammation, and radiological findings. Major outcomes were de-escalation of oxygen-support requirements, clinical improvement defined by weaning from ventilation to oxygen therapy or discharge, and mortality. Adverse drug reactions were also recorded. All data were collected during hospitalization and during a 20-day follow up after treatment. Results: 51 patients were enrolled. A global clinical improvement was recorded in 22 patients (43%) at 12 days, and 36 (71%) at 20 days; in particular, at 12 days, 27 patients (53%) also had a de-escalation of oxygen-support class from a therapeutic point of view. Remdesivir use was associated with a lower hazard ratio for clinical improvement in the elderly (older than 70 years) and in subjects with more extensive lung involvement (total severity score at HRCT of more than 14). The 20-day mortality was 13%. Conclusions: Results demonstrated that Remdesivir is associated with an improvement in clinical, laboratory and radiological parameters in patients with severe COVID-19 and showed an overall mortality of 13%. We conclude that, in this cohort, Remdesivir was a beneficial add-on therapy for severe COVID-19, especially in adults with moderate lung involvement at HRCT. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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10 pages, 1751 KiB

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Cutaneous Manifestations in SARS-CoV-2 Infection—A Series of Cases from the Largest Infectious Diseases Hospital in Western Romania

by Ruxandra Laza, Virgil Filaret Musta, Narcisa Daniela Nicolescu, Adelina Raluca Marinescu, Alexandra Mocanu, Laura Vilceanu, Roxana Paczeyka, Talida Georgiana Cut and Voichita Elena Lazureanu

Healthcare 2021, 9(7), 800; https://doi.org/10.3390/healthcare9070800 - 25 Jun 2021

Cited by 7 | Viewed by 1944

Abstract

(1) Background: SARS-CoV-2 infection, which appeared as an isolated epidemic outbreak in December 2019, proved to be so contagious that, within 3 months, the WHO declared COVID-19 a pandemic. For one year (pre-vaccination period), the virus acted unhindered and was highly contagious, with a predominantly respiratory-oriented aggression. Although this lung damage, responsible for the more than 3,090,025 deaths, has provided sufficient data to facilitate the understanding of pathogenic mechanisms, other observation data, which meet the quality of emerging clinical aspects, such as rashes, remain without well-defined etiopathogenic support or a well-contoured clinical framework. (2) Methods and Results: We followed the occurrence of cutaneous manifestations in patients hospitalized during the second and third outbreak of SARS-CoV-2 in the main clinics of infectious diseases of our county, Timis, and recorded laboratory investigations and clinical evolution for five suggestive cases. (3) Conclusions: The presented cases, added to many other present and future clinical observations, will allow for better knowledge and understanding of SARS-CoV-2 infection, a requirement that has become a global priority for the entire medical and scientific community. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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13 pages, 622 KiB

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Diabetes Mellitus—A Risk Factor for Unfavourable Outcome in COVID-19 Patients—The Experience of an Infectious Diseases Regional Hospital

by Egidia Miftode, Larisa Miftode, Ioana Coman, Cristian Prepeliuc, Maria Obreja, Oana Stămăteanu, Tudorița Gabriela Părângă, Daniela Leca and Claudia Elena Pleşca

Healthcare 2021, 9(7), 788; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9070788 - 23 Jun 2021

Cited by 9 | Viewed by 2177

Abstract

Early research into the implications concerning the evolution of the infection caused by the new coronavirus in people with glucose metabolism dysfunction, in this case diabetics, shows that severe forms of the disease predominate in this risk category. Moreover, it seems that even in patients with normal glycaemic status, COVID-19 may predispose to the development of hyperglycaemia which modulates immune mechanisms and inflammatory responses, with direct effects on morbidity and mortality. Thus, taking into account these scientific data, as well as the increased frequency of diabetes in the general population, we aimed to assess the risk of an unfavourable outcome of diabetic patients, which is in a strong connection with the presence and severity of pulmonary disease such as interstitial pneumonia/bronchopneumonia, as well as the effectiveness of Tocilizumab administration. The results of our study indicate a three-fold higher risk of death in patients with diabetes and COVID-19 (RR = 3.03; IC95%: 2.37–3.86; p = 0.001),compared to nondiabetic patients, and the risk of developing severe forms of acute respiratory failure was 1.5 times higher in the first studied category. In conclusion, we can say that the diabetic diagnosed with SARS-CoV-2 infection is more predisposed to immunological and organic dysfunctions that may ultimately result in death, and treatment with monoclonal anti-IL-6 antibodies was more effective in diabetic patients than non-diabetics (p < 0.05). The effectiveness of Tocilizumab was significant in both studied groups, but diabetic patients responded better to this therapy compared to non-diabetes-mellitus (DM) ones (76.7% vs. 35% p = 0.001). Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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8 pages, 1420 KiB

Open AccessArticle

The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax

by Francesca Simioli, Anna Annunziata, Giorgio Emanuele Polistina, Antonietta Coppola, Valentina Di Spirito and Giuseppe Fiorentino

Healthcare 2021, 9(6), 620; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060620 - 22 May 2021

Cited by 13 | Viewed by 2276

Abstract

Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax (n = 25) received High Flow Nasal Cannula (HFNC), while patients with severe ARDS and pneumomediastinum/pneumothorax underwent HFNC (n = 10) or invasive mechanical ventilation (IMV) (n = 10). Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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Hereditary Thrombophilia in the Era of COVID-19

by Oana Viola Badulescu, Paul Dan Sirbu, Nina Filip, Gabriela Bordeianu, Elena Cojocaru, Cristian Constantin Budacu, Minerva Codruta Badescu, Iris Bararu-Bojan, Bogdan Veliceasa and Manuela Ciocoiu

Healthcare 2022, 10(6), 993; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10060993 - 27 May 2022

Cited by 11 | Viewed by 2896

Abstract

Thrombophilia, also called hypercoagulability or prothrombotic condition, usually reflects a certain imbalance that occurs either in the coagulation cascade or in the anticoagulation/fibrinolytic system. A similar imbalance may be induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thrombotic complications are associated with multiorgan failure and increased mortality. In this context, activation of coagulation and thrombocytopenia appeared as prognostic markers in COVID-19. Our work provides a structured and updated analysis of inherited thrombophilia and its involvement in COVID-19, emphasizing the importance of diagnosing and initiating thromboprophylaxis. Since the state of hypercoagulation is directly correlated with COVID-19, we consider that studies on the genetic profiles of proteins involved in thrombophilia in patients who have had COVID-19 and thrombotic events are of great importance, both in treating and in preventing deaths due to COVID-19. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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Other

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8 pages, 1747 KiB

Open AccessCase Report

Spontaneous Pneumo-Mediastinum in a Post-COVID-19 Patient with Systemic Sclerosis

by Ilaria Mormile, Mauro Mormile, Gaetano Rea, Angelica Petraroli, Vittoria Barbieri, Amato de Paulis and Francesca Wanda Rossi

Healthcare 2022, 10(3), 529; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10030529 - 14 Mar 2022

Cited by 4 | Viewed by 2066

Abstract

Pulmonary involvement is the most common cause of death among patients with systemic sclerosis (SSc). The current coronavirus disease 2019 (COVID-19) is particularly problematic to manage in SSc patients since they may experience a more severe evolution of COVID-19 due to the pre-existent interstitial lung disease (ILD) and the administration of immunosuppressive treatments. In addition, the remarkable radiological similarities between SSc-ILD and COVID-19 complicate the differential diagnosis between these two entities. Herein, we present the first case of spontaneous pneumo-mediastinum in a post-COVID-19 patient with SSc. In our patient, both smoking and pulmonary fibrosis could lead to cyst formation, which possibly spontaneously broke and caused pneumo-mediastinum. Moreover, megaesophagus perforation due to the smooth muscle atrophy, replacement with fibrosis, and achalasia may extend into the mediastinum or pleural space and has also been described as a rare case of spontaneous pneumo-pericardium. Finally, spontaneous pneumo-mediastinum and pneumothorax have been recently reported as an established complication of severe COVID-19 pneumonia and among COVID-19 long-term complication. This case report underlines that the worsening of respiratory symptoms in SSc patients, especially when recovered from COVID-19, requires further investigations for ruling out other tentative diagnoses besides the evolution of the SSc-ILD. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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7 pages, 794 KiB

Open AccessCase Report

The Use of a Video-Assisted Intubating Stylet Technique in a Critically Ill and Contagious COVID-19 Patient

by Chih-Pin Yang, Hsiang-Ning Luk, Jason Zhensheng Qu and Alan Shikani

Healthcare 2022, 10(2), 388; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10020388 - 18 Feb 2022

Cited by 7 | Viewed by 1730

Abstract

Tracheal intubation and ventilatory support are among the important treatments in patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) and severe hypoxia. The intubating team often uses video-assisted intubation equipment to ensure a safe and successful tracheal intubation. In this case report, we demonstrate for the first time, the use of the Shikani video-assisted intubating stylet and the Shikani intubating technique as a safe, speedy, and effective way to intubate a critically ill and highly contagious COVID-19 patient. In addition to the conventional consensus guidelines that are currently available for good practice (such as the proper use of personal protection equipment, etc.), we demonstrated that using the Shikani video-assisted intubating stylet is a reliable and proficient technique that is easy to learn while minimizing the risk of COVID-19 exposure of the airway personnel. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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6 pages, 263 KiB

Open AccessCase Report

An Elderly COVID-19 Patient with Community-Acquired Legionella and Mycoplasma Coinfections: A Rare Case Report

by Sari T. S. Alhuofie

Healthcare 2021, 9(11), 1598; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111598 - 21 Nov 2021

Cited by 6 | Viewed by 1611

Abstract

The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that occurred after several days of hospitalization. Little is known about the incidence of community-acquired atypical bacterial coinfections with SARS-CoV-2. In this work, we report on a rare case of an elderly SARS-CoV-2 patient with underdiagnosed bacterial coinfections who received care in the medical ward for 23 days then was discharged home. Retrospective serological investigation revealed positivity for Legionella pneumophila and Mycoplasma pneumoniae, indicating double community-acquired atypical bacterial coinfections that were in agreement with clinical manifestations that patients showed at his admission to the hospital. Screening for possible community-acquired respiratory co-pathogens among elderly SARS-CoV-2 patients is critical for effective treatment and management. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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13 pages, 298 KiB

Open AccessCase Report

Facial Diplegia—Complication or Manifestation of SARS-CoV-2 Infection? A Case Report and Systemic Literature Review

by Anna K. Szewczyk, Urszula Skrobas, Anna Jamroz-Wiśniewska, Krystyna Mitosek-Szewczyk and Konrad Rejdak

Healthcare 2021, 9(11), 1492; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111492 - 02 Nov 2021

Cited by 8 | Viewed by 1926

Abstract

Since the outbreak of the new coronavirus, healthcare systems around the world have witnessed not only COVID-19 symptoms but also long-term complications of the aforementioned, including neurological problems. We report a clinical case of an adult patient with bilateral facial nerve palsy and progressive ascending paresis of the limbs after contracting the novel coronavirus (COVID-19). Additionally, the systematic review aimed to identify and summarize specific clinical features, outcomes and complications of the studies focusing on bilateral facial diplegia as a sequela of COVID-19 infection. The total number of analyzed patients was 15. Only one patient was diagnosed with isolated bilateral palsy; the rest had Guillain-Barré Syndrome (GBS). With one exception, all the presented cases had favorable outcomes, with facial palsy recovery from slight to almost complete. In patients with a confirmed COVID-19 diagnosis, bilateral facial palsy may be an isolated symptom as well as a variant of GBS. Symptoms of cranial nerve damage during a COVID-19 infection may explain the appearance of facial nerve damage. In order to clarify the spectrum of neurological manifestations and a causal relation between SARS-CoV-2, COVID-19 vaccination and neurological symptoms, direct attention towards the study of this virus is crucial. It seems reasonable to recognize human coronavirus as another potential GBS trigger. Full article

(This article belongs to the Special Issue COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features)

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