22% of children with COVID-19 or MIS-C had neurological involvement in 2020-21
A study of US patients aged 0 to 20 years hospitalized for COVID-19 or pediatric multisystem inflammatory syndrome (MIS-C) in 2020 and 2021 shows that 22% had a neurological condition, including 9% with a life-threatening illness.
In the study published yesterday in JAMA Neurologya team led by researchers at Boston Children’s Hospital looked at rates of neurological disorders in 2,168 children, which ranged from 15%. The mean patient age was 10.3 years and 58% were male.
Of all patients, 22% had neurological involvement, 9% of whom had life-threatening conditions, including 55% with acute central nervous system (CNS) infections or acute disseminated encephalomyelitis (ADEM; damage to the protective covering of nerve fibers in the brain). The most common of these conditions were encephalitis (swelling of the brain caused by infection) and stroke. Seven of 23 (30%) of these patients experienced serious sequelae.
Life-threatening neurological disorders were more common during the delta variant surge than in previous waves (64% vs. 36%). Ten of 42 (24%) patients with neurological involvement were discharged from the hospital with new onset neurological disorders, and 8 (19%) died. Of the patients with non-life-threatening neurological involvement, 4% were discharged from the hospital with neurological deficits, 90% had no neurological disorders, and 5% died.
Compared to patients without neurological involvement, patients with such a disorder were older (mean age 12 vs. 10 years) and more likely to have underlying neurological disorders (107 of 476 [22%] versus 240 out of 1,692 [14%]).
Of the 155 COVID-19 vaccine-eligible patients with neurological involvement and confirmed immunization status, 95% had not received doses, including 15 of 16 patients (94%) with life-threatening illness.
“SARS-CoV-2-related neurological involvement in U.S. children and adolescents hospitalized for COVID-19 or MIS-C persisted in 2021, and acute CNS infections/ADEM made up more of those reported life-threatening cases than in 2020,” the researchers wrote. “COVID-19 vaccination is effective in preventing hospitalizations for acute COVID-19 and MIS-C and may reduce associated neurological complications.”
Nov 7 JAMA Neurol to learn
Study: Cholesterol drug has no significant effect on COVID-19
After showing promise in early laboratory studies, the cholesterol-lowering drug fenofibrate had no significant effect on outcomes in a multicenter, international, randomized, controlled trial in which use of the drug did little to reduce the severity of disease or death from COVID-19. The study was published in natural metabolism.
The large study was conducted by researchers from Penn Medicine, who sponsored the FERMIN study at 26 collaborating institutions from North America, South America, Europe and Western Asia.
Fenofibrate is an inexpensive generic drug approved for use worldwide that helps lower levels of fats such as cholesterol and triglycerides in the blood. In previous laboratory studies, fenofibrate reduced viral replication by altering how cells handle fat.
To conduct the study, researchers enrolled 701 participants who reported COVID-19 symptoms in the past 2 weeks. The study team assigned 351 patients to be treated with fenofibrate 145 milligrams and 350 to be treated with a placebo.
Participants in the intervention arm had no significant reduction in symptom severity up to 30 days after the study. There was no significant effect on death from any cause. Importantly, these results were observed across countries and study sites, and across all participants regardless of gender, age, comorbidities, and body mass index.
According to the study authors, there were 61 (17%) adverse events in the placebo arm compared to 46 (13%) in the fenofibrate arm, with a slightly higher incidence of gastrointestinal adverse events in the fenofibrate group.
In a press release, Penn Professor Jordana B. Cohen, MD, MSCE said, “The cellular effects of drugs observed in a petri dish system may not translate to beneficial effects in people with COVID-19 due to a wide range of potential phenomena throughout organisms. Our study underscores the importance of not equating laboratory efficacy with clinical efficacy in the context of COVID-19.”
Nov 7 Nat Metab to learn
November 7 Penn Medicine press release
USDA researchers say deer are susceptible to scrapie, a relative of CWD
Researchers at the United States Department of Agriculture (USDA) in Ames, Iowa, released a new study showing that white-tailed deer are susceptible to the prion that causes classic scrapie in sheep and that distinguishing them from chronic wasting disease (CWD) is difficult can be. The study appears in Journal of Infectious Diseases.
To conduct the study, the researchers took five healthy white-tailed deer and inoculated them with the classic ovine scrapie pathogen through a simultaneous oral/intranasal challenge. Another six deer were oronasally vaccinated with the classic goat scrapie agent.
None of the animals vaccinated with goat scrapie showed signs of prion disease, but all animals vaccinated with sheep prion disease showed clinical signs of infection, spongiform lesions and widespread signs of disease in neural and lymphoid tissues.
“This study suggests that the potential transmission of scrapie to deer poses an ongoing risk to wild and captive white-tailed deer. Future studies will focus on whether white-tailed deer could serve as a contagion reservoir for scrapie-prone sheep,” the authors concluded.
While neither scrapie nor CWD have been documented in humans, another prion disease called bovine spongiform encephalopathy (BSE or “mad cow disease”) poses a threat to people who consume BSE-infected animals, and officials are concerned the same could happen CWD.
8 Nov J Infection Dis to learn
Cases and deaths rise in Ebola outbreak in Uganda
In recent days, Uganda has reported 5 more Ebola cases, as well as 5 new deaths, according to the latest totals on the Ministry of Health’s website. The latest developments bring the number of laboratory-confirmed cases to 136 and the number of deaths in people with confirmed infections to 53 in the current outbreak.
The outbreak, first reported in September, involves the less common Sudan Ebola virus.
Regarding other outbreak developments, the country’s cabinet has approved a health ministry plan to close schools early for the third term vacation in a bid to contain the Ebola outbreak daily monitor.
The government also extended three-week lockdowns to two of the hardest-hit districts, Mubende and Kassanda, over the weekend, according to Agence France-Presse (AFP). The lockdowns are set to last for a further 3 weeks and will include a night curfew, a ban on personal travel and the closure of markets, bars and churches.
Uganda Ministry of Health Ebola side
8 Nov daily monitor story on school measures
Nov. 5 AFP story