Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.

Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics

Infective endocarditis is a rare disease in children. The etiology is mainly bacterial. However, viral infective endocarditis, possibly related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has also been reported. The pathophysiological principle of the connection between the two entities seems to be attributed to the transient immune deficiency of the body during the infection. Additionally, SARS-CoV-2 is reported in the literature as a direct cardiopathic virus. Therefore, the new coronavirus seems to have the ability to affect both the intact cardiac tissue and the previously damaged one both during the acute episode and at a distance from it. Consequently, we propose to review the main pathophysiological aspects of pediatric cardiac damage caused by SARS-CoV-2. The ultimate goal is to deepen existing knowledge, broaden the horizon of understanding and analysis regarding the systemic damage induced by viral infections, and strengthen an information base from which to start a meta-analysis. Next, we performed a non-systematized screening of the specialized literature with reference to cases of endocarditis in the pediatric population, reported in the period 2020–2023. From the total of articles found, we chose to include in the review a number of 6 case reports, including a number of 7 patients (5 children and 2 adolescents). Analysis of reports suggests that SARS-CoV-2 infection could play a role in the development of endocarditis, either directly through active infection or indirectly through a post-infectious immune response. Also, pre-existing conditions and complex medical history predispose to an increased risk of developing a severe, complicated form of endocarditis. Also, the lack of data on the vaccination history and the failure to categorize the infection depending on the type of antibodies (IgM or IgG) in some studies represent a major bias in the reports. The latter make it difficult to evaluate the influence of vaccination and the impact of acute versus chronic infection on the course of cases. 

Pediatric endocarditis - a stone left after the pandemic cascade

BackgroundSymptoms from SARS-CoV-2 infection can involve multiple organ systems. Several reviews discussed the neurologic involvement and neuroimaging findings in adults but research on children is lacking.Objective1) To analyze the incidence of neurologic involvement in patients diagnosed with pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C); 2) To summarize current literature on possible neuroimaging findings in SARS-CoV-2 infected children.Material and methodsA literature search in six electronic databases was performed to retrieve case series, cohort studies, and cross-sectional studies on neurologic involvement in COVID-19 patients younger than 21 years of age published between December 2019 to September 2023, including COVID-19 patients.Results2, 224 patients with MIS-C from 10 cohort and cross-sectional studies suggested that neurologic involvement in these subset ranges from 8.5% to 32.1%. Symptoms included acute encephalitis, seizures, stroke, cranial nerve palsy, nausea/vomiting, and intracranial hypertension. Neuroradiology findings of 114 children from 50 case reports included splenial or acute disseminated encephalomyelitis (ADEM)-like lesions, cytotoxic brain edema, autoimmune demyelinating diseases, ischemic stroke and arteritis, venous thrombosis, intracranial hemorrhage, meningitis, posterior reversible encephalopathy syndrome, anti-N-methyl-D-aspartate receptor autoimmune encephalitis, acute hemorrhagic leukoencephalitis, hydrocephalus, olfactory bulb atrophy, cerebellitis, and acute necrotizing encephalitis.ConclusionRadiologic findings of SARS-CoV-2 infection in pediatric population is diverse. Neuroimaging studies should be considered in critically ill patients to rule out neurologic involvement and facilitate early interventions. 

Pediatric Neuroimaging Findings and Clinical Presentations of COVID-19: A Systematic Review.

It is well known that COVID-19, caused by the SARS-CoV-2 virus and characterized by an acute respiratory syndrome with a high morbidity and mortality had rapidly spread around the world, taking on the character of a pandemic. The virus affects not only the respiratory tract, but also other organs due to mechanisms of the cytokine storm mechanism, in addition, hypoxic damage, immune mechanism and the mechanism involving angiotensin-converting enzyme. The frequency of CVT associated with COVID-19 is less than 0.02%, on the one hand, is low, but on the other hand, this rate is 30–60 times higher than the frequency of CVT in persons without COVID-19 (0.0003–0.0004% in adults and 0.0007% in children). For an individual patient, it is extremely important that the combination of CVT and COVID-19 is associated with a higher mortality rate (45.5%) in contrast to CVT (15%) and COVID-19 (5.6%) separately. In the presented literature review, the authors focus on the pathophysiological mechanisms of the development of COVID-19 associated cerebral thrombosis for a deeper and more holistic view of the pathological process occurring in the body in order to form and improve the clinical thinking of specialist doctors, and cite their own clinical observation as an illustration of the difficulties of diagnosing COVID-19 associated cerebral thrombosis. The authors believe that this review of the literature describing a clinical case is valuable from the point of view of practical applicability, both for clinicians of various fields and for researchers.

Difficulties in diagnosing complications of COVID-19: description of a clinical case

The recent SARS-CoV-2 pandemic is ending after over three years, and the efforts of physicians in the daily clinical management of infection in inpatients and outpatients and vaccination campaigns allowed to medical experts to understand all possible scientific aspects of COVID-19 [...]

Editorial Comment on the Special Issue Discussing COVID-19 and Thrombosis, Second Edition

Cerebral venous thrombosis in pediatric patient has a varied etiology. The authors present the case of a teenager who, since the debut of SARS-CoV-2 infection, has accused intermittent right side hemicrania, which has become persistent in association with nausea and vomiting since the 5th day of quarantine. She was hospitalized in the 9th day since the debut. Neuroimaging revealed extended venous cerebral thrombosis affecting the right sigmoid sinus, the transverse sinus bilaterally, the confluence of the transverse sinuses and the right internal jugular vein. The evolution was favorable under anticoagulant and symptomatic treatment. Laboratory tests excluded other etiological causes for the cerebral venous thrombosis, thus the authors consider that cerebral thrombosis is a possible complication of SARS-CoV-2 infection in teenagers.

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SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature

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SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature