Saturday, December 25, 2021

Myocarditis and COVID-19: for some people the risk may be higher following vaccination than infection

COVID-19 is a known cause of cardiac complications such as myocarditis and systolic dysfunction. Vaccine associated myocarditis was described following small pox vaccination, streptococcal pneumonia and influenza vaccine. In some cases, autoimmune/inflammatory syndrome induced by adjuvants used in the vaccine have been also implicated. 

Associations of COVID-19 vaccination and myocarditis have been proposed in multiple publications, but the consensus was that the benefits of vaccine are worth the increased risk even though more personalized approach seems warranted by the evidence

A new study presents data about the risk of myocarditis increasing with each subsequent dose of mRNA vaccines, especially mRNA-1273. Moreover, in younger males the risk of myocarditis was higher following vaccination than infection. Another study presents a case of fatal breakthrough infection in an older male who experienced myocarditis-like symptoms after his COVID-19 vaccine. 

REFERENCES

Martina Patone, Winnie Xue Mei, Lahiru Handunnetthi, Sharon Dixon, Francesco Zaccardi, Manu Shankar-Hari, Peter Watkinson, Kamlesh Khunti, Anthony Harnden, Carol AC Coupland, Keith M. Channon, Nicholas L Mills, Aziz Sheikh, Julia Hippisley-Cox Risk of myocarditis following sequential COVID-19 vaccinations by age and sex  medRxiv 2021.12.23.21268276; doi: https://doi.org/10.1101/2021.12.23.21268276

Kim HW, Jenista ER, Wendell DC, Azevedo CF, Campbell MJ, Darty SN, Parker MA, Kim RJ. Patients with acute myocarditis following mRNA COVID-19 vaccination. JAMA cardiology. 2021 Oct 1;6(10):1196-201.

Lazaros G, Anastassopoulou C, Hatziantoniou S, Kalos T, Soulaidopoulos S, Lazarou E, Vlachopoulos C, Vassilopoulos D, Tsakris A, Tsioufis C. A case series of acute pericarditis following COVID-19 vaccination in the context of recent reports from Europe and the United States. Vaccine. 2021 Oct 29;39(45):6585-90.

Hendren NS, Carter S, Grodin JL. Severe COVID-19 vaccine associated myocarditis: Zebra or unicorn?. International journal of cardiology. 2021 Nov 15;343:197-8.

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Athletes with issues after vaccination: 

 Dembele, 29, Atletico Madrid striker collapses in training, requires medical attention https://www.youtube.com/watch?v=-R2_5LMobXc

Alex Apolinario, 24, Brazilian soccer player dies after collapsing on pitch during match: https://www.cbssports.com/soccer/news/brazilian-soccer-player-alex-apolinario-dies-after-collapsing-on-pitch-during-match-in-portugal/

Britain’s Jack Draper, 19, collapses at Miami Open: https://www.youtube.com/watch?v=VDuOP0V1nUw

Mirko Kido, 36, Olympic gold medalist dies of heart attack during game: https://www.reuters.com/lifestyle/sports/indonesian-doubles-star-kido-dies-heart-attack-36-2021-06-14/

Ghanaian referee collapses during AFCON Match: https://www.youtube.com/watch?v=cvPQO44NzN4

Referee Bert Smith collapses on court due to blood clot during Gonzaga-USC men’s Elite Eight game: https://www.espn.com/mens-college-basketball/story/_/id/31222546/referee-bert-smith-says-blood-clot-lung-caused-fall-ncaa-tourney

Josh Downie, 24, cricketer dies after heart attack at practice: https://www.bbc.co.uk/news/uk-england-nottinghamshire-57058626

Giuseppe Perrino, 29, ex-Parma footballer dies at memorial match after collapsing https://www.thesun.co.uk/sport/football/15151824/giuseppe-perrino-dead-29-parma-brother/

Raymond van Barneveld collapses and receives paramedic attention during PDC Championship: https://www.dailystar.co.uk/sport/darts/pdc-players-championship-8-suspended-23759939

Devaraj Anchan, 33, volleyball player collapses during game, dies: https://www.thehindu.com/news/cities/Mangalore/volleyball-player-collapses-during-game-dies/article34185430.ece

Garissone Innocent, 20, fell unconscious due to abnormal electrical impulse in heart during game: https://www.thesun.co.uk/sport/football/13901939/goalkeepers-rushed-hospital-collapsing/

Ethan Jovani Trejo, 16-year-old soccer player, collapsed on the field during training: https://eu.cincinnati.com/story/news/2021/06/25/teen-dies-after-medical-incident-princeton-high-school-field/5344293001/

Samuel Kalu, 24, Bordeaux star collapses minutes into football game: https://www.bbc.com/sport/football/58228778

Roy Butler, 23, Irish footballer Watford FC dies after Jansen: https://twitter.com/NewsForAllIre/status/1428301909715296263?s=20

Dylan Rich, 19, FA Youth Cup – player suffered sudden cardiac arrest on the field, passes away: https://www.bbc.com/news/uk-england-nottinghamshire-58496077

Vinny Curry, 33, out for season due to blood clots: https://nypost.com/2021/08/25/jets-vinny-curry-out-after-rare-blood-disorder-diagnosis/

Cameron Dale, 29, Australian sailor dies after catastrophic stroke: https://7news.com.au/sport/sailing/australian-sailor-jessica-watson-reveals-sudden-death-of-partner-cameron-dale-c-3845979

Two young Columbia High school footballers die: https://www.wistv.com/2021/09/04/he-would-love-it-donadrian-robinsons-family-reacts-tribute-wj-keenan-high-school/?outputType=apps

Bollywood’s star, 40, dies following heart attack https://www.dailymail.co.uk/news/article-9950385/Indian-TV-film-star-Siddharth-Shukla-40-dies-heart-attack.html#reader-comments

Tom Felton, 34, collapses during golf game: https://bbc.in/3i4YpI5?fbclid=IwAR0aZBaXpiX9ky34g3eLiG3pcMs5r2udih4kRGUIi7GOBK3iciefX1-qoXk

Francis Perron, 25, Ottawa footballer dies after game: https://www.cbc.ca/news/canada/ottawa/usports-ottawa-gee-gees-francis-perron-dies-1.6182332

Parys Haralson, 37, former Saints line backer dies: https://www.usatoday.com/story/sports/nfl/2021/09/13/parys-haralson-former-49-ers-and-saints-lb-dies-37/8328669002/

Jimmy Hayes, 31, former Bruins player unexpectedly dies: https://www.bostonglobe.com/2021/08/23/sports/jimmy-hayes-former-bruin-boston-college-hockey-champ-dies-31/

Kjeld Nuis, 31, Dutch professional skater admitted to hospital with inflamed heart: https://www.rtlboulevard.nl/entertainment/news/artikel/5243606/kjeld-nuis-vaccinatie-ziek-update

John Stokes, 21, athlete at Tennessee Uni hospitalized with heart inflammation: https://www.yahoo.com/lifestyle/student-athlete-john-stokes-myocarditis-covid-vaccine-002451374.html?guccounter=1

Jake Ehlinger, 20, found dead – cause unknown: https://usdaynews.com/celebrities/celebrity-death/sam-ehlinger-brother-death-cause/

Jeremy Chardy, 34, tennis pro cannot train or play after vaccine: https://www.tennisworldusa.org/tennis/news/Tennis_Interviews/102836/jeremy-chardy-i-regret-getting-vaccinated-i-have-series-of-problems-now/

Francesca Marcon, 38, volleybal professional can’t play, has pericarditis post vaccine: https://www.lapressa.it/notiziario/sport/la-campionessa-di-volley-ho-una-pericardite-post-vaccino

Yusuke Kinoshita, 27, baseball pro dies 7 weeks post vaccine: https://thecovidworld.com/yusuke-kinoshita-27-year-old-japanese-professional-baseball-player-dies-7-weeks-after-covid-19-vaccine/

Alex Stalock, 34, NHL Oilers goalie out for the season due to heart condition: https://ca.sports.yahoo.com/news/nhl-oilers-goalie-alex-stalock-miss-entire-season-with-heart-condition-covid-19-related-191817673.html

Ceylin Alvarado, 23, pro cyclists out for season due to blood complications: https://www.nu.nl/sport-overig/6160296/veldrijdster-alvarado-voorlopig-niet-in-actie-door-verstoord-bloedbeeld.html

Greg van Aevermat, 36, pro cyclist, loss of form since vaccine: https://www.indeleiderstrui.nl/wielrennen/van-avermaet-wijst-naar-vaccin-als-oorzaak-vormdip-op-deze-manier-heeft-wk-geen-zin/amp?__twitter_impression=true

Three young Belgian cyclists suffer heart issues following race: https://rtv.be/artikels/jonge-kempense-wielrenners-krijgen-hartklachten-na-vaccinatie-a102612

Kamila Label-Farrel, 19, Uni Basketball Star died unexpectedly: https://www.baytoday.ca/obituaries/lebel-farrell-kamila-3884874

Jacob Downey, 19, Queens Uni Hockey player passes away after medical emergency: https://www.kawartha411.ca/2021/10/01/local-teen-queens-university-student-passed-away-suddenly-after-medical-emergency/

Christian Eriksen, 29, Collapses at Euros due to heart issue https://youtu.be/s0B03LSzXvo

Josh Archibald, 28, Oilers hockey forward out indefinitely due to myocarditis: https://www.si.com/hockey/.amp/news/oilers-forward-josh-archibald-out-indefinitely-with-myocarditis

Jen Gouveia, 38, suffered cardiac arrest during a run: https://toronto.ctvnews.ca/husband-of-toronto-mother-who-died-suddenly-on-run-says-he-lost-his-everything-1.5501767

Kyle Warner, pro BMX cyclist has pericarditis post vaccine: https://youtu.be/aebtcTi7EaA

16 year old youth suffered cardiac arrest after weightlifting: https://www.straitstimes.com/singapore/health/16-year-old-suffers-cardiac-arrest-following-strenuous-weightlifting-session-six

Brandon Goodwin, 26, Atlanta Hawks star, career over due to blood clots: https://www.peachtreehoops.com/2021/10/3/22706769/former-atlanta-hawks-guard-brandon-goodwin-claims-covid-19-vaccine-ended-his-season

Ewan Fraser, 30, Glasgow hockey player suffered cardiac arrest, passes away: https://www.thescottishsun.co.uk/news/7832060/glasgow-hockey-player-died-collapse-life/amp/?__twitter_impression=true

David Jenkins, 31, Olympic silver medalist diver unexpectedly passes away: https://metro.co.uk/2021/10/12/david-jenkins-dead-at-31-tributes-pour-in-for-team-gb-olympic-diving-coach-15404658/amp/?__twitter_impression=true

Paul Zisper, 27, Munich basketball pro, has emergency surgery after brain hemorrhage related to J and J: https://www.fr.de/sport/drama-um-zipser-90801217.html

Filip Ingebrigsten, 28, Norwegian runner suffers loss of form post vaccine: https://norwaytoday.info/sport/filip-ingebrigtsen-is-back-in-training-after-experiencing-long-corona-vaccination-side-effects/

Avi Barot, 29, Saurashtra cricketer suffers cardiac arrest, passes away: https://www.thehindu.com/sport/cricket/young-saurashtra-cricket-player-avi-barot-dies-after-suffering-cardiac-arrest/article37015873.ece

Abou Ali, 22, professional footballer collapses on pitch during game: https://www.thesun.co.uk/sport/football/16118079/footballer-wessam-abou-ali-awake-hospital-collapse/

Fabrice NSakala, 31, Besiktas defender collapses on pitch during game: https://www.theguardian.com/football/2021/aug/22/fabrice-nsakala-besiktas-collapse

Jens De Smet, 27, footballer collapses on field, passes away of heart attack: https://newswep.com/jens-27-collapses-on-the-football-field-and-dies-this-is-not-maldegem/

Jente van Genechten, 25, footballer collapses on field due to heart attack: https://www.sudinfo.be/id411745/article/2021-08-18/25-ans-un-joueur-belge-de-football-fait-un-arret-cardiaque-sur-le-terrain-avant

Frederic Lartillot, French footballer collapses in changing room, passes away due to heart attack after game: https://www.leprogres.fr/culture-loisirs/2021/09/11/deces-d-un-joueur-de-foot-apres-un-match-ses-coequipiers-ont-tout-tente-pour-le-sauver

Benjamin Taft, 31, German footballer collapses after game, passes away due to heart attack: https://www.anpfiff.info/mobile/sites/cms/artikel.aspx?SK=2&Btr=96044&Rub=390

Rune Coghe, 18, Belgian footballer suffers cardiac arrest on pitch: https://www.sudinfo.be/id409738/article/2021-08-07/rune-jeune-joueur-de-18-ans-secroule-sur-le-terrain-du-rds-plus-le-temps-passe

Helen Edwards, referee taken off court during World Cup qualifier due to heart issues: https://www.rtl.de/cms/dfb-spiel-unterbrochen-linienrichterin-vom-platz-getragen-4834888.html

Dimitri Lienard, 33, FC Strasbourg midfielder collapses during game: https://madeinfoot.ouest-france.fr/infos/article-rc-strasbourg-dimitri-lienard-a-ete-victime-d-un-malaise-354221.html

Sergio Aguero, 33, Barecelona star striker admitted to hospital for cardiac exam after match: https://www.cnn.com/2021/10/31/football/sergio-aguero-barcelona-chest-pain-spt-intl/index.html

Emil Palsson, 28, Sognal midfielder collapses due to cardiac arrest during game: https://www.independent.co.uk/sport/football/norway-footballer-emil-palsson-cardiac-arrest-b1949583.html

Antoine M├ęchin, 31, French triathlete suffers pulmonary embolism following Moderna: https://www.sudouest.fr/sport/course-pedestre/triathlon/le-triathlete-saintais-antoine-mechin-met-un-terme-a-sa-saison-et-ne-se-referait-pas-vacciner-si-c-etait-a-refaire-6234090.php

Luis Ojeda, 20, Argentine football player unexpectedly passes away: https://www.antena3.com/noticias/deportes/futbol/emotiva-carta-lola-ortiz-muerte-novio-futbolista-luis-ojeda-soporto-idea-volver-ver-verte-nunca-mas_20210426608696616e5d5b0001eb20e9.html

Greg Luyssen, 22, Belgian pro cyclist ends career due to heart issues: https://kw.be/sport/wielrennen/wielerbelofte-greg-luyssen-22-uit-de-panne-over-gedwongen-afscheid-door-hartprobleem-dat-akelig-gevoel-wil-ik-nooit-meer/

Pedro Obiang, 29, ex-West Ham star suffers myocarditis post vaccine: https://thecovidworld.com/pedro-obiang-29-year-old-professional-footballer-suffers-myocarditis-after-covid-19-vaccine/

Cienna Knowles, 19, equestrian star hospitalized due to blood clots: https://www.news.com.au/lifestyle/health/health-problems/teen-equestrian-star-cienna-knowles-hospitalised-with-blood-clots-after-pfizer-vaccine/news-story/286e7cd42e896b091e4b257322296a05

Boise pro mountain biker Kyle Warner tells about his vaccine journey: Big Health Update / Checking In - YouTube

Boris Sadecky, 24, Slovak hockey player dies of heart attack during hockey game: https://www.rt.com/sport/539312-bruno-sadecki-hockey-player-khl-death/

Thursday, December 16, 2021

Cutaneous manifestations of SARS-CoV-2 and COVID-19 vaccines

 COVID-19 is associated with a wide range of skin signs. 


The following six main clinical patterns have been proposed for such manifestations most recently: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, and (vi) purpuric "vasculitic" pattern. Livedo or necrosis - blotchy red or blue appearance with a net-like pattern - was associated with increased disease severity while measles-like (morbilliform) rash was generally seen in patients with moderate to severe infection (like in the patient shown on the left who died) and pseudo-chilblains, a late sign of COVID-19, was associated with decreased severity and more likely to happen for younger patients. The median duration of chiblain-like acral pattern, however, was significantly longer that all other patterns. One study of 200 patients found the following frequencies of these signs: 10.2% for Urticarial rash; 25.7% for confluent erythematous/maculo-papular/morbilliform rash; 15.5% for papulovesicular exanthem, 24.6% for a chilblain-like acral pattern; 2.1% for a livedo reticularis/racemosa-like pattern; and 6.9% for a purpuric vasculitic pattern. 15% of skin patterns were not clearly classified while 6.5% had more than one pattern present.

The prevalence of cutaneous involvement was 7.8% in a binational Chinese-Italian cohort of 678 hospitalized adults with laboratory-confirmed disease. Dermatologic reactions after COVID-19 vaccines have been also reported and can mimic SARS-CoV-2 infection itself (eg, pernio/chilblains). The prevalence was the highest after the 2nd dose of mRNA-1273 (over 12% in Moderna), although only 1-2% experienced it with ChAdOx1 nCov-19 vaccine (AstraZeneca).

Delayed large local reactions were most common among vaccinees, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. In a study of 414 people, forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less-common reactions included pernio/chilblains, dyshidrotic eczema, psoriasiform dermatitis, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. 

Some of more serious reactions could be exacerbation of Erythema multiforme. It mostly happens in mild form of a sudden rash that goes away in a few weeks but could progress to larger raised patches that look like a target or "bulls-eye" and may have a blister or crust. Relapses of autoimmune bullous disease have been also reported as well as new onset Lichen planus or flares of subacute cutaneous lupus erythematosus, psoriasis and atopic dermatitis. 

Morphologic misclassification is, however, possible. 


REFERENCES

Tan SW, Tam YC, Oh CC. Skin manifestations of COVID-19: A worldwide review. JAAD international. 2021 Mar 1;2:119-33.

Slimani Y, Abbassi R, El Fatoiki FZ, Barrou L, Chiheb S. Systemic lupus erythematosus and varicella‐like rash following COVID‐19 in a previously healthy patient. Journal of Medical Virology. 2021 Feb;93(2):1184-7.

Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID-19: current knowledge and future perspectives. Dermatology. 2021 Jan 1:1-2. 

Marzano AV, Genovese G, Moltrasio C, Gaspari V, Vezzoli P, Maione V, Misciali C, Sena P, Patrizi A, Offidani A, Quaglino P. The clinical spectrum of COVID-19–associated cutaneous manifestations: An Italian multicenter study of 200 adult patients. Journal of the American Academy of Dermatology. 2021 May 1;84(5):1356-63. 

Bogdanov G, Bogdanov I, Kazandjieva J, Tsankov N. Cutaneous adverse effects of the available COVID-19 vaccines. Clinics in Dermatology. 2021 Apr 27.

Rice SM, Ferree SD, Mesinkovska NA, Kourosh AS. The art of prevention: COVID-19 vaccine preparedness for the dermatologist. International journal of women's dermatology. 2021 Jan 12.



Friday, November 26, 2021

The Omicron

On 26 November 2021, WHO designated the variant B.1.1.529 a variant of concern, named Omicron. It is associated with substantial ability to evade immunity from prior infection. But many important questions about this variant's severity remain unanswered.
Omicron has more than 30 mutations in the spike protein targeted by COVID-19 vaccines. H655Y (Histidine at position 655 substituted by Tyrosine; first detected in Brazil) was previously shown to confer escape from human monoclonal antibodies. Another mutation borrowed from Gamma variant, N679K, may also increase infectivity.






Cases in US

California man who returned from South Africa mild (was fully vaccinated)

Minnesota man who recently traveled to NYC for a 3-day anime festival - mild (was fully vaccinated)

New York already had cases by that time one of which was a traveler returning from South Africa, 10 cases identified by December 5

Nebraska man who brought it from Nigeria and passed it to 5 other people, only one of whom was vaccinated

Wisconsin man tested positive for Omicron after a recent trip to South Africa 

The 1st Hawaii case is a 65 with no history of travel outside state who already had COVID-19 before. 

A middle-aged woman who recently traveled from South Africa became both New Jersey and Georgia’s first confirmed case after seeking care for moderate symptoms at an emergency room. 

640 deaths since Omicron dominant in South Africa

1st death confirmed in UK on Dec. 13 2021


REFERENCES

Juliet R.C. Pulliam, Cari van Schalkwyk, Nevashan Govender, Anne von Gottberg, Cheryl Cohen, Michelle J. Groome, Jonathan Dushoff, Koleka Mlisana, Harry Moultrie Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa  medRxiv 2021.11.11.21266068; doi: https://doi.org/10.1101/2021.11.11.21266068 

Rapp M, Shapiro L, Frank J. Contributions of single-particle cryoelectron microscopy toward fighting COVID-19. Trends in biochemical sciences.:S0968-0004.

Liu L., et al. Potent neutralizing antibodies against multiple epitopes on SARS-CoV-2 spike. Nature. 2020;584:450–456.


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