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09.03.2021 | COVID-19 | Original Article Zur Zeit gratis

Incidence, clinical characteristics, risk factors and outcomes of meningoencephalitis in patients with COVID-19

verfasst von: Marcos Fragiel, Òscar Miró, Pere Llorens, Sònia Jiménez, Pascual Piñera Salmerón, Guillermo Burillo-Putze, Alfonso Martín, Francisco Javier Martín-Sánchez, Eric Jorge García Lamberechts, Javier Jacob, Aitor Alquézar-Arbé, Ferran Llopis-Roca, Jorge Pedraza García, Ricardo Calvo López, María Teresa Maza Vera, Francisco Javier Lucas-Imbernón, Félix González Martinez, Ricardo Juárez, Marcos Expósito Rodriguez, Beatriz Maria Martinez Bautista, Ana Patricia Niembro Valdés, Jose Andres Sanchez Nicolas, José María Ferreras Amez, Jesús Porta-Etessam, Elpidio Calvo, Juan González del Castillo, on behalf of the Spanish Investigators on Emergency Situations TeAm (SIESTA) network

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 8/2021

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Abstract

We investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40‰, 95%CI=0.27–0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11‰, 95%CI=0.09–0.13; OR=3.65, 95%CI=2.45–5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1–0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4–10.2), headache (OR=24.7, 95%CI=10.2–60.1), and altered mental status (OR=12.9, 95%CI=6.6–25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04–4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19–66.7) and intensive care admission (OR=5.89; 95%CI=3.12–11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation (<0.5‰ cases), but is more than 4-fold more frequent than in non-COVID patients attending the ED. As the majority of these MEs had lymphocytic predominance and in one patient SARS-CoV-2 antigen was detected in CSF, SARS-CoV-2 could be the cause of most of the cases observed. COVID-ME patients had a higher unadjusted in-hospital mortality than non-COVID-ME patients.
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Metadaten
Titel
Incidence, clinical characteristics, risk factors and outcomes of meningoencephalitis in patients with COVID-19
verfasst von
Marcos Fragiel
Òscar Miró
Pere Llorens
Sònia Jiménez
Pascual Piñera Salmerón
Guillermo Burillo-Putze
Alfonso Martín
Francisco Javier Martín-Sánchez
Eric Jorge García Lamberechts
Javier Jacob
Aitor Alquézar-Arbé
Ferran Llopis-Roca
Jorge Pedraza García
Ricardo Calvo López
María Teresa Maza Vera
Francisco Javier Lucas-Imbernón
Félix González Martinez
Ricardo Juárez
Marcos Expósito Rodriguez
Beatriz Maria Martinez Bautista
Ana Patricia Niembro Valdés
Jose Andres Sanchez Nicolas
José María Ferreras Amez
Jesús Porta-Etessam
Elpidio Calvo
Juan González del Castillo
on behalf of the Spanish Investigators on Emergency Situations TeAm (SIESTA) network
Publikationsdatum
09.03.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 8/2021
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-021-04206-5

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