Case report: Microcirculatory leukocytes in a pediatric patient with severe SARS-CoV-2 pneumonia. Findings of leukocytes trafficking beyond the lungs.

Autor:	Bottari G; Pediatric Intensive Care Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Ince C; Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Confalone V; Pediatric Intensive Care Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Perdichizzi S; Pediatric Intensive Care Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Casamento Tumeo C; Department of Pediatrics, Residency School of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, University of Rome Tor Vergata, Rome, Italy., Nunziata J; Pediatric Intensive Care Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Bernardi S; Infectious Diseases and Immuno-Infectiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Calò Carducci F; Infectious Diseases and Immuno-Infectiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Lancella L; Infectious Diseases and Immuno-Infectiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Bernaschi P; Unit of Microbiology and Diagnostic Immunology, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Russo C; Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Perno CF; Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.; Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Cecchetti C; Pediatric Intensive Care Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Villani A; General Pediatric and Infectious Disease Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy.
Jazyk:	angličtina
Zdroj:	Frontiers in pediatrics [Front Pediatr] 2022 Sep 08; Vol. 10, pp. 978381. Date of Electronic Publication: 2022 Sep 08 (Print Publication: 2022).
DOI:	10.3389/fped.2022.978381
Abstrakt:	Background: SARS-CoV-2 can lead to excessive coagulation and thrombo-inflammation with deposition of microthrombi and microvascular dysfunction. Several studies in human and animal models have already evidenced biomarkers of endothelial injury during SARS-CoV-2 infection. Real-time observation of sublingual microcirculation using an handheld vital microscopy with an Incident Dark Field (IDF) technique could represent a non-invasive way to assess early signs of microvascular dysfunction and endothelial inflammation in patients with severe COVID-19 infection. Clinical Case: We report for the first time in a pediatric patient with severe SARS-CoV-2 pneumonia findings about microcirculatory leukocytes in the sublingual microcirculation of a 7 month-old patient admitted to our PICU using handheld vital microscopy with IDF technique. Results: Sublingual microcirculation analysis revealed the presence of microcirculatory alterations and an extensive presence of leukocytes in the patient's sublingual microcirculation. It's significant to underline how the patient didn't show a contextual significant increase in inflammatory biomarkers or other clinical signs related to an inflammatory response, beyond the presence of severe hypoxic respiratory failure. Conclusion: Leukocyte activation in multiple organs can occur at the endothelial lining of the microvasculature where a surge of pro-inflammatory mediators can result in accumulation of activated leukocytes and degradation of the endothelium. The introduction of a method to assess in a non-invasive, real-time manner the extent of inflammation in a patient with COVID19 could lead to potential clinical and therapeutic implications. However, more studies are required to prove that studying leukocytes microcirculation using sublingual microcirculation analysis could be useful as a bedside point of care monitor to predict the presence of systemic inflammation associated with the impact of COVID-19, leading in a late phase of severe SARS-CoV-2 infection to a microvascular dysfunction and micro-thrombosis. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Bottari, Ince, Confalone, Perdichizzi, Casamento Tumeo, Nunziata, Bernardi, Calò Carducci, Lancella, Bernaschi, Russo, Perno, Cecchetti and Villani.)
Databáze:	MEDLINE
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