TY - JOUR
T1 - Case report
T2 - Microcirculatory leukocytes in a pediatric patient with severe SARS-CoV-2 pneumonia. Findings of leukocytes trafficking beyond the lungs
AU - Bottari, Gabriella
AU - Ince, Can
AU - Confalone, Valerio
AU - Perdichizzi, Salvatore
AU - Casamento Tumeo, Chiara
AU - Nunziata, Joseph
AU - Bernardi, Stefania
AU - Calò Carducci, Francesca
AU - Lancella, Laura
AU - Bernaschi, Paola
AU - Russo, Cristina
AU - Perno, Carlo Federico
AU - Cecchetti, Corrado
AU - Villani, Alberto
N1 - Funding Information: We thank all the medical and nursing PICU staff of Bambino Gesù Children’s Hospital who continue to care for patients and parents. Publisher Copyright: Copyright © 2022 Bottari, Ince, Confalone, Perdichizzi, Casamento Tumeo, Nunziata, Bernardi, Calò Carducci, Lancella, Bernaschi, Russo, Perno, Cecchetti and Villani.
PY - 2022/9/8
Y1 - 2022/9/8
N2 - 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.
AB - 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.
KW - SARS-CoV-2
KW - inflammation
KW - micro-thrombosis
KW - microcirculation
KW - pediatric critical care
KW - rolling leukocytes
UR - http://www.scopus.com/inward/record.url?scp=85138571399&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fped.2022.978381
DO - https://doi.org/10.3389/fped.2022.978381
M3 - Article
C2 - 36160802
SN - 2296-2360
VL - 10
JO - Frontiers in pediatrics
JF - Frontiers in pediatrics
M1 - 978381
ER -