zithromax and Myocarditis

The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.

Topics: Acute Coronary Syndrome; Anti-Bacterial Agents; Antiviral Agents; Arrhythmias, Cardiac; Azithromycin; Betacoronavirus; Cardiotonic Agents; Chronic Disease; Coronavirus Infections; COVID-19; Cytokine Release Syndrome; Enzyme Inhibitors; Extracorporeal Membrane Oxygenation; Heart Failure; Heart-Assist Devices; Humans; Hydroxychloroquine; Intra-Aortic Balloon Pumping; Myocardial Infarction; Myocarditis; Pandemics; Percutaneous Coronary Intervention; Pneumonia, Viral; SARS-CoV-2; Shock, Cardiogenic; Thromboembolism

Topics: Azithromycin; Betacoronavirus; Biomarkers; Coronavirus Infections; COVID-19; Cytokine Release Syndrome; Diagnosis, Differential; Drug Therapy, Combination; Humans; Hydroxychloroquine; Hypoxia; Long QT Syndrome; Myocardial Infarction; Myocarditis; Pandemics; Pericarditis; Pneumonia, Viral; SARS-CoV-2; Systemic Inflammatory Response Syndrome; Tachycardia, Ventricular; Thrombophilia; Ventricular Dysfunction, Left; Ventricular Fibrillation

We report two cases of acute hypotension after intravenous azithromycin administration in children with acute, decompensated heart failure. In each of our reported cases, azithromycin was being used to treat possible

Topics: Azithromycin; Child; Heart Failure; Humans; Hypotension; Infusions, Intravenous; Myocarditis

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Campylobacter Infections; Campylobacter jejuni; Colchicine; Diarrhea; Electrocardiography; Female; Foodborne Diseases; Humans; Magnetic Resonance Imaging; Middle Aged; Myocarditis; Pericarditis; Troponin I; Tubulin Modulators

Novel coronavirus disease 2019 (COVID-19) emerged in late December 2019 in Wuhan, China. Since then, COVID-19 has become a pandemic affecting more than 4.1 million people worldwide. Patients with COVID-19 have a wide spectrum of manifestations, one being cytokine release syndrome (CRS) and its fatal correlate, secondary hemophagocytic lymphohistiocytosis (sHLH). Anti-cytokine therapy such as tocilizumab, an IL-6 receptor antagonist, is a potential treatment for COVID-19; however, data regarding the efficacy of this anti-IL-6 therapy are currently lacking. We report two cases of patients who received a diagnosis of COVID-19 complicated by CRS and were treated with tocilizumab. Both patients progressed to sHLH despite treatment with tocilizumab, and one developed viral myocarditis, challenging the safety and clinical usefulness of tocilizumab in the treatment of COVID-19-induced CRS. These cases highlight the need for clinical trials to determine optimal patient selection and timing for the use of tocilizumab during this disease process.

Topics: Adult; Aged; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Azithromycin; Betacoronavirus; C-Reactive Protein; Clinical Deterioration; Coronavirus Infections; COVID-19; Cytokine Release Syndrome; Fatal Outcome; Female; Humans; Hydroxychloroquine; Hypoxia; Lymphohistiocytosis, Hemophagocytic; Male; Myocarditis; Pandemics; Pneumonia, Viral; Respiration, Artificial; SARS-CoV-2; Shock, Septic

Topics: Adrenergic beta-Agonists; Aged; Anti-Infective Agents; Azithromycin; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Electrocardiography; Humans; Hydroxychloroquine; Isoproterenol; Long QT Syndrome; Male; Myocarditis; Pandemics; Pneumonia, Viral; SARS-CoV-2; Treatment Outcome; Troponin I

We present a 46-year-old male patient with complete atrio-ventricular block. A inflammatory etiology was suspected and finally lyme carditis was diagnosed. The conduction abnormalities disappeared with antibiotic treatment and a pacemaker implantation was not needed. Further follow-up of two years was uneventful.

Topics: Anti-Bacterial Agents; Atrioventricular Block; Azithromycin; Ceftriaxone; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Electrocardiography; Humans; Lyme Disease; Male; Middle Aged; Myocarditis; Pacemaker, Artificial

An 11-year-old boy with serologically confirmed Chlamydophila pneumoniae infection presented with clinical, laboratory, and echocardiographic changes consistent with myopericarditis. No reports on C. pneumoniae myopericarditis in children are found in the medical literature. The boy, previously healthy, presented with fever, rash, constitutional symptoms, elevated acute phase reactants, elevated cardiac enzymes, and high brain natriuretic peptide levels. Hemodynamic instabilities, including hypotension and mild hypoxia, were noted. Two-dimensional echocardiographic findings showed mildly depressed left ventricular systolic function and small pericardial effusion. Requiring inotropic support, the boy was treated with azithromycin 10 mg/kg once daily for 7 days and a single dose of intravenous immunoglobulin 2 g/kg. He recovered fully with improved left ventricular systolic function before hospital discharge. An early definitive diagnosis is essential to knowing the etiology of pediatric myocarditis. Specific therapy may play role in the management and prognosis of this disorder.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Child; Chlamydophila Infections; Chlamydophila pneumoniae; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Male; Myocarditis; Pericarditis; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Azathioprine; Azithromycin; Drug Hypersensitivity; Drug Therapy, Combination; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Myocarditis; Prednisone