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Case Presentation

22 y/o male presenting with fever and headache. Not appearing ill. Has been in Congo for 1 month, 1 month ago. Guess the pathogen.

Diagnosis added by author

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Plasmodium falciparum

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Research Analysis

"In this analysis of 222 offspring of mothers infected with SARS-CoV-2, compared with the offspring of 7550 mothers in the control group (not infected) delivered during the same period, we observed neurodevelopmental diagnoses to be significantly more common among exposed offspring, particularly those exposed to third-trimester maternal infection," they write. The study included 7772 mostly singleton live births across six hospitals in Massachusetts between March and September 2020, including 222 (2.9%) births to mothers with SARS-CoV-2 infection confirmed by polymerase chain reaction testing during pregnancy. In all, 14 of 222 children born to SARS-CoV-2-infected mothers (6.3%) were diagnosed with a neurodevelopmental disorder in the first year of life vs 227 of 7550 unexposed offspring (3%) (unadjusted odds ratio [OR], 2.17; 95% CI, 1.24 - 3.79; P = .006). In models adjusted for preterm delivery, as well as race, ethnicity, insurance status, child sex and maternal age, COVID-exposed offspring were significantly more likely to receive a neurodevelopmental diagnosis in the first year of life (adjusted OR, 1.86; 95% CI, 1.03 - 3.36; P = .04). The magnitude of the association with neurodevelopmental disorders was greater with third-trimester SARS-CoV-2 infection (adjusted OR, 2.34; 95% CI, 1.23 - 4.44; P = .01). The majority of these diagnoses reflected developmental disorders of motor function or speech and language. The researchers note the finding of an association between prenatal SARS-CoV-2 exposure and neurodevelopmental diagnoses at 12 months are in line with a "large body of literature" linking maternal viral infection and maternal immune activation with offspring neurodevelopmental disorders later in life. They caution, however, that whether a definitive connection exists between prenatal SARS-CoV-2 exposure and adverse neurodevelopment in offspring is not yet known, in part because children born to women infected in the first wave of the pandemic haven't reached their second birthday — a time when neurodevelopment disorders such as autism are typically diagnosed. There is also the risk for ascertainment bias arising from greater concern for offspring of infected mothers who were ill during pregnancy. These parents may be more inclined to seek evaluation, and clinicians may be more inclined to diagnose or refer for evaluation. Source: JAMA Network Open.

Case Summary

22 y/o F, P.t referred from clinic with dyspnea, associated with fever and rigours. She had flu-like illness two weeks ago, from 2 days ago she had severe dyspnea with fever and rigours. On admission SpO2 60%, BP 80/50, HR 110, Generally appears very ill, agitated and dyspneic. What's cause of her death?

Additional Case Insights

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.