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BACKGROUND:Myriad infectious and noninfectious causes of encephalomyelitis (EM) have similar clinical manifestations, presenting serious challenges to diagnosis and treatment. Metabolomics of cerebrospinal fluid (CSF) was explored as a method of differentiating among neurological diseases causing EM using a single CSF sample. METHODOLOGY/PRINCIPAL FINDINGS:1H NMR metabolomics was applied to CSF samples from 27 patients with a laboratory-confirmed disease, including Lyme disease or West Nile Virus meningoencephalitis, multiple sclerosis, rabies, or Histoplasma meningitis, and 25 controls. Cluster analyses distinguished samples by infection status and moderately by pathogen, with shared and differentiating metabolite patterns observed among diseases. CART analysis predicted infection status with 100% sensitivity and 93% specificity. CONCLUSIONS/SIGNIFICANCE:These preliminary results suggest the potential utility of CSF metabolomics as a rapid screening test to enhance diagnostic accuracies and improve patient outcomes.

Objectives: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry., Design: Retrospective study., Setting: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry., Patients: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021., Interventions: None., Measurements and Main Results: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased., Conclusions: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults., Competing Interests: Dr. Bhalala is currently funded by the National Institutes of Health (NIH) (Site Principal Investigator [PI] for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (Site-PI for Pediatric Resuscitation Quality Collaborative – PediResQ), Voelcker Pilot Grant (PI for project on prearrest electrocardiographic changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) (coronavirus disease 2019 [COVID-19]) Registry and SCCM VIRUS electronic medical records, automation pilot. Ms. Boman’s institution received funding from The Gordon and Betty Moore Foundation. Ms. Boman and Drs. Kumar and Kashyap's institutions received funding from Janssen Research and Development, LLC. Dr. Kumar is currently funded by Gordon and Betty Moore Foundation, Centers for Disease Control and Prevention (CDC) Foundation through University of Washington and Janssen Research & Development, LLC. Dr. Chiotos funded by Agency for Healthcare Research and Quality(K12-HS026393). Dr. Bjornstad’s institution received funding from the International Society of Nephrology, The NIH-National Institute of Diabetes and Digestive and Kidney Diseases/T32, and Bioporto. Dr. Dapul disclosed that the deidentified data of some patients submitted to the VIRUS registry were also used in the Overcoming COVID-19 Virus Registry. Dr. Blatz funded by NIH grant T32GM-075766. Dr. Levy’s institution received funding from the CDC (No. 75D30120C07725) and the National Institute of Allergy and Infectious Diseases (AI 144301); she received funding from SinoUnited Health Shanghai Children’s Hospital. Drs. Kaufman’s, Abdelaty’s, and Briton’s institutions received funding from SCCM. Dr. Kaufman received funding from EngleWood Health for consulting work as medical director. Dr. Khanna’s institution received funding for COVID-19 trials Blood Volume Analyzer-Daxor and Chair Steering Committee for the Siltuximab in Selected Hospitalized Patients With Viral Acute Respiratory Distress Syndrome trial. Dr. Khanna is currently funded by a Clinical Translational Science Institute NIH/National Center for Advanced Translational Science KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring and is a site PI (institutional funding) for a randomized trial of cytokine filtration in severe COVID-19 and a prospective observational trial of blood volume assessment in COVID-19. His institution also received funding for the SCCM VIRUS EMR automation pilot. Dr. Stulce received funding from the American Physician Institute. Dr. Anderson III disclosed that he is on the Advisory Board for the Gift of Life Michigan. Dr. Bello disclosed government work. Dr. Walkey currently funded the NIH/National Heart, Lung and Blood Institute (NHLBI) grants R01HL151607, R01HL139751, R01HL136660, Agency of Healthcare Research and Quality, R01HS026485, Boston Biomedical Innovation Center/NIH/NHLBI 5U54HL119145-07, and royalties from UptoDate. Dr. Bihorac received support for article research from the NIH. His institution received funding from the NIH (R01 GM110240 R21 EB 027344), Atox Bio, Astute Medical Research, Mallinckrodt Pharmaceuticals, and La Jolla Pharmaceuticals; she disclosed three institutional patents (20200161000, WO2020172607A12020, and 20190326013). Dr. Zimmerman’s institution received funding from the NIH-National Institute of Child Health and Human Development and Immunexpress; he received funding from Elsevier Publishing. Dr. Kashyap receives funding from the NIH/NHLBI: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Antiphospholipid antibody syndrome, also known as Hughes syndrome, is a hypercoagulable disorder that increases the risk of recurrent vascular thrombosis. We present a case of 26-year-old female who developed massive bilateral pulmonary emboli after being started on oral contraceptive pills. Further work-up of the patient revealed that she had anticardiolipin antibody syndrome and the thrombotic event was precipitated by oral contraceptive pills.