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3. Neurological, Neuropsychiatric and Psychiatric Symptoms During COVID- 19 Infection and After Recovery:A Systematic Review of Observational Studies

Author

Stavrou, Maria, Solomou, Solomis, Kythreotou, Anthousa, Ioannou, Antreas, Lioutas, Eva, Lioutas, Joanna, Karayiannis, Peter, Stavrou, Maria, Solomou, Solomis, Kythreotou, Anthousa, Ioannou, Antreas, Lioutas, Eva, Lioutas, Joanna, and Karayiannis, Peter

Abstract

Background: The SARS-CoV-2 virus causes a wide spectrum of disease severity. Initial manifestations include fever, dry cough, and constitutional symptoms, which may progress to respiratory disease. There may also be neurological and psychiatric manifestations, involving both the central and peripheral nervous system. Methods: We performed a literature search of the databases PubMed, EMBASE, The Cochrane Library and Web of Science for observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. This was followed by a narrative synthesis to summarise the data and discuss neuropsychiatric associations, symptom severity, management, and recovery. Findings: The most frequently reported neurological symptoms were ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. Statistically significant relationships were noted between Asian ethnicity and peripheral neuropathy (p=0·0001) and neuro-syndromic symptoms (p=0·001). ITU admission was found to have a statistically significant relationship with male sex (p=0·024). Depression and anxiety were also identified both during and after infection. The most frequent treatments used were intravenous immunoglobulins, followed by antibiotics, antivirals, and hydroxychloroquine; with mean treatment duration of 6 days. Interpretation: Various neuropsychiatric symptoms have been associated with COVID-19 infection. More studies are required to further our knowledge in the management of neurological and psychiatric symptoms during and after COVID-19 infection

Published
2021

4. Neurological, Neuropsychiatric and Psychiatric Symptoms During COVID- 19 Infection and After Recovery : A Systematic Review of Observational Studies

Author

Stavrou, Maria, Solomou, Solomis, Kythreotou, Anthousa, Ioannou, Antreas, Lioutas, Eva, Lioutas, Joanna, Karayiannis, Peter, Stavrou, Maria, Solomou, Solomis, Kythreotou, Anthousa, Ioannou, Antreas, Lioutas, Eva, Lioutas, Joanna, and Karayiannis, Peter

Abstract

Background: The SARS-CoV-2 virus causes a wide spectrum of disease severity. Initial manifestations include fever, dry cough, and constitutional symptoms, which may progress to respiratory disease. There may also be neurological and psychiatric manifestations, involving both the central and peripheral nervous system. Methods: We performed a literature search of the databases PubMed, EMBASE, The Cochrane Library and Web of Science for observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. This was followed by a narrative synthesis to summarise the data and discuss neuropsychiatric associations, symptom severity, management, and recovery. Findings: The most frequently reported neurological symptoms were ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. Statistically significant relationships were noted between Asian ethnicity and peripheral neuropathy (p=0·0001) and neuro-syndromic symptoms (p=0·001). ITU admission was found to have a statistically significant relationship with male sex (p=0·024). Depression and anxiety were also identified both during and after infection. The most frequent treatments used were intravenous immunoglobulins, followed by antibiotics, antivirals, and hydroxychloroquine; with mean treatment duration of 6 days. Interpretation: Various neuropsychiatric symptoms have been associated with COVID-19 infection. More studies are required to further our knowledge in the management of neurological and psychiatric symptoms during and after COVID-19 infection

Published
2021

6. Complicated Lemierre Syndrome Caused by Streptococcus gordonii and Possible Rickettsial Co-Infection in a Patient with Thrombophilia Predisposition

Author

Ioannou, Antreas Dimitriou, Dimitra Dimitriou, Panagiotis Katsios, Aram Petrikkos, Georgios

Abstract

AIMS: Lemierre syndrome is a life-threating condition characterized by recent oropharyngeal infection, internal jugular vein thrombosis, and anaerobic septicemia. It is usually caused by Fusobacterium necrophorum. METHODS: A young Romanian male presented with fever and rigors, mild tachypnea, hypoxia, sore throat, decayed teeth, and tenderness of the left carotid triangle. Laboratory examination indicated severe sepsis with disseminated intravascular coagulation, acute renal failure, and acute respiratory distress syndrome while the Doppler ultrasonography of the carotids revealed left internal jugular venous thrombosis. The patient was administered piperacillin/tazobactam and vancomycin intravenously, doxycycline orally, and anti-coagulation by enoxaparin based on the diagnosis of Lemierre syndrome. Meanwhile, he was complicated by bilateral diffuse pulmonary cavities and encapsulated pleural effusions and so transcutaneous drainage was performed. The patient was discharged after a month and continued his treatment with oral phenoxypenicillin and doxycycline until full radiographic improvement. He was switched to oral anti-coagulation by vitamin-K antagonists and was referred to a hematologist, a vascular-surgeon, and a dentist. RESULTS: Streptococcus gordonii was isolated from the patient's blood and pleural fluid cultures and serology for Rickettsial spp. IgM was positive. Thrombophilia genetic tests revealed three minor mutations for fibrinogen-455, plasminogen activator inhibitor-1, and methylenetetrahydrofolate reductase. According to the literature, S. gordonii is not usually a causative agent and Rickettsial spp. have as yet not been correlated with Lemierre syndrome. The failure of left jugular vein recanalization shows a possible causative role of the underlying thrombophilic predisposition. DISCUSSION: Because of the syndrome's rarity and the atypical microorganisms isolated in this case, increased awareness is advised for its diagnosis and the underlying mechanisms involved in its genesis. The role of anti-coagulation is debatable. LEARNING POINTS: Very rare condition. Medical practitioners should be vigilant in its diagnosis since septic jugular vein thrombophlebitis could be misdiagnosed as neck lymphadenitis.Duration of antibiotic therapy and additional anticoagulation treatment are still under discussion.Underlying thrombophilia predisposition should be excluded.

Published
2017

11. Insidious manifestation of pyogenic liver abscess caused by Streptococcus intermedius and Micrococcus luteus: a case report.

Author

Ioannou, Antreas, Xenophontos, Eleni, Karatsi, Alexandra, Petrides, Christos, Kleridou, Maro, and Zintilis, Chrysostomos

Subjects
*PYOGENIC liver abscess, *STREPTOCOCCUS, *MICROCOCCUS luteus
Abstract

Pyogenic liver abscesses are caused by various microorganisms and usually present with fever, abdominal pain, leukocytosis and liver enzyme abnormalities. This case presents the insidious manifestation of a pyogenic liver abscess in a 34-year-old immunocompetent male, where classical manifestations of a liver abscesswere absent. The microorganisms cultured from the abscess belonged to oral cavity's and gastrointestinal tract's normal flora. [ABSTRACT FROM AUTHOR]

Published
2016
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