The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality across the world, with no current effective treatments available. Recent studies suggest the possibility of a cytokine storm associated with severe COVID-19, similar to the biochemical profile seen in hemophagocytic lymphohistiocytosis (HLH), raising the question of possible benefits that could be derived from targeted immunosuppression in severe COVID-19 patients. We reviewed the literature regarding the diagnosis and features of HLH, particularly secondary HLH, and aimed to identify gaps in the literature to truly clarify the existence of a COVID-19 associated HLH. Diagnostic criteria such as HScore or HLH-2004 may have suboptimal performance in identifying COVID-19 HLH-like presentations, and criteria such as soluble CD163, NK cell activity, or other novel biomarkers may be more useful in identifying this entity.

Introduction: Late-onset disease with Group B Streptococcus (GBS LOD) remains a significant problem in neonates. Unlike early-onset disease, rates of GBS LOD have not changed with prenatal testing. Effects of GBS LOD can be severe and thus identifying risk factors for severe GBS LOD, such as hypervirulence genes, may help in managing these infants. Case presentation: We present a case of a neonate with capsular serotype III GBS sepsis without meningitis that recurred 6 days after a 10-day-treatment period with IV ampicillin. The second episode was characterized by sepsis, neuroinvasion, meningitis and subsequent profound encephalomalacia. The short duration between the two episodes suggested recrudescence rather than reinfection. The GBS isolate was ultimately found to be positive for hypervirulence gene hvgA+, which encodes for a protein known to mediate meningeal tropism and neuroinvasion. Conclusion: hvgA positivity may thus potentially serve as an important biomarker for severe and neuroinvasive GBS LOD that can influence treatment decisions.