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Legarda EM, Martínez J, Sisa I. Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19: Retrospective Cohort From Ecuador. Pediatr Infect Dis J 2023; 42:305-309. [PMID: 36728828 PMCID: PMC9990476 DOI: 10.1097/inf.0000000000003811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C). METHODS One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission. RESULTS Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities. CONCLUSIONS Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.
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Affiliation(s)
- Eliana M. Legarda
- From the Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Quito, Ecuador
- Unidad de Cuidados Intensivos Pediátricos, Hospital Pediátrico Baca Ortiz, Quito, Ecuador
| | - Jenny Martínez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Pediátrico Baca Ortiz, Quito, Ecuador
| | - Ivan Sisa
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Hospital de los Valles, Quito, Ecuador
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Edinoff AN, Alpaugh ES, Newgaard O, Wajid I, Klapper RJ, Cornett EM, Kaye AM, Iyer P, Kaye AD. Tocilizumab for Severe COVID-19 Infection and Multisystem Inflammatory Syndrome in Adults and Children. Life (Basel) 2023; 13:life13040889. [PMID: 37109418 PMCID: PMC10142952 DOI: 10.3390/life13040889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) rapidly emerged as a global pandemic, placing imminent stress and burden on healthcare resources and workers worldwide. Many patients who present with a severe COVID-19 infection are at high risk of developing severe acute respiratory distress syndrome (ARDS), leading to a vast number of patients requiring mechanical ventilation and a high mortality rate. Similar to Middle East respiratory syndrome, COVID-19 demonstrates an initial viral replication phase that manifests as a variety of symptoms typically flu-like in nature, followed by a profound inflammatory response leading to rapid production of cytokines and uncontrolled inflammation. There have also been many cases of COVID-19 in pediatric patients presenting with elevated inflammatory markers and multisystem involvement labeled as a multisystem inflammatory syndrome (MIS-C) by the world health organization (WHO). The recent treatment of systemic inflammatory response to COVID-19 targets the secondary phase involving cytokine release syndrome. The detrimental effects of IL-6 can be profound and elevated levels are associated with a higher mortality rate and mechanical ventilation. Tocilizumab is an IL-6 inhibitor most widely investigated to target cytokine storm syndrome. Since June 2021, the FDA enacted an emergency use authorization for tocilizumab in the treatment of COVID-19. Several clinical trials have investigated tocilizumab combined with corticosteroids for treating severe ARDS associated with COVID-19. An increasing amount of evidence suggests that targeting the cytokine storm syndrome related to COVID-19 can lead to improved outcomes, especially in those patients requiring mechanical ventilation and with a critical illness. Additional studies are warranted to further look at the positive effects of tocilizumab in the COVID-19 population while additionally defining possible adverse effects.
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Petrovic D, Benzon B, Srsen S, Polic B, Vukovic Novogradec A, Milic P, Markic J. The Impact of Vitamin D Levels on Clinical Manifestations of Multisystem Inflammatory Syndrome in Children: A Cross-Sectional Study. Life (Basel) 2023; 13:674. [PMID: 36983830 PMCID: PMC10057472 DOI: 10.3390/life13030674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hyperinflammatory response that resembles Kawasaki disease may develop in children after COVID-19 disease, and it is called multisystem inflammatory syndrome in children. The cause of MIS-C is dysregulated innate immune response and a subsequent cytokine storm that results in endothelial damage. It has been determined that low levels of serum 25(OH)D increase the risk of developing immune-related diseases and disorders. METHODS To determine the incidence of hypovitaminosis D, and a possible correlation between 25(OH)D levels and the clinical severity of MIS-C, 21 patients hospitalized in the University Hospital of Split due to MIS-C were evaluated. RESULTS Hypovitaminosis D was detected in 95% of MIS-C patients. We found a significant relationship between the severity of MIS-C and 25(OH)D levels, as patients with more severe MIS-C had lower 25(OH)D. MIS-C patients with lower vitamin D levels had worse systolic and diastolic function of the left ventricle according to echocardiograms. There was no relationship between 25(OH)D levels and the tested laboratory inflammatory and cardiac markers. CONCLUSION Hypovitaminosis D is very common in children with MIS-C and influences the severity of the disease. VD could be a new potential biomarker in MIS-C, and VD replacement therapy should be considered early on in the treatment of MIS-C.
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Affiliation(s)
- Davor Petrovic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Benjamin Benzon
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Sasa Srsen
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Branka Polic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | | | - Petra Milic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
| | - Josko Markic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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Marinho AKBB. Vaccination in children with immune-mediated disorders. J Pediatr (Rio J) 2023; 99 Suppl 1:S62-S69. [PMID: 36566017 PMCID: PMC10066448 DOI: 10.1016/j.jped.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To present an updated review of recommendations for the vaccination of children with immune-mediated diseases, with an emphasis on rheumatic and inflammatory diseases. SOURCE OF DATA Studies published in the PubMed and Scielo databases between 2002 and 2022, Guidelines of Brazilian Scientific Societies, Manuals and Technical Notes of the Ministry of Health of Brazil, on current immunization schedules for special populations. DATA SYNTHESIS Immunosuppressive drugs and biological agents reduce the immunogenicity of vaccines and favor susceptibility to infections. The safety and efficacy of immunogens are important points for vaccination in children with immune-mediated diseases. The safety threshold of a vaccine applied to immunocompromised individuals can be reduced when compared to healthy individuals. Very often, the recommendations for the immunization of children with immune-mediated diseases follow the recommendations for immunocompromised patients. Vaccination against COVID-19, on the other hand, should ideally occur when the disease is stabilized and in the absence of a low degree of immunosuppression. The patients should be informed about the possibility that the immunization may fail during treatment with immunosuppressants. Specific vaccination schedules should be considered to ensure better protection. CONCLUSIONS Recent studies have allowed updating the recommendations on the safety and immunogenicity of vaccination in children with immune-mediated diseases, especially for live attenuated vaccines. There is a scarcity of data on the safety and efficacy of COVID-19 vaccines in patients, particularly pediatric patients, with rheumatic diseases. The completion of ongoing studies is expected to help guide recommendations on COVID-19 vaccines in this group of patients.
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Affiliation(s)
- Ana Karolina Barreto Berselli Marinho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Serviço de Imunologia Clínica e Alergia, São Paulo, SP, Brazil.
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Kukulski L, Scharf G, Schierling W, Pfister K, Linnemann B. Spontaneous dissection of the superior mesenteric artery related to COVID-19. VASA 2023; 52:107-118. [PMID: 36636830 DOI: 10.1024/0301-1526/a001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Spontaneous peripheral dissections are rare, and in a substantial number of cases, the underlying aetiology remains unclear. Patients and methods: We report the case of a 63-year-old male patient with a recent asymptomatic SARS-CoV-2 infection who presented with sudden-onset intermittent abdominal pain. Imaging studies revealed a dissection of the superior mesenteric artery (SMA) and large-vessel vasculitis involving the SMA as well as the carotid, subclavian, axillary and femoropopliteal arteries. In the absence of other predisposing factors, we supposed an association with prior COVID-19 and performed a systematic review of the literature to search for similar cases with arterial dissection related to acute or recent SARS-CoV-2 infection. Results: We identified 25 cases, including ours: 13 males and 12 females, with a median age of 48 years. In 22/25 patients, arterial dissection occurred within 4 weeks after the diagnosis of COVID-19 and involved the cerebral (11/25; 44%), coronary (10/25; 40%), splanchnic (3/25; 12%) and renal (2/25; 8%) arteries. Conclusions: Although initially known for its respiratory manifestations, it has become evident that SARS-CoV-2 not only infects pneumocytes but also enters the vascular endothelium, leading to endothelial dysfunction and hypercoagulability and - as shown in our case - large-vessel vasculitis, which may predispose patients to intramural haemorrhage and arterial dissection.
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Affiliation(s)
- Leszek Kukulski
- Department of Vascular Surgery, University Hospital Regensburg, Germany.,Department of Cardiac, Vascular and Endovascular Surgery and Tranplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Gregor Scharf
- Department of Radiology, Interventional Radiology, University Hospital Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Hospital Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Germany
| | - Birgit Linnemann
- Division of Angiology, East Bavarian Center of Vascular Medicine, University Hospital Regensburg, Germany
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Al Badi E, Al Shukri I, Al Mahruqi S. Correlation of Viral Load With the Biochemical and Hematological Profiles of COVID-19 Patients in Al Buraimi Hospital, Sultanate of Oman: A Cross-Sectional Study. Cureus 2023; 15:e35228. [PMID: 36968904 PMCID: PMC10032618 DOI: 10.7759/cureus.35228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Background Rapid identification of COVID-19 is crucial during the pandemic for the treatment and management of patients. Thus, early diagnosis of the disease using laboratory parameters can help in the rapid management of infected patients. This study aimed to investigate the correlation of viral load with hematological and biochemical parameters. This will ultimately help physicians to better understand the dynamics of this novel virus and aid in the management of patients. Methodology Laboratory confirmation of SARS-CoV-2 was performed by reverse transcription-polymerase chain reaction (RT-PCR) at the Al-Buraimi Hospital Laboratory Department using oropharyngeal and nasopharyngeal swabs. Positive cases were collected from July 2020 to January 2021 to be enrolled in this study. Results In this study, 264 confirmed positive patients were included initially and divided into three groups according to their cycle threshold (Ct) values obtained by PCR. Out of the total 264 patients, 174 (65.9%) were male, while 90 (34.1%) were female. However, the final sample was only 253 patients who met the inclusion criteria. With regard to Ct values, the study population was divided into the following three groups: Group 1 with Ct values of 9-20 (n = 87; 34.4%), group 2 with Ct values of 21-30 (n = 122; 47.8%), and group 3 with Ct values of 31-42 (n = 44; 17.4%). Conclusions We found that the proportion of male patients infected with COVID-19 was higher compared to females. In addition, the highest incidence was among patients in the age group of 51-70 years. The ferritin and alanine transaminase levels were highest in the initial stage of the infection (group 1) and decreased at the recovery stage. However, neutrophil, lymphocyte, alkaline phosphatase, and C-reactive protein showed an increasing trend from high viral load groups to low viral load groups. The values of the rest of the parameters, such as albumin, total bilirubin, lactate dehydrogenase, and D-dimer, were slightly higher in the initial stage of the infection but the decreasing trend was low; therefore, they were not considered helpful in predicting the disease severity reflected by their Ct value in the three different groups.
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Özgür Gündeşlioğlu Ö, Subaşı B, Pişkin F, Atmış A, Demir F, Erdem S, Alabaz D, Çay Ü, Tapaç N, Kılınç F, Kaymaz ST, Özgür Horoz Ö, Yıldızdaş RD, Ünal İ. Cardiac effects of multisystem inflammatory syndrome in children: One-year follow-up. J Paediatr Child Health 2023; 59:637-643. [PMID: 36786503 DOI: 10.1111/jpc.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/27/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
AIM Cardiovascular involvement is common among children with multisystem inflammatory syndrome (MIS-C) and can cause shock and death. In this study, we evaluated the early and long-term cardiac effects of MIS-C. METHODS In this observational cohort study, we included all children treated for MIS-C from October 2020 to November 2021 in the Department of Paediatric Infectious Disease at Cukurova University School of Medicine Hospital. The patients underwent serial echocardiographical evaluation during hospitalisation and at 1, 3, 6 and 12 months after discharge. The patients were evaluated using Holter monitorisation between 4 and 6 months and using cardiac magnetic resonance imaging at 6 months and thereafter. RESULTS Twenty-six patients diagnosed with MIS-C and with a median age of 84 months were included. Cardiac involvement was found in 19 (73.1%) patients. At initial echocardiographic evaluation, the mean ejection fraction value of the patients was 56.7% (range: 30-75). Coronary artery dilatation was detected in two (7.7%) patients, and mitral regurgitation persisted in only one patient by month 3. Treatment was started in two (7.7%) patients due to ventricular arrhythmia. Cardiac magnetic resonance imaging was performed in 13 (50%) patients at a median of 6 months (range: 5-9). The cardiac magnetic resonance imaging findings were consistent with possible interstitial fibrosis in two (7.7%) patients. CONCLUSION Our results showed that cardiac involvement of patients improved rapidly with treatment, as indicated by previous studies. However, during the 1-year follow-up, frequent extraventricular systole was detected in two patients, one of whom initially did not show cardiac involvement. Moreover, possible interstitial fibrosis was detected in the cardiac magnetic resonance imaging (MRI) evaluation of two patients. In particular, we believe that these findings may be useful to evaluate critically ill paediatric patients and patients with severely low EF with cardiac MRI in their follow-up.
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Affiliation(s)
- Özlem Özgür Gündeşlioğlu
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Berivan Subaşı
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Ferhat Pişkin
- Department of Radiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Anıl Atmış
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Fadli Demir
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Ümmühan Çay
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Nisanur Tapaç
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Fatma Kılınç
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Selime T Kaymaz
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Özden Özgür Horoz
- Department of Pediatric Intensive Care, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Rıza D Yıldızdaş
- Department of Pediatric Intensive Care, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
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Farrell AN, Raol NP, Goudy SL, Evans SS. Atypical Head and Neck Phlegmons as an Early Indicator to MIS-C in the Pediatric Population. Otolaryngol Head Neck Surg 2023. [PMID: 36939523 DOI: 10.1002/ohn.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/23/2022] [Accepted: 12/04/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Annie N Farrell
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA.,Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nikhila P Raol
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA.,Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Steven L Goudy
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA.,Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sean S Evans
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA.,Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Paediatric inflammatory multisystem syndrome in a neonate with CHD: case description and current issues in children with CHD. Cardiol Young 2023; 33:321-322. [PMID: 35876498 DOI: 10.1017/s1047951122001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a case of possible vertical COVID-19 transmission-related paediatric inflammatory multisystem syndrome in a neonate with CHD. Myocarditis and supraventricular tachycardia along with hepatic injury and renal failure were diagnosed on a background of mild aortic valve stenosis; the patient was successfully treated with immunomodulation. Since paediatric inflammatory multisystem syndrome can affect the heart, we could consider neonates with haemodynamically insignificant CHD to be at a higher risk of fatal outcomes. Issues related to early diagnosis and management need to be addressed.
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Giryes S, McGonagle D. Immune and non-immune mechanisms that determine vasculitis and coronary artery aneurysm topography in Kawasaki disease and MIS-C. Clin Exp Rheumatol 2023; 22:103240. [PMID: 36496111 DOI: 10.1016/j.autrev.2022.103240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
The overlap between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) including coronary artery aneurysms (CAA) and broadly shared gastrointestinal and mucocutaneous disease is poorly defined. In this perspective, we highlight common age-related extravascular epicardial microanatomical and immunological factors that might culminate in CAA expression in both MIS-C and KD. Specifically, the coronary vasa vasorum originates outside the major coronary arteries. Widespread inflammation in the epicardial interstitial compartment in shared between KD and MIS-C. Age-related changes in the neonatal and immature coronary vasculature including the impact of coronary artery biomechanical factors including coronary vessel calibre, age-related vessel distensibility, flow, and vessel neurovascular innervation may explain the decreasing CAA frequency from neonates to older children and the virtual absence of CAA in young adults with the MIS-C phenotype. Other KD and MIS-C features including mucocutaneous disease with keratinocyte-related immunopathology corroborate that disease phenotypes are centrally influenced by inflammation originating outside vessel walls but a potential role for primary coronary artery vascular wall inflammation cannot be excluded. Hence, common extravascular originating tissue-specific responses to aetiologically diverse triggers including superantigens may lead to widespread interstitial tissue inflammation characteristically manifesting as CAA development, especially in younger subjects. Given that CAA is virtually absent in adults, further studies are needed to ascertain whether epicardial interstitial inflammation may impact on both coronary artery physiology and cardiac conduction tissue and contribute to cardiovascular disease- a hitherto unappreciated consideration.
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Affiliation(s)
- Sami Giryes
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, United Kingdom.
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Tripathi AK, Pilania RK, Bhatt GC, Atlani M, Kumar A, Malik S. Acute kidney injury following multisystem inflammatory syndrome associated with SARS-CoV-2 infection in children: a systematic review and meta-analysis. Pediatr Nephrol 2023; 38:357-370. [PMID: 35943577 PMCID: PMC9362633 DOI: 10.1007/s00467-022-05701-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Multisystem inflammatory syndrome (MIS-C) is a rare paediatric hyper-inflammatory disorder that occurs following SARS-CoV-2 infection. Acute kidney injury (AKI) occurs in approximately one-quarter to one-third of the patients with MIS-C and is associated with poor prognosis in critically ill children. This systematic review is aimed to evaluate the incidence of AKI, mortality, and the need for kidney replacement therapy (KRT) in patients with MIS-C. METHODS We searched databases from Medline, EMBASE, Cochrane Register, and Google Scholar from December 2019 to December 2021 with our search strategy. Studies meeting the following criteria were included in this systematic review: (1) articles on AKI in MIS-C; (2) studies providing AKI in MIS-C and COVID-19 infection separately; (3) studies reporting outcomes such as mortality, KRT, serum creatinine; length of hospital/ICU stay. QUALITY ASSESSMENT The quality of the included studies was independently assessed by using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool for cohort studies and case series. STATISTICAL ANALYSIS Outcomes and their 95% confidence intervals (CI) were reported if a meta-analysis of these outcomes was conducted. Heterogeneity was reported using I2 statistics, and heterogeneity ≥ 50% was considered high. We used Baujat's plot for the contribution of each study toward overall heterogeneity. In sensitivity analysis, the summary estimates were assessed by repeating meta-analysis after omitting one study at a time. Forest plots were used for reporting outcomes in each study and with their 95% CI. All statistical tests were performed using R software version 4.0.3. RESULTS A total of 24 studies were included in this systematic review and of these, 11 were included in the meta-analysis. The pooled proportion of patients with MIS-C developing AKI was 20% (95% CI: 14-28%, I2 = 80%). Pooled proportion of death in children with MIS-C was 4% (95% CI: 1-14%; I2 = 93%). The odds of death in patients with AKI were 4.68 times higher than in patients without AKI (95% CI: 1.06-20.7%; I2 = 17%). The overall pooled proportion of MIS-C-induced AKI patients requiring KRT was 15% (95% CI: 4-42%; I2 = 91%). CONCLUSION Approximately one-fifth of children with MIS-C develop AKI which is associated with higher odds of death. PROSPERO registration: CRD42022306170 A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anchal Kumar Tripathi
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP, 462024, India
| | - Rakesh Kumar Pilania
- Advanced Pediatrics Centre, Division of Clinical Immunology and Rheumatology, Post Graduate Institute of Medical Sciences (PGI), Chandigarh, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP, 462024, India.
| | - Mahendra Atlani
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, MP, India
| | - Amber Kumar
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP, 462024, India
| | - Shikha Malik
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP, 462024, India
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Tan W, Jing L, Wang Y, Li W. A global bibliometric analysis on Kawasaki disease research over the last 5 years (2017-2021). Front Public Health 2023; 10:1075659. [PMID: 36703854 PMCID: PMC9871775 DOI: 10.3389/fpubh.2022.1075659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Background Kawasaki disease (KD) is a systemic vasculitis of unknown etiology that mainly affects children. We aim to conduct a bibliometric analysis to explore the latest research hotspots and trends of KD. Method By using the keywords "Kawasaki disease," "Kawasaki syndrome", and "Mucocutaneous Lymph Node Syndrome," the Web of Science (WOS) and Scopus databases were searched for publications related to KD from 2017 to 2021. Author, country and journal submissions were classified and evaluated using Biblioshiny software (using R language). VOSviewer (version 1.6.18) was used to visualize the relevant network relationships. Result According to the search strategy, 5,848 and 6,804 KD studies were published in WOS and Scopus, respectively. The results showed an overall increasing trend in the number of publications and citations during the study period. The three most influential institutions in the WOS were St. Marianna University, Kawasaki Medical School and The University of Tokyo in Japan, while in Scopus, Harvard Medical School, University of California and Tehran University of Medical Sciences were the most influential institutions. The most influential authors of the two databases are Goodman SG, Kazunori Kataoka, and Takeshi Kimura of the WOS and Marx Nikolau and Wang Y, Burns JC, and Newburger JW of the Scopus, respectively. And Scientific Reports and Frontiers in Pediatrics were the most critical journals. The most cited documents were the WOS document by McCrindle et al. and the Scopus document by Benjamin et al. published in 2017, while the keywords in the last few years were focused on "COVID-19," "multisystem inflammatory syndrome," and "pandemic." Conclusion This bibliometric analysis summarizes for the first time the research progress in KD (2017-2021), providing a qualitative and quantitative assessment of KD research bibliometric information. In the field, researchers mainly from Japan and USA are dominant, followed by China. It is recommended to pay close attention to the latest hot spots, such as "COVID-19" and "multisystem inflammatory syndrome." These results provide a more intuitive and convenient way for researchers to obtain the latest information on KD.
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Affiliation(s)
- Weifu Tan
- Department of Neonatology, The First Clinical Medical College of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China,Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Liao Jing
- Department of Neonatology, The First Clinical Medical College of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China,Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Yunxiao Wang
- Department of Neonatology, The First Clinical Medical College of Jinan University, The First Affiliated Hospital of Jinan University, Guangzhou, China,Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Wei Li
- Department of Neonatology, The Dongguan Affiliated Hospital of Medical College of Jinan University, The Binhaiwan Central Hospital of Dongguan, Dongguan, China,*Correspondence: Wei Li ✉
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Pektaş A, Bükülmez A, Çeleğen M, Eker İ. Rash and Gastrointestinal Dysfunction May Indicate Cardiac Involvement in Children with Multisystem Inflammatory System Associated with Coronavirus Disease 2019. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractThis study aims to investigate the management of children diagnosed with “multisystem inflammatory syndrome” (MIS-C) potentially associated with coronavirus disease 2019 (COVID-19) at a tertiary health center. This is a retrospective review of 34 children who were diagnosed with MIS-C at the pediatrics department of the study center from August 2021 to December 2021. Data related to age, sex, body mass index, vital findings, laboratory data, clinical symptoms, ultrasonography, and echocardiography findings were acquired from hospital records. Cardiac markers were compared with respect to clinical symptoms and imaging. Fever (91.2%), rash (50%), and abdominal pain (44.1%) were the most observed symptoms. Echocardiography visualized mild mitral regurgitation in 12 patients (35.3%), pericardial effusion in 9 patients (26.5%), and mild coronary dilatation in 9 patients (26.5%). All patients received corticosteroids, whereas acetylsalicylic acid was prescribed in 29 patients (85.3%) and intravenous immunoglobulins were administered in 21 patients (61.8%). Serum probrain natriuretic peptide concentrations were significantly higher in MIS-C patients with rash than those without rash (9,592.2 ± 7,764.5 vs. 1,501.2 ± 1,385.4 pg/mL, p = 0.021). Serum troponin T concentrations were significantly higher in MIS-C patients with ileitis than those without ileitis (0.026 ± 0.024 vs. 0.008 ± 0.003 µg/L, p = 0.013). Serum troponin T concentrations were also significantly higher in MIS-C patients with pericardial effusion than those without pericardial effusion (0.022 ± 0.020 vs. 0.008 ± 0.007 µg/L, p = 0.036). The presence of rash and sonographic visualization of ileitis might act as signs for cardiac involvement in children exposed to COVID-19. To assess the cardiac involvement in MIS-C patients, cardiac enzymes should be measured and echocardiography examination should be performed.
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Affiliation(s)
- Ayhan Pektaş
- Division of Pediatric Cardiology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Ayşegül Bükülmez
- Division of Pediatric Gastroenterology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mehmet Çeleğen
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - İbrahim Eker
- Division of Pediatric Hematology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
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64
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Al-ma’aiteh A, Al-Momani H, Elhaj I, Alkhatatba M. Limping as Presenting Symptom of Multisystem Inflammatory Syndrome in Children (MIS-C): a Case Report of Large Vessel Vasculitis in MIS-C. Med Arch 2023; 77:310-313. [PMID: 37876567 PMCID: PMC10591239 DOI: 10.5455/medarh.2023.77.310-313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background Multisystem Inflammatory Syndrome of children (MIS) is a pathological condition that occurs in response to a SARS-CoV-2 infection, the syndrome has been described as a "Kawasaki disease"-like illness and the spectrum of associated abnormalities, including vascular complications, remain to be fully defined. Objective The aim of this article was to present a case of MISC presented with limping and associated with large vessel vasculitis. Case presentation In this article we present a case of 10-year-old male presented to emergency department complaining of limping of one-week duration and left hip pain, associated with high grade prolonged fever, abdominal pain and weight loss. The patient was ill looking, couldn't bear weight and was admitted to pediatric intensive care unit. Laboratory workup have rule out infectious and malignant causes as well as known rheumatological causes. Inflammatory markers were elevated. Ultrasound, Doppler ultrasound, CT scan of the affected hip showed evidence of vasculitis extending from the left femoral artery reaching the left common iliac artery with intramural thrombus. According to WHO criteria the patient diagnoses was MIS-C. treatment was started immediately with IVIG and steroids in addition to anticoagulants, dramatic improvement was noticed within 24 hours. Patient was discharged after 10 days of hospitalization. Conclusion MIS-C is a new emerging medical diagnosis after the pandemic of COVID-19. it is described a Kawasaki-like syndrome that affect small to medium vessels. This case reports a large vessel vasculitis associated with MIS-C, it helps the understand the extend of this new syndrome and the variety of complaints that may result from large vessels involvement.
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Affiliation(s)
- Ala’a Al-ma’aiteh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Momani
- Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Ibrahim Elhaj
- Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mohammad Alkhatatba
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Lee YH. Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections. Clin Exp Pediatr 2023; 66:1-11. [PMID: 35760413 PMCID: PMC9815937 DOI: 10.3345/cep.2022.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/14/2022] [Indexed: 01/13/2023] Open
Abstract
Despite studies on the etiology of Kawasaki disease (KD) ongoing for half a century since its discovery, its cause has not yet been clearly identified. Although the clinical, epidemiological, and pathophysiological characteristics of KD are presumed to be closely related to infectious diseases, studies of various pathogens to identify its etiology have been actively conducted. To date, bacteria, fungi, and viruses have been investigated to determine the relationship between KD and infection, among which viruses have attracted the most attention. In particular, during the coronavirus disease 2019 pandemic, there were many reports in Europe of a sharp increase in cases of Kawasaki-like disease (KLD), while conflicting reports that the prevalence of KD decreased due to thorough "social distancing" or "wearing mask" in Asian countries drew more attention regarding the association between KD and viral infection. Therefore, the differential diagnosis of KD from KLD with these similar spectra has become a very important issue; simultaneously, research to solve questions about the association between KD and viral infections, including sudden acute respiratory syndrome coronavirus 2, is drawing attention again. Moreover, a new concept has emerged that immune responses occurring in patients with KD can be caused by the pathogen itself as well as host cells damaged by infection. This paper summarizes the research trends into KD etiology and related pathophysiology, especially its association with viral infections, and present future research tasks to increase our understanding of KD.
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Affiliation(s)
- Young Hwan Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
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66
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Das BB, Shakti D, Ghaleb S, Akam-Venkata J, Moskowitz WB, Osakwe O, Weiland MD, Arya S, Gajula V, Taylor MB. Racial and Ethnic Disparity in Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 in Mississippi, USA. Clin Pediatr (Phila) 2023; 62:8-16. [PMID: 35801262 PMCID: PMC9720419 DOI: 10.1177/00099228221108591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We aimed to study the disparity in the clinical profile and outcomes of hospitalized Multisystem Inflammatory Syndrome in Children (MIS-C) patients at our center. The second goal was to examine the temporal association with preceding SARS-CoV-2 infection by race/ethnicity in our community in Mississippi. We found the racial disparity in the prevalence of MIS-C exceeded its temporal association with SARS-CoV-2 infections. We included 51 consecutive MIS-C patients hospitalized, whose median age was 9 (interquartile range [IQR] 5-12) years, 58% were male, 71% were black, 25% were white, and 4% belonged to other groups. We found a delay between onset of symptoms and hospitalization in black patients compared with white patients with a median of 2 (IQR 0-7) vs median of 0 (0-5) urgent care visits (P = .022), respectively. Black patients were hospitalized longer (median 8, IQR 2-39 days) than whites (median 5, IQR 3-14 days), P = .047. A total of 38.9% of blacks and 23.1% of whites were admitted to intensive care unit (P = .498); 36.1% of blacks had severe cardiac involvement vs 23.1% of white patients, P = .531. Future studies of MIS-C are required to improve health equity for children.
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Affiliation(s)
- Bibhuti B. Das
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA,Bibhuti B. Das, Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, 2500 N State St., Jackson, MS 39216, USA.
| | - Divya Shakti
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephanie Ghaleb
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Jyothsna Akam-Venkata
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - William B. Moskowitz
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Onyekachukwu Osakwe
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael D. Weiland
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandeep Arya
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Viswanath Gajula
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Mary B. Taylor
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
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Cem E, Böncüoğlu E, Kıymet E, Şahinkaya Ş, Yılmaz Çelebi M, Gülderen M, Kaçar P, Akaslan Kara A, Aydın A, Murat M, Yılmazer MM, Bayram N, Devrim İ. Which Findings Make multisystem Inflammatory Syndrome in Children Different from the Pre-Pandemic Kawasaki Disease? Pediatr Cardiol 2023; 44:424-432. [PMID: 35804239 PMCID: PMC9282145 DOI: 10.1007/s00246-022-02961-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
Abstract
Multisystem Inflammatory Syndrome in Children associated with COVID-19 infection attracted attention because some features overlapped with Kawasaki disease. And due to these overlapping features with Kawasaki disease, it has become difficult to diagnose both disorders. Therefore, this study focused on the differences between the patients diagnosed with MIS-C after COVID-19 and Kawasaki patients analyzed, particularly during the pre-pandemic period. In this way, it is aimed to reduce the dilemmas experienced in Diagnosis. In this descriptive study, 98 patients diagnosed with MIS-C throughout the pandemic were compared to 37 patients diagnosed with Kawasaki Disease during the pre-pandemic period.The patients in the MIS-C group were older children and clinically suffered from more headaches, vomiting, diarrhea, abdominal pain, and chest pain than Kawasaki patients. Signs of shock such as hypotension and tachycardia were more remarkable. Also, myocarditis and mitral regurgitation were detected at a higher rate in the MIS-C group. Besides, in the laboratory, lymphopenia, hypoalbuminemia, and creatinine elevation were more apparent.In conclusion, our present study findings support that although the MIS-C and Kawasaki share common features, they present with different clinical and laboratory features. And these differences are thought to be supportive in treatment and patient management.
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Affiliation(s)
- Ela Cem
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
| | - Elif Böncüoğlu
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Elif Kıymet
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Şahika Şahinkaya
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Miray Yılmaz Çelebi
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Mustafa Gülderen
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Pelin Kaçar
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Aybüke Akaslan Kara
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Ayşenur Aydın
- grid.414112.30000 0004 0419 2150Department of Paediatrics, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Mehmet Murat
- grid.414112.30000 0004 0419 2150Department of Paediatric Cardiology Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Murat Muhtar Yılmazer
- grid.414112.30000 0004 0419 2150Department of Paediatric Cardiology Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Nuri Bayram
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - İlker Devrim
- grid.414112.30000 0004 0419 2150Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
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Zhang HY, Xiao M, Zhou D, Yan F, Zhang Y. Platelet and ferritin as early predictive factors for the development of macrophage activation syndrome in children with Kawasaki disease: A retrospective case-control study. Front Pediatr 2023; 11:1088525. [PMID: 36873655 PMCID: PMC9977190 DOI: 10.3389/fped.2023.1088525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To investigate the early predictive factors for Kawasaki disease complicated with macrophage activation syndrome (KD-MAS). METHODS We performed a retrospective case-control study in children with KD from August 2017 to August 2022, involving 28 cases with KD-MAS and 112 cases not developing KD-MAS. Based on the univariate analysis, binary logistic regression was used to identify the early predictive factors for KD-MAS development, and the receiver operating characteristic curve (ROC) analysis was carried out to obtain the optimal cut-off value. RESULTS Two predictive factors were associated with the development of KD-MAS, which were PLT (OR = 1.013, 95%CI, 1.001-1.026), and serum ferritin (OR = 0.991, 95%CI, 0.982-0.999). The cut-off value of PLT was 110 × 109/L, and the cut-off value of serum ferritin was 548.4 ng/ml. CONCLUSION Children with KD who had a PLT count under 110 × 109/L, and a serum ferritin level over 548.4 ng/ml are more likely to develop KD-MAS.
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Affiliation(s)
- Hua-Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Min Xiao
- Department of Rheumatology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Dan Zhou
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Fan Yan
- Department of Critical Care Medicine, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Chun-Ern Ng D, Liew CH, Tan KK, Lim HY, Zailanalhuddin NEB, Tan SF, Chandra Mohan VAA, Mahendran SA, Tan YC, Chin L, Ong SQ, Siew Yin Eng C. Epidemiology, clinical characteristics and outcomes of multisystem inflammatory syndrome in children. Pediatr Int 2023; 65:e15690. [PMID: 38037505 DOI: 10.1111/ped.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND We describe the epidemiology, clinical characteristics, and outcomes of multisystem inflammatory syndrome in children (MIS-C) among children from Negeri Sembilan, Malaysia. METHODS A retrospective, multicentre, observational study was performed among children ≤15 years old who were hospitalized for MIS-C between January 18, 2021 and June 30, 2023. The incidence of MIS-C was estimated using reported SARS-CoV-2 cases and census population data. Descriptive analyses were used to summarize the clinical presentation and outcomes. RESULTS The study included 53 patients with a median age of 5.7 years (IQR 1.8-8.7 years); 75.5% were males. The overall incidence of MIS-C was approximately 5.9 cases per 1,000,000 person-months. Pediatric intensive care unit (PICU) admission was required for 22 (41.5%) patients. No mortalities were recorded. Children aged 6-12 years were more likely to present with cardiac dysfunction/shock (odds ratio [OR] 5.43, 95% confidence interval [CI] 1.67-17.66), whereas children below 6 years were more likely to present with a Kawasaki disease phenotype (OR 5.50, 95% CI 1.33-22.75). Twenty patients (37.7%) presented with involvement of at least four organ systems, but four patients (7.5%) demonstrated single-organ system involvement. CONCLUSION An age-based variation in the clinical presentation of MIS-C was demonstrated. Our findings suggest MIS-C could manifest in a spectrum, including single-organ involvement. Despite the high requirement for PICU admission, the prognosis of MIS-C was favorable, with no recorded mortalities.
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Affiliation(s)
| | - Chuin-Hen Liew
- Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri Sembilan, Malaysia
| | - Kah Kee Tan
- Perdana University Seremban Clinical Academic Center, Seremban, Negeri Sembilan, Malaysia
| | - Hui Yi Lim
- Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | | | - Shir Fong Tan
- Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | | | | | - Yuong Chie Tan
- Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri Sembilan, Malaysia
| | - Ling Chin
- Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Song-Quan Ong
- Institute for Tropical Biology and Conservation, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Martínez-García JJ, López-Acosta JR, Arce-Cabrera D, León-Sicairos N, Hernández-Parra AC, Cuen-Diaz HM, Zatarain-Lopez R, Canizalez-Roman A. Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease. Front Pediatr 2023; 11:1167828. [PMID: 37138560 PMCID: PMC10149839 DOI: 10.3389/fped.2023.1167828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C), is a severe complication of coronavirus disease 2019 (COVID-19), characterized by persistent fever, systemic inflammatory response, and organ failure. MIS-C with a history of COVID-19 may share clinical features with other well-defined syndromes such as macrophage activation syndrome, Kawasaki disease, hemophagocytic syndrome and toxic shock syndrome. Case 1 An 11-year-old male with a history of hypothyroidism and precocious puberty with positive antibody test for COVID-19 was admitted for fever, poor general condition, severe respiratory distress, refractory shock, and multiple organ failure. His laboratory examination showed elevated inflammatory parameters, and bone marrow aspirate showed hemophagocytosis. Case 2 A 13-year-old male with a history of attention deficit hyperactivity disorder and cognitive delay presented clinical manifestations of Kawasaki disease, fever, conjunctival congestion, exanthema, and hyperemia in oral mucosa, tongue, and genitals, with refractory shock and multiple organ failure. Reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies for COVID-19 were negative, inflammation parameters were elevated, and bone marrow aspirate showed hemophagocytosis. Patients required intensive care with invasive mechanical ventilation, vasopressor support, intravenous gamma globulin, systemic corticosteroids, low molecular weight heparin, antibiotics, and monoclonal antibodies and, patient 2 required renal replacement therapy. Conclusions Multisystemic inflammatory syndrome in children can have atypical manifestations, and identifying them early is very important for the timely treatment and prognosis of patients.
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Affiliation(s)
- Jesús Javier Martínez-García
- Pediatric Intensive Care Unit, Pediatric Hospital of Sinaloa, Culiacan, Mexico
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Mexico
| | | | | | - Nidia León-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Mexico
- Research Department, Pediatric Hospital of Sinaloa, Culiacan, Mexico
| | | | | | | | - Adrian Canizalez-Roman
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Mexico
- Research Department, The Women’s Hospital, Secretariat of Health, Culiacan, Mexico
- Correspondence: Adrian Canizalez Roman
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Younger DS. Pediatric neuropsychiatric disorders with motor and nonmotor phenomena. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:367-387. [PMID: 37620079 DOI: 10.1016/b978-0-323-98817-9.00028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The concept of pediatric autoimmune neuropsychiatric disorders associated with group A beta-hemolytic streptococcus (PANDAS) has become seminal since first introduced more than two decades ago. At the time of this writing, most neurologists, pediatricians, psychiatrists, and general pediatricians will probably have heard of this association or treated an affected child with PANDAS. The concept of an acute-onset, and typically self-limited, postinfectious autoimmune neuropsychiatric disorder resembling PANDAS manifesting vocal and motor tics and obsessive-compulsive disorder has broadened to other putative microbes and related endogenous and exogenous disease triggers. These disorders with common features of hypometabolism in the medial temporal lobe and hippocampus in brain 18fluorodeoxyglucose positron emission tomography fused to magnetic resonance imaging (FDG PET-MRI), form a spectrum: with the neuropsychiatric disorder Tourette syndrome and PANDAS with its well-defined etiopathogenesis at one end, and pediatric abrupt-onset neuropsychiatric syndrome (PANS), alone or associated with specific bacterial and viral pathogens, at the other end. The designation of PANS in the absence of a specific trigger, as an exclusionary diagnosis, reflects the current problem in nosology.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Sadeghi P, Gorji M, Assari R, Tahghighi F, Raeeskarami SR, Ziaee V. Methylprednisolone pulses as an initial treatment in hyperinflammatory syndrome after COVID-19 in children: evaluation of laboratory data, serial echocardiography and outcome: a case series. Intensive Care Med Exp 2022; 10:56. [PMID: 36585531 PMCID: PMC9803403 DOI: 10.1186/s40635-022-00484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/17/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hyper-inflammatory syndrome in children and young adult occur 2-6 weeks after COVID-19 infection or closed contact with COVID-19 persons. In this study, the laboratory data and echocardiography and abdominal ultrasonography assessments were evaluated before and after Methylprednisolone pulse as an initial treatment of hyper-inflammatory syndrome. Therefore, the aim of this study is to assessment the clinical manifestations and laboratory data and outcome after methylprednisolone pulse as an initial treatment. METHOD In this retrospective study, the demographic status, clinical features, laboratory data, echocardiography, abdominal ultrasound, treatment and outcome of 31 pediatric patients under 16 years old, with inflammatory process after COVID-19 were evaluated. The clinical assessments, laboratory data, sonography and echocardiography were evaluated before and after methylprednisolone pulse. The patients were divided in two age group < and ≥ 7 years old and the clinical manifestations were compared with each other. The Mann-Whitney U test was used to assess the difference in quantitative variables between two groups. To compare pre- and post- treatment values, Wilcoxol test was used. To assess the correlation between qualitative variables chi-square test was used. The level of significant was considered 0.05. These patients with fever and hyper-inflammation features admitted to the referral pediatric rheumatology ward in Children Medical Center of Tehran University of medical sciences, from April 2020 to May 2021 were assessed. RESULT The mean age ± SD were (5.94 ± 3) and 51.6% (16) patients were male and 48.4% (15) patients were female. The most documented of previous COVID infection were antibody positive in about 27 (87%) patients. Moreover, 1 (3.8%) was PCR positive, 2 (7.7%) were positive in both PCR and serology and 3(11.5%) had closed contact with COVID-19 patients. About 9(29%) of patients were admitted in Intensive Care Unit (ICU). There were significant correlation between days of delay in starting treatment and ICU admission (P-value = 0.02). The mortality rate was negative in patients and no re-hospitalization was documented. There were significant differences (P-value < 0.05) between lymphocytes, platelet, Erythrocyte Sedimentation rate, C-reactive protein, Aspartate transaminase, Alanine transaminase and ferritin before and after treatment. Skin rashes and cardiac involvement totally as carditis (myocarditis, vulvulitis and pericarditis) (33.3%) and coronary involvements (53.3%) were the most prominent initial presentation in patients. There were near significant correlation (P-value = 0.066) between ferritin level and carditis before treatment. Cervical lymphadenopathy was seen significantly more in ≥ 7 years old (P-value = 0.01). CONCLUSION Multisystem inflammatory system in children as a hyperinflammatory syndrome could be treated with first step methylprednisolone pulse with decreasing inflammation in laboratory data and cardiac involvements and good outcome. Furthermore, the ferritin level may be one of the predictor of severe hyper-inflammatory syndrome leading to aggressive and urgent treatment with methylprednisolone pulse.
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Affiliation(s)
- Payman Sadeghi
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
| | - Mojtaba Gorji
- grid.411705.60000 0001 0166 0922Department of Pediatric Cardiology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, Tehran, Iran
| | - Raheleh Assari
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
| | - Fatemeh Tahghighi
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
| | - Seyed Reza Raeeskarami
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
| | - Vahid Ziaee
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
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Franczuk P, Tkaczyszyn M, Kulak M, Domenico E, Ponikowski P, Jankowska EA. Cardiovascular Complications of Viral Respiratory Infections and COVID-19. Biomedicines 2022; 11:71. [PMID: 36672579 PMCID: PMC9856218 DOI: 10.3390/biomedicines11010071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Paweł Franczuk
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Michał Tkaczyszyn
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Maria Kulak
- Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Esabel Domenico
- Faculty of Medicine, Wroclaw Medical University, 50-345 Wroclaw, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
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Gouda N, Dimitriadou M, Sotiriou G, Christoforidis A. The impact of COVID-19 vaccination on glycaemic control in children and adolescents with type 1 diabetes mellitus on continuous glucose monitoring. Acta Diabetol 2022; 59:1609-1614. [PMID: 36069940 PMCID: PMC9449273 DOI: 10.1007/s00592-022-01968-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
Abstract
AIMS To investigate the impact of SARS-COV-2 vaccination on the glycaemic control in children and adolescents with T1DM wearing continuous glucose monitoring (CGM). METHODS Caregivers of children and adolescents with T1DM were questioned regarding SARS-CoV-2 vaccination during their regular visits at the Pediatric Diabetes Outpatient Clinic. Data regarding Time in Range (TIR) (glucose levels: 70-180 mg/dl) 7 days prior and 7 days after a vaccination dose were collected in patients wearing CGM and data regarding insulin daily doses were also obtained for the insulin pump users. RESULTS From a total of 135 patients eligible for SARS-CoV-2 vaccination, 70 (51.9%) children (37 boys, 52.9%) were vaccinated with at least one dose. Seven patients received only one dose, whereas two children received a third booster shot. No statistically significant difference was observed in either TIR (64.19% post vs. 65.53% pre, p = 0.158) or total daily insulin dose (40.08 U/day post vs. 39.32 U/day pre, p = 0,282). Additionally, in ten patients on Hybrid Closed-Loop System the percentage of the automated insulin boluses given post-vaccination was not statistically significant different compared to the boluses given pre-vaccination (15.80% vs. 16.90%, p = 0,491). CONCLUSIONS Vaccination against SARS-CoV-2 in children and adolescents with T1DM is safe and is not associated with immediate glucose imbalance.
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Affiliation(s)
- Niki Gouda
- 1st Paediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 49 Konstantinoupoleosstr, 54642, Thessaloniki, Greece
| | - Meropi Dimitriadou
- 1st Paediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 49 Konstantinoupoleosstr, 54642, Thessaloniki, Greece
| | - Georgia Sotiriou
- 1st Paediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 49 Konstantinoupoleosstr, 54642, Thessaloniki, Greece
| | - Athanasios Christoforidis
- 1st Paediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 49 Konstantinoupoleosstr, 54642, Thessaloniki, Greece.
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75
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Fridman MD, Tsoukas P, Jeewa A, Yeung RS, Gamulka BD, McCrindle BW. Differentiation of COVID-19-Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers. Can J Cardiol 2022:S0828-282X(22)01049-2. [PMID: 36462758 PMCID: PMC9711900 DOI: 10.1016/j.cjca.2022.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 shares clinical similarities to Kawasaki disease (KD). We sought to determine whether cardiac biomarker levels differentiate MIS-C from KD and their association with cardiac involvement. METHODS Subjects included 38 MIS-C patients with confirmed prior COVID-19 and 32 prepandemic and 38 contemporaneous KD patients with no evidence of COVID-19. Patient, clinical, echocardiographic, electrocardiographic, and laboratory data timed within 72 hours of cardiac biomarker assessment were abstracted. Groups were compared, and regression analyses were used to determine associations between biomarker levels, diagnosis and cardiac involvement, adjusting for clinical factors. RESULTS MIS-C patients had fewer KD clinical features, with more frequent shock, intensive care unit admission, inotrope requirement, and ventricular dysfunction, with no difference regarding coronary artery involvement. Multivariable regression analysis showed that both higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (TnI) were associated with MIS-C vs KD, after adjusting for significant covariates. Receiver operating characteristic curves for diagnosis showed that any detectable TnI greater than 10 ng/L was predictive of MIS-C vs KD with 91% sensitivity and 76% specificity. NT-proBNP > 2000 ng/L predicted MIS-C vs KD with 82% sensitivity and 82% specificity. Higher TnI but not NT-proBNP was associated with lower LV ejection fraction. Neither biomarker was associated with coronary artery involvement. CONCLUSIONS Positive TnI and higher NT-proBNP may differentiate MIS-C from KD, which may become more relevant as evidence of prior COVID-19 becomes more challenging to determine. Cardiac biomarkers may have limited associations with cardiac involvement in this setting.
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Affiliation(s)
- Michael D. Fridman
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Tsoukas
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rae S.M. Yeung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Beth D. Gamulka
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada,Corresponding author: Dr Brian W. McCrindle, Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Tel.: +1-416-813-7654 ext 207609
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Sezer M, Çelikel E, Tekin ZE, Aydın F, Kurt T, Tekgöz N, Karagöl C, Coşkun S, Kaplan MM, Öner N, Polat MC, Gül AEK, Parlakay AÖ, Acar B. Multisystem inflammatory syndrome in children: clinical presentation, management, and short- and long-term outcomes. Clin Rheumatol 2022; 41:3807-3816. [PMID: 36018446 PMCID: PMC9411826 DOI: 10.1007/s10067-022-06350-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In this study, it was aimed to evaluate the demographic, clinical and laboratory characteristics of MIS-C patients in our hospital, to share our treatment approach, and to assess the outcomes of short- and long-term follow-up. METHODS MIS-C patients who were admitted and treated in our hospital between July 2020 and July 2021 were evaluated. Demographic, clinical, laboratory, and follow-up data were collected from patient records retrospectively. RESULTS A total of 123 patients with MIS-C (median age, 9.6 years) were included the study. Nineteen (15.4%) were mild, 56 (45.6%) were moderate, and 48 (39%) were severe MIS-C. High CRP, ferritin, pro-BNP, troponin, IL-6, and D-dimer values were found in proportion to the severity of the disease (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, p < 0.001), respectively. Two (1.6%) patients died. The mean follow-up period was 7.8 months. Valve failure, left ventricular dysfunction/hypertrophy, coronary involvement, and pericardial effusion were the most common cardiac pathologies in the short- and long-term follow-up of the patients. In the long-term follow-up, the most common reasons for admission to the hospital were recurrent abdominal pain (14.2%), cardiac findings (14.2%), pulmonary symptoms (8%), fever (7.1%), neuropsychiatric findings (6.2%) and hypertension (3.5%). Neuropsychiatric abnormalities were observed significantly more common in severe MIS-C patients at follow-up (p = 0.016). In the follow-up, 6.2% of the patients required recurrent hospitalization. CONCLUSION MIS-C is a serious and life-threatening disease, according to short-term outcomes. In addition to the cardiac findings of patients with MIS-C, long-term outcomes such as neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms should be monitored. Key Points • In MIS-C patients, attention should be paid not only to cardiac findings, but also to symptoms related to other systems. • Patients should be followed up in terms of neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms that may occur during follow-up.
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Affiliation(s)
- Müge Sezer
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Çelikel
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Zahide Ekici Tekin
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatric Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tuba Kurt
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilüfer Tekgöz
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cüneyt Karagöl
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Coşkun
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Melike Mehveş Kaplan
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nimet Öner
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Merve Cansu Polat
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar Gül
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Fergie J, Moran MM, Cane A, Pather S, Türeci Ӧ, Srivastava A. COVID-19 Epidemiology, Immunity, and Vaccine Development in Children: A Review. Vaccines (Basel) 2022; 10:vaccines10122039. [PMID: 36560448 PMCID: PMC9781884 DOI: 10.3390/vaccines10122039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
Although pediatric populations experienced lower COVID-19 severity and mortality than adults, the epidemiology of this disease continues to evolve. COVID-19 clinical manifestations in pediatrics commonly include fever and cough, but may differ from adults and by variant. Serious complications, including MIS-C, rarely occur. Although early data showed a decreased likelihood of COVID-19 transmission from children versus adults, outbreaks and viral shedding studies support pediatric transmission potential. Children may mount more robust initial immune responses to SARS-CoV-2 versus adults. COVID-19 vaccines with available pediatric data include BNT162b2, mRNA-1273, CoronaVac, and BBIBP-CorV. Depending on age group and jurisdiction, BNT162b2 and mRNA-1273 have received full approval or emergency/conditional authorization in the United States and European Union from 6 months of age. Clinical trials have shown BNT162b2 and mRNA-1273 safety and high efficacy in pediatric populations, with demonstrably noninferior immune responses versus young adults. Real-world studies further support BNT162b2 safety and effectiveness against the Delta variant. mRNA vaccination benefits are considered to outweigh risks, including myocarditis; however, pediatric vaccination rates remain relatively low. Given a growing body of clinical trial and real-world data showing vaccine safety and effectiveness, pediatric vaccination should be prioritized as an important strategy to control the pandemic.
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Affiliation(s)
- Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, TX 78411, USA
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Wang WY, Wang YJ, An CX, Zhao QJ, Wang SY, Li WY, Yi B, Li H. Multisystem inflammatory syndrome (MIS-C) with SARS-CoV-2 omicron variant BA.2.38 in a four-year-old Chinese girl: A case report. Front Public Health 2022; 10:1021200. [PMID: 36438223 PMCID: PMC9682626 DOI: 10.3389/fpubh.2022.1021200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
We report a severe COVID-19 complicated with MIS-C in a girl treated by the author in China, and discuss the current research status and progress in the diagnosis and therapy of MIS-C in children. The patient was a 4-year-old child previously healthy who was referred to the hospital with a complaint of fever, finally, Multisystem inflammatory syndrome was diagnosed with COVID-19.
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Affiliation(s)
- Wen-yuan Wang
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Yong-jun Wang
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Cai-xia An
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Qi-jun Zhao
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Shu-ying Wang
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Wan-yi Li
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Bin Yi
- Pediatric Respiratory Department II, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Huan Li
- Department of Rehabilitation, Gansu Province Hospital Rehabilitation Center, Lanzhou, China
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Rajamanickam A, Nathella PK, Venkataraman A, Varadarjan P, Kannan S, Pandiarajan AN, Renji RM, Elavarasan E, Thimmaiah A, Sasidaran K, Krishnamoorthy N, Natarajan S, Ramaswamy G, Sundaram B, Putlibai S, Hissar S, Selladurai E, Uma Devi KR, Nutman TB, Babu S. Unique cellular immune signatures of multisystem inflammatory syndrome in children. PLoS Pathog 2022; 18:e1010915. [PMID: 36322537 PMCID: PMC9629618 DOI: 10.1371/journal.ppat.1010915] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
The clinical presentation of MIS-C overlaps with other infectious/non-infectious diseases such as acute COVID-19, Kawasaki disease, acute dengue, enteric fever, and systemic lupus erythematosus. We examined the ex-vivo cellular parameters with the aim of distinguishing MIS-C from other syndromes with overlapping clinical presentations. MIS-C children differed from children with non-MIS-C conditions by having increased numbers of naïve CD8+ T cells, naïve, immature and atypical memory B cells and diminished numbers of transitional memory, stem cell memory, central and effector memory CD4+ and CD8+ T cells, classical, activated memory B and plasma cells and monocyte (intermediate and non-classical) and dendritic cell (plasmacytoid and myeloid) subsets. All of the above alterations were significantly reversed at 6-9 months post-recovery in MIS-C. Thus, MIS-C is characterized by a distinct cellular signature that distinguishes it from other syndromes with overlapping clinical presentations. Trial Registration: ClinicalTrials.gov clinicaltrial.gov. No: NCT04844242.
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Affiliation(s)
- Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- * E-mail: (AR); (NPV)
| | - Pavan Kumar Nathella
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
- * E-mail: (AR); (NPV)
| | | | | | - Srinithi Kannan
- Institute of Child Health and Hospital for Children, Chennai, India
| | - Arul Nancy Pandiarajan
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Rachel Mariam Renji
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | | | | | | | | | | | | | | | | | - Syed Hissar
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | | | | | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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80
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Woo HO. Recent research trends in Kawasaki disease-related infection. Clin Exp Pediatr 2022; 65:538-539. [PMID: 35879868 PMCID: PMC9650356 DOI: 10.3345/cep.2022.00696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/07/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
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81
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Talarico LB, Toledano A, Contrini MM, Torrado LE, Martínez MP, Gaillard MI, Caratozzolo A, Byrne AB, Bonnin FA, Tineo MS, Yfran EW, Acosta PL, López EL. Distinct Immune Phenotypes and Cytokine Profiles in Children with Differing Severity of COVID-19. Pediatr Infect Dis J 2022; 41:919-926. [PMID: 36102684 PMCID: PMC9555606 DOI: 10.1097/inf.0000000000003669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is usually mild and self-limited in children. However, a few Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections in children may progress to severe disease with respiratory distress or can result in a multisystem inflammatory syndrome (MIS-C) associated with COVID-19. The immune mechanisms for these differential clinical outcomes are largely unknown. METHODS A prospective cohort study was performed to analyze the laboratory parameters, antibody response, immune phenotypes and cytokine profiles of 51 children with different clinical presentations of COVID-19. RESULTS We found that the absolute lymphocyte counts gradually decreased with disease severity. Furthermore, SARS-CoV-2 IgG levels in the acute phase and convalescence were not significantly different in patients with different disease severity. A decrease in CD3 + , CD4 + and CD8 + T cells was observed as disease severity increased. Both CD4 + and CD8 + T cells were activated in children with COVID-19, but no difference in the percentage of HLADR + -expressing cells was detected across the severity groups. In contrast, MIS-C patients exhibited augmented exhausted effector memory CD8 + T cells. Interestingly, the cytokine profile in sera of moderate/severe and MIS-C patients revealed an increase in anti-inflammatory IL-1RA and a suppression of tumor necrosis factor-α, RANTES, eotaxin and PDGF-BB. MIS-C patients also exhibited augmented IL-1β. CONCLUSIONS We report distinct immune profiles dependent on severity in pediatric COVID-19 patients. Further investigation in a larger population will help unravel the immune mechanisms underlying pediatric COVID-19.
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Affiliation(s)
- Laura Beatriz Talarico
- Department of Medicine, Laboratory of Infectious Diseases and Molecular Biology, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Analía Toledano
- Department of Medicine, Laboratory of Infectious Diseases and Molecular Biology, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Marta Contrini
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Lidia E. Torrado
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María Paula Martínez
- Immunology, Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP- CONICET-GCBA)-Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Isabel Gaillard
- Immunology, Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP- CONICET-GCBA)-Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ana Caratozzolo
- Department of Medicine, Laboratory of Infectious Diseases and Molecular Biology, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Alana Brooke Byrne
- Department of Medicine, Laboratory of Infectious Diseases and Molecular Biology, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Florencia Agustina Bonnin
- Department of Medicine, Laboratory of Infectious Diseases and Molecular Biology, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Soledad Tineo
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Walter Yfran
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Patricio Leandro Acosta
- Department of Medicine, Laboratory of Infectious Diseases and Molecular Biology, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Eduardo Luis López
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires, Argentina
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Zhang M, Zhang P, Liang Y, Du B, Li L, Yu Z, Wang H, Wang Q, Zhang X, Zhang W. A systematic review of current status and challenges of vaccinating children against SARS-CoV-2. J Infect Public Health 2022; 15:1212-1224. [PMID: 36257126 PMCID: PMC9557115 DOI: 10.1016/j.jiph.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has inflicted immense damage to countries, economies and societies worldwide. Authorized COVID-19 vaccines based on different platforms have been widely inoculated in adults, showing up to 100% immunogenicity with significant efficacy in preventing SARS-CoV-2 infections and the occurrence of severe COVID-19. It has also greatly slowed the evolution of SARS-CoV-2 variants, as shown in clinical trials and real-world evidence. However, the total dosage of COVID-19 vaccines for children is much smaller than that for adults due to limitations from parental concern of vaccine safety, presenting a potential obstacle in ending the COVID-19 pandemic. SARS-CoV-2 not only increases the risk of severe multisystem inflammatory syndrome (MIS-C) in children, but also negatively affects children's psychology and academics, indirectly hindering the maintenance and progress of normal social order. Therefore, this article examines the clinical manifestations of children infected with SARS-CoV-2, the status of vaccination against COVID-19 in children, vaccination-related adverse events, and the unique immune mechanisms of children. In particular, the necessity and challenges of vaccinating children against SARS-CoV-2 were highlighted from the perspectives of society and family. In summary, parental hesitancy is unnecessary as adverse events after COVID-19 vaccination have been proven to be infrequent, comprise of mild symptoms, and have a good prognosis.
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Affiliation(s)
- Mengxin Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Pin Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Ying Liang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Bang Du
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Lifeng Li
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Zhidan Yu
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Huanmin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Qionglin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
| | - Xianwei Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
| | - Wancun Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
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Zengin N, Bal A, Goren TA, Bayturan SS, Alkan F, Akcali S. Serum Vitamin D Levels in Relation to Development of Multisystem Inflammatory Syndrome in Pediatric COVID-19. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1756713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Objective The aim of the study is to evaluate vitamin D (vit D) levels in children with and without development of multisystem inflammatory syndrome in children (MIS-C) after coronavirus disease 2019 (COVID-19) and also between those with severe and moderate MIS-C.
Methods This comprises retrospective data of 68 patients including 34 patients with MIS-C and admitted into the pediatric intensive care unit (MIS-C group) and 34 patients without MIS-C (non-MIS-C group) were analyzed for their presenting characteristics, serum vit D levels, ventilatory needs, and prognostic scores.
Results Vit D levels were significantly lower in patients with versus without MIS-C [9 (2–18) vs. 19 (10–43) ng/mL, p <0.001], and also in patients with severe versus moderate MIS-C [7.5 (2–17) vs. 9 (5–18) ng/mL, p = 0.024]. Vit D deficiency (levels <12 ng/mL) was more common in the MIS-C versus non-MIS-C group (79.4 vs. 11.8%, p <0.001) and in severe versus moderate MIS-C (92.9 vs. 70.0%, p <0.001). The severe versus moderate MIS-C was associated with significantly higher levels of procalcitonin [7.6 (0.9–82) vs. 1.7 (0.2–42) ng/mL, p = 0.030] and troponin [211 (4.8–4,545) vs. 14.2 (2.4–3,065) ng/L, p = 0.008] and higher likelihood of reduced ejection fraction (75.0 vs. 15.4%, p = 0.004).
Conclusion Our findings indicate the higher prevalence of vit D deficiency in pediatric COVID-19 patients with versus without MIS-C, as well as in those with severe versus moderate MIS-C. Higher troponin and procalcitonin levels and dyspnea at presentation seem also to be risk factors for severe MIS-C, more pronounced cardiac dysfunction, and poorer prognosis.
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Affiliation(s)
- Neslihan Zengin
- Division of Pediatric Intensive Care, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Alkan Bal
- Division of Pediatric Emergency Care, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Tugba Aysun Goren
- Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Semra Sen Bayturan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatos Alkan
- Division of Pediatric Cardiology, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Sinem Akcali
- Department of Microbiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
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Estrada-Luna D, Carreón-Torres E, González-Reyes S, Martínez-Salazar MF, Ortiz-Rodríguez MA, Ramírez-Moreno E, Arias-Rico J, Jiménez-Osorio AS. Nutraceuticals for Complementary Treatment of Multisystem Inflammatory Syndrome in Children: A Perspective from Their Use in COVID-19. Life (Basel) 2022; 12:life12101652. [PMID: 36295088 PMCID: PMC9605437 DOI: 10.3390/life12101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has been widely reported in some children diagnosed with SARS-CoV-2. Clinical signs of MIS-C are manifested at 2 to 4 weeks after SARS-CoV-2 infection, where elevated biomarkers of inflammation and cardiac dysfunction are the hallmark of this syndrome when infection or exposure to SARS-CoV-2 has been confirmed. However, after two years of acknowledgment, MIS-C treatment is still under research to reach safety and effectiveness in the acute phase in children. Therefore, in this review, we discuss the potential use of natural compounds with antioxidant and anti-inflammatory effects to reduce collateral damage caused by hyperinflammation in MIS-C pathology for new research in treatment and interventions.
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Affiliation(s)
- Diego Estrada-Luna
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Elizabeth Carreón-Torres
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Susana González-Reyes
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana 22390, Mexico
| | - María Fernanda Martínez-Salazar
- Facultad de Ciencias del Deporte, Universidad Autónoma del Estado de Morelos, Av. Universidad No. 1001 Col. Chamilpa, Cuernavaca 62209, Mexico
| | - María Araceli Ortiz-Rodríguez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Iztaccíhuatl 100 Col. Los Volcanes, Cuernavaca 62350, Mexico
| | - Esther Ramírez-Moreno
- Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - José Arias-Rico
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Angélica Saraí Jiménez-Osorio
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
- Correspondence: ; Tel.: +52-771-717-2000 (ext. 4323)
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Singh R, Freeman EE. Viruses, Variants, and Vaccines: How COVID-19 Has Changed the Way We Look at Skin. CURRENT DERMATOLOGY REPORTS 2022; 11:289-312. [PMID: 36274754 PMCID: PMC9574791 DOI: 10.1007/s13671-022-00370-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rhea Singh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114 USA
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Esther E. Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114 USA
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
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86
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Keka-Sylaj A, Ramosaj A, Baloku A, Beqiraj Q, Gjaka P. Aseptic meningitis in multisystem inflammatory syndrome in children associated with coronavirus disease 2019: a case report. J Med Case Rep 2022; 16:352. [PMID: 36192799 PMCID: PMC9529331 DOI: 10.1186/s13256-022-03617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As the coronavirus disease 2019 infections are still ongoing, there is an increasing number of case reports and case series with various manifestations of life-threatening multisystem inflammatory syndrome in children . Our case aims to remind all providers to scrutinize for clinical manifestations, including neurological symptoms, which may mimic aseptic meningitis. CASE PRESENTATION A 5-year-old Albanian male child with obesity was admitted to the pediatric intensive care unit due to persistent fever, headache, vomiting, abdominal pain, mucocutaneous manifestations, and fatigue. Initial laboratory results revealed high level of inflammatory markers, including C-reactive protein of 156.8 mg/l, erythrocyte sedimentation rate of 100 mm/hour, procalcitonin of 13.84, leukocytosis with neutrophilia, and lymphopenia. Liver and renal functions, and capillary blood electrolytes (Na, K, Ca), were also altered. Cerebrospinal fluid was slightly turbid, with a white blood cell count of 128/mm3 (80% mononuclear cells and 20% polymorphonuclear), consistent with aseptic meningitis. The clinical presentation with prolonged fever, multiorgan dysfunction, and elevated inflammatory markers, with no plausible alternative diagnosis, matches the case definition of multisystem inflammatory syndrome in children. Combining corticosteroid methylprednisolone with intravenous immunoglobulin was effective. CONCLUSIONS Apart from the most common presentation of multisystem organ dysfunction, neurological manifestations of multisystem inflammatory syndrome in children such as aseptic meningitis, may be present as an immune response post-viral to coronavirus disease 2019. Given the rapid deterioration of children with multisystem inflammatory syndrome, early treatment with immunoglobulins and corticosteroids should be considered.
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Affiliation(s)
- Alije Keka-Sylaj
- Institute of Anatomy, Pediatric Clinic, Faculty of Medicine, University of Prishtina, Pristina, 10000, Kosovo.
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, 10000, Kosovo.
| | - Atifete Ramosaj
- Institute of Anatomy, Pediatric Clinic, Faculty of Medicine, University of Prishtina, Pristina, 10000, Kosovo
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, 10000, Kosovo
| | - Arbana Baloku
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, 10000, Kosovo
| | - Qëndresa Beqiraj
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, 10000, Kosovo
| | - Petrit Gjaka
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, 10000, Kosovo
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Castaldo A, D’Anna C, Gelzo M, Giannattasio A, Maglione M, Muzzica S, Raia M, Scalia G, Tripodi L, Castaldo G, Tipo V, Grieco D, Grieco M. Immunophenotyping of peripheral blood cells allows to discriminate MIS-C and Kawasaki disease. TRANSLATIONAL MEDICINE COMMUNICATIONS 2022; 7:22. [PMID: 36093039 PMCID: PMC9440857 DOI: 10.1186/s41231-022-00128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/09/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND The pathogenesis of the novel described multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) is still debated as it is not clear if they are the same or different nosological entities. However, for both the diseases a rapid and unequivocal diagnosis is mandatory to start the therapy before the onset of severe complications. In this study, we aimed to evaluate the white cell populations in MIS-C and KD as potential markers to discriminate between the two diseases. METHODS We studied white cell populations by flow cytometry in 46 MIS-C and 28 KD patients in comparison to 70 age-matched healthy children. RESULTS MIS-C patients had a significant lymphopenia that involved both B and T populations while KD patients showed a significant neutrophilia and thrombocythemia. Granulocyte/lymphocyte ratio helped to diagnose both MIS-C and KD with a high diagnostic sensitivity, while a multivariate analysis of granulocyte and T lymphocyte number contributed to discriminate between the two diseases. CONCLUSIONS The relevant lymphopenia observed in MIS-C patients suggests that the disease would be a post-infectious sequel of COVID-19 immunologically amplified by a massive cytokine release, while the significant neutrophilia and thrombocythemia observed in KD confirmed that the disorder has the genesis of a systemic vasculitis. The analysis of a panel of circulating cells may help to early diagnose and to discriminate between the two diseases. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s41231-022-00128-2.
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Affiliation(s)
- Alice Castaldo
- Dipartimento Di Scienze Mediche Traslazionali, Sezione Di Pediatria, Università Di Napoli Federico II, Naples, Italy
| | - Carolina D’Anna
- Dipartimento Di Emergenza, AORN Santobono-Pausilipon, Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, scarl, Naples, Italy
- Dipartimento Di Medicina Molecolare E Biotecnologie Mediche, Università Di Napoli Federico II, Naples, Italy
| | | | - Marco Maglione
- Dipartimento Di Emergenza, AORN Santobono-Pausilipon, Naples, Italy
| | - Stefania Muzzica
- Dipartimento Di Emergenza, AORN Santobono-Pausilipon, Naples, Italy
| | - Maddalena Raia
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, scarl, Naples, Italy
| | - Giulia Scalia
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, scarl, Naples, Italy
| | - Lorella Tripodi
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, scarl, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, scarl, Naples, Italy
- Dipartimento Di Medicina Molecolare E Biotecnologie Mediche, Università Di Napoli Federico II, Naples, Italy
| | - Vincenzo Tipo
- Dipartimento Di Emergenza, AORN Santobono-Pausilipon, Naples, Italy
| | - Domenico Grieco
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, scarl, Naples, Italy
| | - Michela Grieco
- Dipartimento Di Emergenza, AORN Santobono-Pausilipon, Naples, Italy
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Schlatterer K, Maxeiner HG, Zouboulis CC, Daeschlein G. Hygiene in der Dermatologie: SARS-CoV-2 und weitere Virus-Varianten. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1703-1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie COVID-19-Pandemie hat weltweit erhebliche Beeinträchtigungen des Lebens und Arbeitens mit sich gebracht. Mit dem Beginn der Impfungen steigt die Hoffnung auf eine Kehrtwende. Dennoch sind COVID- und Intensivstationen in den Kliniken nach wie vor erheblich belastet. Häufig muss in den Kliniken aus Kapazitätsgründen auch dermatologisches Fachpersonal zur Betreuung von COVID-19-Patienten herangezogen werden. Dies führte dazu, dass im Verlauf der Pandemie dermatologische Manifestationen von COVID-19 erkannt und näher klassifiziert werden konnten. Differenzierte Hygienekonzepte, insbesondere die der Händehygiene, bringen jedoch ein weiteres, mit der Pandemie-assoziiertes dermatologisches Problem zum Vorschein: die Ausbildung von Handekzemen. Dies ist nicht nur auf medizinische Berufe beschränkt und zeigt daher eine mögliche übergeordnete Bedeutung der Dermatologie im Rahmen von zukünftigen Pandemiestrategien.
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Affiliation(s)
- Kathrin Schlatterer
- Institut für Laboratoriumsmedizin, Sankt Gertrauden Krankenhaus, Berlin, Deutschland
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | | | - Christos C. Zouboulis
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - Georg Daeschlein
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
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Gadiwala S, Mistry A, Patel S, Chaithanya A, Pathak S, Satnarine T, Bekina-Sreenivasan D, Bakarr AA, Das BB, Chakinala RC, Patel S, Areti S. MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management. LE INFEZIONI IN MEDICINA 2022; 30:344-352. [PMID: 36148163 PMCID: PMC9448305 DOI: 10.53854/liim-3003-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 06/25/2022] [Indexed: 06/16/2023]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawasaki-like disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a total of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C presented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunctival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase in IL-17A, IL-6, and arterial damage, a distinct difference from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were successful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potentially fatal pediatric complication, after COVID-19 infection. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.
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Affiliation(s)
- Salika Gadiwala
- Department of Public Health, Drexel University/Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ayushi Mistry
- Department of Pediatrics, Dr. N. D. Desai Medical College and Research Center, Gujarat, India
| | - Sejal Patel
- Department of Pediatrics, Government Medical College, Surat, India
| | | | | | | | | | | | - Bibhuti Bhusan Das
- Department of Forensic Psychiatry, Central New York Psychiatric Center, OMH, NY, USA
| | - Raja Chandra Chakinala
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Saurabhkumar Patel
- Department of Pediatrics, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Sathya Areti
- Department of Internal-Medicine-Pediatrics, Case Western University Hospitals/Rainbow Babies, Cleveland, OH, USA
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Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Pediatr Res 2022; 93:1499-1508. [PMID: 36050390 PMCID: PMC9436161 DOI: 10.1038/s41390-022-02263-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/07/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
During the SARS-CoV-2-associated infection (COVID-19), pandemic initial reports suggested relative sparing of children inversely related to their age. Children and neonates have a decreased incidence of SARS-CoV-2 infection, and if infected they manifested a less severe phenotype, in part due to enhanced innate immune response. However, a multisystem inflammatory syndrome in children (MIS-C) or paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 emerged involving coronary artery aneurysms, cardiac dysfunction, and multiorgan inflammatory manifestations. MIS-C has many similarities to Kawasaki disease and other inflammatory conditions and may fit within a spectrum of inflammatory conditions based on immunological results. More recently neonates born to mothers with SARS-CoV-2 infection during pregnancy demonstrated evidence of a multisystem inflammatory syndrome with raised inflammatory markers and multiorgan, especially cardiac dysfunction that has been described as multisystem inflammatory syndrome in neonates (MIS-N). However, there is a variation in definitions and management algorithms for MIS-C and MIS-N. Further understanding of baseline immunological responses to allow stratification of patient groups and accurate diagnosis will aid prognostication, and inform optimal immunomodulatory therapies. IMPACT: Multisystem inflammatory system in children and neonates (MIS-C and MIS-N) post COVID require an internationally recognized consensus definition and international datasets to improve management and plan future clinical trials. This review incorporates the latest review of pathophysiology, clinical information, and management of MIS-C and MIS-N. Further understanding of the pathophysiology of MIS-C and MIS-N will allow future targeted therapies to prevent and limit clinical sequelae.
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Thrombotic Presentation of MIS-C After COVID-19 Infection in a Nine-Year-Old Boy. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2022. [DOI: 10.5812/pedinfect-127250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: SARS-CoV-2 is the cause of the recent pandemic. Although children are less affected by the virus, they can present with various presentations ranging from asymptomatic or fatigue and fever to multisystem inflammatory syndrome in children (MIS-C). Case Presentation: In this case report, we presented a case of a 9-year-old boy who presented with bilateral deep vein thromboses (DVTs) of the femoral and iliac veins as his main presentation of MIS-C, which occurred following a COVID-19 infection. A complete history was taken from the patient, and then a series of tests, including complete blood counts (CBCs), liver function tests (LFTs), and D-dimer, were performed. Bilateral doppler sonography to confirm the event and its location, as well as a decent follow-up method, were performed. Levels of anti-Xa assays followed the toxic levels of enoxaparin. The child was treated with a regimen of enoxaparin and corticosteroids, with a dosage of 1 mg/kg/12 h for both. The child was in the hospital for two weeks, after which he got better and was managed as an out-patient with a regularly scheduled appointment. Finally, once the radiologic evidence of DVTs was cleared, the patient tapered off his enoxaparin over the course of three weeks. Conclusions: Thrombotic events following COVID-19-associated MIS-C are an unlikely yet deadly event, especially in children. Prompt treatment with anticoagulants and corticosteroids alongside monitoring the patients are strongly advised.
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Does Multisystem Inflammatory Syndrome Only Mimic Acute Appendicitis in Children or Can It Coexist: When Should We Suspect MIS-C? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081101. [PMID: 36013568 PMCID: PMC9416076 DOI: 10.3390/medicina58081101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.
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93
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Cheng AT, Watson AL, Picardo N. Lessons Learnt from the COVID-19 Pandemic in Pediatric Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022; 10:456-463. [PMID: 35965652 PMCID: PMC9361255 DOI: 10.1007/s40136-022-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/21/2022]
Abstract
Purpose of Review The current COVID-19 pandemic has challenged the international paediatric otolaryngology community: we review its impact in clinical, resource, and human settings. Recent Findings The SARS-CoV-2 virus, while generally mild in paediatric populations, has caused an increased incidence in severe croup, invasive fungal sinus disease, and multi system inflammatory syndrome (MIS-C). The incidence of other common otolaryngology presentations such as otitis media and tonsillitis has decreased due to quarantine measures. The pandemic has also changed the way in which we work: guidelines for aerosol-generating procedures (AGPs) have changed, digital technology and videoconferencing platforms have flourished, and new pathways of providing healthcare have been developed to minimise footfall and avoid overcrowded waiting rooms. Finally, the importance of personal protective equipment (PPE) to protect healthcare workers and patients cannot be understated, although the mental and physical toll is considerable. Summary There has been a tectonic shift in paediatric otolaryngology and healthcare globally. Continued adaptability and resilience are required to face these challenges in the coming months. With lessons learnt from managing SARS-CoV-2, we are hopefully well equipped to combat any future pandemics.
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Affiliation(s)
- Alan T. Cheng
- Department of Paediatric ENT, The Children’s Hospital at Westmead, NSW Westmead, Australia
- Discipline of Child and Adolescent Health, Faculty of Health and Medicine, Sydney Medical School, University of Sydney, Westmead, NSW Australia
| | - Antonia L. Watson
- Discipline of Otolaryngology, Department of Surgery, Canterbury Hospital, Campsie, NSW Australia
| | - Naina Picardo
- Department of ENT, Paediatric ENT Unit, Christian Medical College, Vellore, Tamil Nadu India
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Ultrasound Comparative Analysis of Coronary Arteries before and after Immune Blocking Therapy with Gamma Globulin in Children with Kawasaki Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2900378. [PMID: 35966739 PMCID: PMC9371854 DOI: 10.1155/2022/2900378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022]
Abstract
Objective To investigate the ultrasound characteristics and clinical efficacy of coronary arteries before and after immune blocking therapy with gamma globulin in children with Kawasaki disease. Methods A total of 64 children with Kawasaki disease who were treated in our hospital from January 2018 to October 2021 were selected. All the children were given immune blocking therapy with gamma globulin on the basis of conventional treatment. The disappearance time of related symptoms and signs (fever, mucosal congestion, cervical lymphadenopathy, and swelling of the hands and feet) in children were counted. The white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP), and procalcitonin (PCT) levels of the children before and after treatment were compared, and the characteristics of coronary echocardiography before and after treatment were observed for analysis and discussion, to carefully observe whether the coronary artery involvement of the children was improved. Results The inner diameter of the left and right coronary arteries significantly decreased (P < 0.05), and the levels of leukocytes, platelets, CRP, erythrocyte sedimentation rate, vascular endothelial growth factor (VEGF), and endostatin were significantly decreased compared with those before treatment, with a statistical difference (P < 0.05). Conclusion The effect of gamma globulin in the treatment of Kawasaki disease is remarkable, which can improve the blood indexes, VEGF, and endostatin levels in children, significantly reduce coronary dilatation, and reduce the incidence of coronary artery disease. Echocardiography is of high value in the examination of children with Kawasaki disease, which can accurately detect the size, location, and inner diameter of coronary artery lesions, and can effectively evaluate the treatment effect on children.
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Llenas-García J, Paredes-Martínez ML, Boils-Arroyo PL, Pérez-Gómez IM. [Multisystem inflammatory syndrome in adults associated to SARS-CoV-2]. Enferm Infecc Microbiol Clin 2022; 40:407-409. [PMID: 34898786 PMCID: PMC8647029 DOI: 10.1016/j.eimc.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jara Llenas-García
- Servicio de Medicina Interna-Infecciosas, Hospital Vega Baja, FISABIO, Orihuela (Alicante), España
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche (Alicante), España
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96
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Llenas-García J, Paredes-Martínez ML, Boils-Arroyo PL, Pérez-Gómez IM. Multisystem inflammatory syndrome in adults associated to SARS-CoV-2. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:407-409. [PMID: 35550361 PMCID: PMC9058030 DOI: 10.1016/j.eimce.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Jara Llenas-García
- Servicio de Medicina Interna-Infecciosas, Hospital Vega Baja, FISABIO, Orihuela (Alicante), Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche (Alicante), Spain.
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97
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Qin Z, Sun Y, Zhang J, Zhou L, Chen Y, Huang C. Lessons from SARS‑CoV‑2 and its variants (Review). Mol Med Rep 2022; 26:263. [PMID: 35730623 PMCID: PMC9260876 DOI: 10.3892/mmr.2022.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has swept through mainland China by human-to-human transmission. The rapid spread of SARS-CoV-2 and its variants, including the currently prevalent Omicron strain, pose a serious threat worldwide. The present review summarizes epidemiological investigation and etiological analysis of genomic, epidemiological, and pathological characteristics of the original strain and its variants, as well as progress in diagnosis and treatment. Prevention and control measures used during the current Omicron pandemic are discussed to provide further knowledge of SARS-CoV-2.
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Affiliation(s)
- Ziwen Qin
- Department of Respiratory Diseases, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
| | - Yan Sun
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Jian Zhang
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ling Zhou
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Yujuan Chen
- Department of Respiratory Diseases, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
| | - Chuanjun Huang
- Department of Respiratory Diseases, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
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Orendáčová M, Kvašňák E. Effects of vaccination, new SARS-CoV-2 variants and reinfections on post-COVID-19 complications. Front Public Health 2022; 10:903568. [PMID: 35968477 PMCID: PMC9372538 DOI: 10.3389/fpubh.2022.903568] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Post-COVID-19 complications involve a variety of long-lasting health complications emerging in various body systems. Since the prevalence of post-COVID-19 complications ranges from 8-47% in COVID-19 survivors, it represents a formidable challenge to COVID-19 survivors and the health care system. Post-COVID-19 complications have already been studied in the connection to risk factors linked to their higher probability of occurrence and higher severity, potential mechanisms underlying the pathogenesis of post-COVID-19 complications, and their functional and structural correlates. Vaccination status has been recently revealed to represent efficient prevention from long-term and severe post-COVID-19 complications. However, the exact mechanisms responsible for vaccine-induced protection against severe and long-lasting post-COVID-19 complications remain elusive. Also, to the best of our knowledge, the effects of new SARS-CoV-2 variants and SARS-CoV-2 reinfections on post-COVID-19 complications and their underlying pathogenesis remain to be investigated. This hypothesis article will be dedicated to the potential effects of vaccination status, SARS-CoV-2 reinfections, and new SARS-CoV-2 variants on post-COVID-19 complications and their underlying mechanisms Also, potential prevention strategies against post-COVID complications will be discussed.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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Patel H, McArdle A, Seaby E, Levin M, Whittaker E. The immunopathogenesis of SARS-CoV-2 infection in children: diagnostics, treatment and prevention. Clin Transl Immunology 2022; 11:e1405. [PMID: 35903804 PMCID: PMC9314314 DOI: 10.1002/cti2.1405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/21/2021] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Symptoms and outcomes for paediatric COVID-19 differ vastly from those for adults, with much lower morbidity and mortality. Immunopathogenesis drives severe outcomes in adults, and it is likely that age-related differences in both the innate and specific immune responses underlie much of the variation. Understanding the protective features of the paediatric immune system may be crucial to better elucidate disease severity in adult COVID-19 and may pave the way for novel therapeutic approaches. However, as well as uncommon cases of severe paediatric acute COVID-19, there have been children who have presented with delayed multisystem inflammation, including cardiac, gastrointestinal, skin, mucosa and central nervous system involvement. The occurrence of coronary artery aneurysms has drawn comparisons with Kawasaki Disease, but similarities with the inflammatory phase of adult acute COVID-19 have also been drawn. In this review, we summarise findings from studies investigating pre-existing immunity, cytokine profiles, innate, B-cell, antibody, T-cell and vaccine responses in children with acute COVID-19 and multisystem inflammation, compared with COVID-19 adults and controls. We further consider the relevance to therapeutics in the context of limited evidence in children and highlight key questions to be answered about the immune response of children to SARS-CoV-2.
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Affiliation(s)
- Harsita Patel
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
| | - Andrew McArdle
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
| | - Eleanor Seaby
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Genomic Informatics GroupUniversity of SouthamptonSouthamptonUK
- Translational Genomics GroupBroad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Michael Levin
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Department of PaediatricsImperial College Healthcare NHS TrustLondonUK
| | - Elizabeth Whittaker
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Department of PaediatricsImperial College Healthcare NHS TrustLondonUK
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Schneider M. The Role of Biomarkers in Hospitalized COVID-19 Patients With Systemic Manifestations. Biomark Insights 2022; 17:11772719221108909. [PMID: 35783222 PMCID: PMC9243490 DOI: 10.1177/11772719221108909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023] Open
Abstract
The following article aims to review COVID-19 biomarkers used in hospital
practice. It is apparent that COVID-19 is not simply a pulmonary disease but has
systemic manifestations. For this reason, biomarkers must be used in the
management of diagnosed patients to provide holistic care. Patients with
COVID-19 have been shown to have pulmonary, hepatobiliary, cardiovascular,
neurologic, and renal injury, along with coagulopathy and a distinct cytokine
storm. Biomarkers can effectively inform clinicians of systemic organ injury due
to COVID-19. Furthermore, biomarkers can be used in predictive models for severe
COVID-19 in admitted patients. The utility of doing so is to allow for risk
stratification and utilization of proper treatment protocols. In addition,
COVID-19 biomarkers in the pediatric population are discussed, specifically in
predicting Multisystem Inflammatory Syndrome. Ultimately, biomarkers can be used
as predictive tools to allow clinicians to identify and adequately manage
patients at increased risk for worse outcomes from COVID-19. Both literature
review and anecdotal evidence has shown that severe COVID-19 is a systemic
disease, and understanding associated biomarkers are crucial for hospitalized
patients’ proper clinical decision-making. For example, the cytokine storm
releases inflammatory markers in different organ systems such as the pulmonary,
hepatobiliary, hematological, cardiac, neurological, and renal systems. This
review summarizes the latest research of COVID-19 that can help inform
healthcare professionals how to better mitigate morbidity and mortality
associated with this disease and provides information about certain systemic
biomarkers that can be incorporated into hospital practice to provide more
comprehensive care for hospitalized COIVD-19 patients.
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Affiliation(s)
- Michael Schneider
- University of Queensland Ochsner Clinical School, New Orleans, LA, USA
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