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Zhang J, Huang H, Xu L, Wang S, Gao Y, Zhuo W, Wang Y, Zheng Y, Tang X, Jiang J, Lv H. Knowledge framework of intravenous immunoglobulin resistance in the field of Kawasaki disease: A bibliometric analysis (1997-2023). Immun Inflamm Dis 2024; 12:e1277. [PMID: 38775687 PMCID: PMC11110715 DOI: 10.1002/iid3.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an autoimmune disease with cardiovascular disease as its main complication, mainly affecting children under 5 years old. KD treatment has made tremendous progress in recent years, but intravenous immunoglobulin (IVIG) resistance remains a major dilemma. Bibliometric analysis had not been used previously to summarize and analyze publications related to IVIG resistance in KD. This study aimed to provide an overview of the knowledge framework and research hotspots in this field through bibliometrics, and provide references for future basic and clinical research. METHODS Through bibliometric analysis of relevant literature published on the Web of Science Core Collection (WoSCC) database between 1997 and 2023, we investigated the cooccurrence and collaboration relationships among countries, institutions, journals, and authors and summarized key research topics and hotspots. RESULTS Following screening, a total of 364 publications were downloaded, comprising 328 articles and 36 reviews. The number of articles on IVIG resistance increased year on year and the top three most productive countries were China, Japan, and the United States. Frontiers in Pediatrics had the most published articles, and the Journal of Pediatrics had the most citations. IVIG resistance had been studied by 1889 authors, of whom Kuo Ho Chang had published the most papers. CONCLUSION Research in the field was focused on risk factors, therapy (atorvastatin, tumor necrosis factor-alpha inhibitors), pathogenesis (gene expression), and similar diseases (multisystem inflammatory syndrome in children, MIS-C). "Treatment," "risk factor," and "prediction" were important keywords, providing a valuable reference for scholars studying this field. We suggest that, in the future, more active international collaborations are carried out to study the pathogenesis of IVIG insensitivity, using high-throughput sequencing technology. We also recommend that machine learning techniques are applied to explore the predictive variables of IVIG resistance.
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Affiliation(s)
- Jiaying Zhang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Hongbiao Huang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
- Department of PediatricsFujian Province HospitalFuzhouFujianChina
| | - Lei Xu
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Shuhui Wang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yang Gao
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Wenyu Zhuo
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yan Wang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yiming Zheng
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xuan Tang
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Jiaqi Jiang
- Department of Pediatrics, No.2 Affiliated HospitalAir Force Medical UniversityXianShanxiChina
| | - Haitao Lv
- Institute of Pediatric ResearchChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
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Akhtar S, Anis I, Kumar NA, Ihsan MT, Raheem A, Bano S. Assessing pattern of the Pediatric Multisystem Inflammatory Syndrome (PMIS) in children during the COVID-19 pandemic: experience from the emergency department of tertiary care center of a low-middle-income country. BMC Pediatr 2024; 24:98. [PMID: 38310210 PMCID: PMC10837963 DOI: 10.1186/s12887-024-04572-x] [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: 02/02/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Pediatric Multisystem Inflammatory Syndrome (PMIS) is a hyperinflammatory condition affecting multiple organs in children, often resembling incomplete Kawasaki Disease during later phases of COVID-19 infection. Data on PMIS in low-middle-income countries, particularly in emergency department settings, is limited. OBJECTIVES This prospective observational study at Aga Khan University Hospital, Karachi, aimed to determine the frequency, clinical presentation patterns, and laboratory parameters of children with PMIS visiting the emergency department during the COVID-19 pandemic. Secondary objectives included assessing factors associated with in-hospital mortality. METHODS From March 2020 to September 2021, patients meeting World Health Organization PMIS criteria were enrolled. COVID-19 testing included PCR and antibody testing. Data was collected through a questionnaire and analyzed statistically. RESULTS Among 56 PMIS patients (85.7% male, mean age 7.67 ± 4.8 years), respiratory symptoms (70%), neurological symptoms (57%), and gastrointestinal symptoms (54%) were common presentations. Signs included delayed capillary refill time (93%), low-volume pulses (89%), and hypotension (68%). COVID-19 antibodies were positive in the majority (78.6%) while PCR was positive in 18%. Risk factors for mortality included prolonged emergency department stay, and high Ferritin and Lactate Dehydrogenase levels. CONCLUSION PMIS affects children of all ages. Respiratory and gastrointestinal symptoms are the most frequent presentations. Elevated inflammatory markers, including LDH, Ferritin, D-dimer, and Pro-BNP, correlate with higher mortality risk.
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Affiliation(s)
- Saleem Akhtar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqra Anis
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nirdosh Ashok Kumar
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Surraiya Bano
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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Harahsheh AS, Shah S, Dallaire F, Manlhiot C, Khoury M, Lee S, Fabi M, Mauriello D, Tierney ESS, Sabati AA, Dionne A, Dahdah N, Choueiter N, Thacker D, Giglia TM, Truong DT, Jain S, Portman M, Orr WB, Harris TH, Szmuszkovicz JR, Farid P, McCrindle BW. Kawasaki Disease in the Time of COVID-19 and MIS-C: The International Kawasaki Disease Registry. Can J Cardiol 2024; 40:58-72. [PMID: 37290536 PMCID: PMC10245460 DOI: 10.1016/j.cjca.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics, clinical presentation, management, and outcomes of patients according to evidence of previous SARS-CoV-2 infection. METHODS The International Kawasaki Disease Registry (IKDR) enrolled KD and MIS-C patients from sites in North, Central, and South America, Europe, Asia, and the Middle East. Evidence of previous infection was defined as: Positive (household contact or positive polymerase chain reaction [PCR]/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). RESULTS Of 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible for 89 (4%), Negative for 404 (17%) and Unknown for 311 (13%). Clinical outcomes varied significantly among the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to intensive care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, and patients in the Negative and Unknown groups had more severe coronary artery abnormalities. CONCLUSIONS There appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for previous acute SARS-CoV-2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.
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Affiliation(s)
- Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital; George Washington University School of Medicine and Health Sciences; Washington, DC, USA.
| | - Samay Shah
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Frederic Dallaire
- Department of Paediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Khoury
- Division of Paediatric Cardiology, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marianna Fabi
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniel Mauriello
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Elif Seda Selamet Tierney
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California, USA
| | | | - Audrey Dionne
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nagib Dahdah
- Division of Paediatric Cardiology, CHU Ste-Justine, University of Montréal, Montréal, Québec, Canada
| | - Nadine Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Therese M Giglia
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dongngan T Truong
- University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Supriya Jain
- New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
| | | | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Pedrom Farid
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Dizon BLP, Redmond C, Gotschlich EC, Sule S, Ronis T, Vazzana KM, Sherman MA, Connor R, Bosk A, Dham N, Harahsheh AS, Wells E, DeBiasi R, Srinivasalu H. Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study. Pediatr Rheumatol Online J 2023; 21:76. [PMID: 37525200 PMCID: PMC10388456 DOI: 10.1186/s12969-023-00858-z] [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: 04/10/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Evidence for the treatment of multisystem inflammatory syndrome in children (MIS-C) is lacking. Anakinra, which targets IL-1-mediated inflammation, is reserved for refractory cases of MIS-C; however, its use in the treatment of MIS-C is not clearly established. PATIENTS AND METHODS To examine a role for anakinra in MIS-C, we performed a single center observational cohort study of all MIS-C patients diagnosed at our children's hospital from May 15 to November 15, 2020. Demographics, clinical features, diagnostic testing, and cardiac function parameters were compared between MIS-C patients treated with intravenous immunoglobulin (IVIG) monotherapy and IVIG with anakinra (IVIG + anakinra). RESULTS Among 46 patients with confirmed MIS-C, 32 (70%) were in the IVIG + anakinra group, of which 9 (28%) were also given corticosteroids (CS). No patients were treated with anakinra alone. MIS-C patients in the IVIG + anakinra group were enriched in a CV shock phenotype (p = 0.02), and those with CV shock were treated with higher doses of anakinra for a longer duration. Furthermore, MIS-C patients in the IVIG + anakinra group exhibited improvements in fever and cardiac function with or without CS. No significant adverse events were observed, and no differences in IL-1β levels were found among MIS-C patients in the IVIG + anakinra group. CONCLUSIONS Anakinra treatment, which was co-administered with IVIG primarily in patients with severe MIS-C, was associated with improvements in fever and cardiac function, and demonstrated a favorable side-effect profile. These findings suggest a role for adjunctive anakinra in the treatment of severe MIS-C.
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Affiliation(s)
- Brian L P Dizon
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
- Rheumatology Fellowship and Training Branch, The National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Christopher Redmond
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
- Rheumatology Fellowship and Training Branch, The National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Emily C Gotschlich
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
| | - Sangeeta Sule
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Tova Ronis
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kathleen M Vazzana
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
- Department of Pediatric Rheumatology, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Matthew A Sherman
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
| | - Rachael Connor
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
| | - Abigail Bosk
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Niti Dham
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Ashraf S Harahsheh
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Elizabeth Wells
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Neurology, Children's National Hospital, Washington, DC, USA
| | - Roberta DeBiasi
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
| | - Hemalatha Srinivasalu
- Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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5
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García-Domínguez M, Anaya-Enríquez N, Luque-Vega L, Canizales-Muñoz S, Flores R, Tostado-Morales E, Torres CG, Melchor V, Quibrera J, Velázqueaz-Ríos C, León-Ramírez ÁR, Carreón-Guerrero JM, Llausás-Magaña E. [Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico]. REVISTA ALERGIA MÉXICO 2023; 70:80-88. [PMID: 37566771 DOI: 10.29262/ram.v70i3.1237] [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: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C). METHODS We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospi-talized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria be-tween May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups. RESULTS Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and lab-oratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symp-toms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C. CONCLUSIONS Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, signifi-cant differences such as severity of clinical presentation with multi-organ involvement and worst inflammato-ry response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C thanpatients with KD. Similar results have been observed in other studies where both disorders were compared.
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Affiliation(s)
| | | | - Lynnete Luque-Vega
- Departamento de Pediatría, Hospital Pediátrico de Sinaloa, Culiacán, México
| | | | - Rosalino Flores
- Departamento de Epidemiología, Hospital Pediátrico de Sinaloa, Culiacán, México
| | | | - Cynthia G Torres
- Departamento de Terapia intensiva, Hospital Pediátrico de Sinaloa, Culiacán, México
| | - Vianey Melchor
- Departamento de Terapia intensiva, Hospital Pediátrico de Sinaloa, Culiacán, México
| | - José Quibrera
- Departamento de Cardiología, Hospital Pediátrico de Sinaloa, Culiacán, México
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6
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Kim JH, You J. Comparison of Clinical Manifestations of Kawasaki Disease According to SARS-CoV-2 Antibody Positivity. J Korean Med Sci 2023; 38:e181. [PMID: 37337806 DOI: 10.3346/jkms.2023.38.e181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/26/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the most common cause of acquired heart disease in paediatric patients, with infectious agents being the main cause. This study aimed to determine whether there are differences in the clinical manifestations of KD between patients with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. METHODS From January 1, 2021 to August 15, 2022, 82 patients with analysable echocardiographic data were diagnosed with KD. Twelve patients with multisystem inflammatory syndrome in children were excluded. Serologic tests were performed by chemiluminescence immunoassay for both the nucleocapsid (N) and the spike (S) proteins in blood samples. Among the 70 patients diagnosed with KD at Jeonbuk University Children's Hospital, the SARS-CoV-2 antibody test was performed in 41 patients. RESULTS The SARS-CoV-2 antibody test results for the N antigen were positive in 12 patients, while those for S protein were positive in 14 patients. N antigen SARS-CoV-2 antibody-positive KD was different from N antigen SARS-CoV-2 antibody-negative KD in terms of sex (male predominance in the positive group, 83.3% vs. female predominance in the negative group 62.1%, P = 0.008) and the incidence of refractory KD (41.7% vs. 10.3%, P = 0.034). The pro-B-type natriuretic peptide level was lower in the N-antigen SARS-CoV-2 antibody-positive KD group than that in the negative group (518.9 ± 382.6, 1,467.0 ± 2,417.6, P = 0.049). No significant differences in the echocardiographic findings between both groups were noted. In the multi-variable analysis, SARS-CoV-2 antibody (N antigen) was the only predictor of refractory KD (odds ratio, 13.70; 95% confidence interval, 1.63-115.44; P = 0.016). CONCLUSION High incidence of intravenous immunoglobulin-refractory KD may occur in up to 40% of the patients having recent history of coronavirus disease 2019. For patients having KD with N-type SARS-CoV-2 antibody positivity, adjunctive treatment, such as corticosteroids, can be considered as the first line of treatment.
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Affiliation(s)
- Jin Ho Kim
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
| | - Jihye You
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
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7
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Ng Q, Loke YH, Smith KL, DeBiasi RL, Berul CI, Sharron MP, Wessel D, Bost JE, Lowndes RW, Ansusinha E, Mehrtens K, Schultz J, Harahsheh AS. Cardiac evaluation of hospitalized children with 2019 coronavirus (COVID-19) infection at a single large quaternary center. Heliyon 2023; 9:e17395. [PMID: 37366529 PMCID: PMC10277255 DOI: 10.1016/j.heliyon.2023.e17395] [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: 05/17/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background Cardiac complications of serious SARS-CoV-2 infections, especially Multisystem Inflammatory Syndrome of Children (MIS-C) are well described, however current studies have not considered pediatric patients hospitalized with no cardiac concerns. We established a protocol for cardiac evaluation of all admitted COVID-19 patients three weeks post-discharge, irrespective of cardiac concerns. We assessed cardiovascular outcomes and hypothesized that patients with absent cardiac concerns are at lower risk for cardiac abnormalities. Methods This was a retrospective study of 160 patients admitted for COVID-19 (excluding MIS-C) between March 2020 and September 2021 with subsequent echocardiogram(s) performed at our center. Patients were divided into 4 subgroups: Group 1 included patients with absent cardiac concerns, admitted to acute care (1a) and intensive care unit (ICU) (1 b). Group 2 included patients with cardiac concerns, admitted to acute care (2a) and ICU (2 b). Groups were compared based on clinical endpoints and echocardiographic measurements, including tissue Doppler imaging (TDI) assessment of diastolic function (z-score of septal Mitral E/TDI E' and lateral E/TDI E'). Chi-squared, Fisher's exact, and Kruskal-Wallis tests were used. Results Traditional cardiac abnormalities varied significantly between the groups; with Group 2 b having the most (n = 8, 21%), but still found in Group 1a (n = 2, 3%) and Group 1 b (n = 1, 5%). No patients in Group 1 demonstrated abnormal systolic function, compared to Group 2a (n = 1, 3%) and Group 2 b (n = 3, 9%, p = 0.07). When including TDI assessment of diastolic function, the total incidence of abnormalities found on echocardiogram was increased in all groups. Conclusion Cardiac abnormalities were found in pediatric patients admitted with COVID-19, even those without apparent cardiovascular concerns. The risk was greatest in ICU-admitted patients with cardiac concerns. The clinical significance of diastolic function assessment in these patients remains unknown. Further studies are needed to assess long-term cardiovascular sequelae of children with COVID-19, irrespective of cardiac concerns.
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Affiliation(s)
- Qimin Ng
- Pediatric Residency Program, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Karen L Smith
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Hospital Medicine, Children's National Hospital, Washington, DC, USA
| | - Roberta L DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Charles I Berul
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Matthew P Sharron
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - David Wessel
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - James E Bost
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Robert W Lowndes
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Emily Ansusinha
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
| | - Kristine Mehrtens
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - John Schultz
- Division of Ambulatory Services, Children's National Hospital, Washington, DC, USA
| | - Ashraf S Harahsheh
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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8
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COVID-19 Positive Versus Negative Complete Kawasaki Disease: A Study from the International Kawasaki Disease Registry. Pediatr Cardiol 2023:10.1007/s00246-023-03109-w. [PMID: 36786810 PMCID: PMC9926414 DOI: 10.1007/s00246-023-03109-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
To determine clinical differences for children with complete Kawasaki disease (KD) with and without evidence of preceding SARS-CoV-2 infection. From January 2020, contemporaneous patients with complete KD criteria were classified as either SARS-CoV-2 positive (KDCOVID+; confirmed household exposure, positive PCR and/or serology) or SARS-CoV-2 negative (KDCOVID-; negative testing and no exposure) and compared. Of 744 patients in the International Kawasaki Disease Registry, 52 were KDCOVID- and 61 were KDCOVID+. KDCOVID+ patients were older (median 5.5 vs. 3.7 years; p < 0.001), and all additionally met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C). They were more likely to have abdominal pain (60% vs. 35%; p = 0.008) and headache (38% vs. 10%; p < 0.001) and had significantly higher CRP, troponin, and BUN/creatinine, and lower hemoglobin, platelets, and lymphocytes. KDCOVID+ patients were more likely to have shock (41% vs. 6%; p < 0.001), ICU admission (62% vs. 10%; p < 0.001), lower left ventricular ejection fraction (mean lowest LVEF 53% vs. 60%; p < 0.001), and to have received inotropic support (60% vs. 10%; p < 0.001). Both groups received IVIG (2 doses in 22% vs. 18%; p = 0.63), but KDCOVID+ were more likely to have received steroids (85% vs. 35%; p < 0.001) and anakinra (60% vs. 10%; p = 0.002). KDCOVID- patients were more likely to have medium/large coronary artery aneurysms (CAA, 12% vs. 0%; p = 0.01). KDCOVID+ patients differ from KDCOVID-, have more severe disease, and greater evidence of myocardial involvement and cardiovascular dysfunction rather than CAA. These patients may be a distinct KD phenotype in the presence of a prevalent specific trigger.
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You SD, Kim JH, You J. Clinical characteristics and short-term outcomes of multisystem inflammatory syndrome in a country with a high prevalence of KD. Front Pediatr 2023; 11:1088529. [PMID: 36865687 PMCID: PMC9971980 DOI: 10.3389/fped.2023.1088529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has spread continuously. Multisystem inflammatory syndrome in children (MIS-C), like Kawasaki disease (KD), is a potentially severe illness in children that appears to be a delayed, post-infectious complication of COVID-19. However, based on the relatively low MIS-C prevalence and high KD prevalence in Asian children, the clinical features of MIS-C are not fully recognized, especially after the spread of the Omicron variant. Here, we aimed to identify the clinical characteristics of MIS-C in a country with high KD prevalence. METHODS We retrospectively analyzed 98 children diagnosed with KD and MIS-C admitted to Jeonbuk National University Hospital between January 1, 2021, and October 15, 2022. Twenty-two patients were diagnosed with MIS-C, following CDC diagnostic criteria for MIS-C. We reviewed medical records for clinical features, laboratory findings, and echocardiography. RESULTS Age, height, and weight were higher for patients with MIS-C than for those with KD. Lymphocytes percentage was lower, and the segmented neutrophil percentage was higher in the MIS-C group. The inflammation marker C-reactive protein was higher in the MIS-C group. Prothrombin time was prolonged in the MIS-C group. Albumin level was lower in the MIS-C group. The MIS-C group had lower potassium, phosphorus, chloride, and total calcium. Twenty-five percent of patients diagnosed with MIS-C had positive RT-PCR, and all the patients were N-type SARS-CoV-2 antibody-positive. Albumin ≤3.85 g/dl effectively predicted MIS-C. Regarding echocardiography, the right coronary artery z-score, the absolute value of apical 4-chamber left ventricle longitudinal strain, and the ejection fraction (EF) was significantly lower in the MIS-C group. A month after diagnosis using echocardiographic data, all coronary artery z-scores had reduced significantly. EF and fractional shortening (FS) also improved one month after diagnosis. CONCLUSION Albumin values can differentiate MIS-C and KD. In addition, a decrease in the absolute LV longitudinal strain value, EF, and FS was observed in the MIS-C group using echocardiography. Coronary artery dilatation was not evident at the initial diagnosis; however, a change in coronary artery size, EF, and FS was observed on follow-up echocardiography a month after diagnosis.
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Affiliation(s)
- Sung Doo You
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
| | - Jin Ho Kim
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea
| | - Jihye You
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
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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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Effect of the COVID-19 outbreak on emergency transport of children by an emergency medical service system: a population-based, ORION registry study. BMC Emerg Med 2022; 22:206. [PMID: 36539698 PMCID: PMC9767795 DOI: 10.1186/s12873-022-00765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has spread rapidly around the world. OBJECTIVE To assess the effect of the COVID-19 pandemic on the emergency medical service (EMS) and hospital admission course for children transported by ambulance. METHODS This study was a retrospective, descriptive study with a study period from January 1, 2018 to December 31, 2020 using the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. All children who were transported by ambulance in Osaka Prefecture were included. The main outcome of this study was the rate of difficult-to-transfer cases, which was calculated by univariate and multivariate Poisson regression analyses. RESULTS Over the 3 years between January 1, 2018 and December 31 2020, 1,436,212 patients were transported to hospitals by ambulances in Osaka Prefecture, with children accounting for 102,473 (37,064, 39,590, and 25,819, in 2018, 2019, and 2020, respectively). Poisson regression analysis showed that children were negatively associated with difficult-to-transfer cases (risk ratio (RR) 0.35, 95% CI 0.33 to 0.37). With reference to 2018, 2020 was not significantly associated with difficult-to-transfer cases in children (RR 1.14, 95% CI 0.99 to 1.32, P = 0.075), but was significantly related (RR 1.24, 95% CI 1.21 to 1.27, P < 0.001) to difficult-to-transfer cases in the general population. CONCLUSION Children were consistently associated with a reduced RR for difficult-to-transfer cases, even in the COVID-19 pandemic in 2020.
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Schwartz BN, Harahsheh AS, Krishnan A, Martin GR. Cardiac Effects of COVID-19 Infection, MIS-C, and the Vaccine in Infants and Children: What Is Known and Future Implications. Am J Perinatol 2022; 39:S1-S6. [PMID: 36307093 DOI: 10.1055/s-0042-1757238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The cardiac effects of novel coronavirus disease 2019 (COVID-19) infection on the pediatric heart has become an area of particular interest as elevated cardiac enzymes and abnormalities on echocardiogram and electrocardiogram were seen in a portion of children affected by the virus. In this article, we review the cardiac manifestations of acute COVID-19 infection, multisystem inflammatory syndrome in children, and postvaccine myocarditis. The limited research on the effects of COVID-19 on neonates and infants is also reported. KEY POINTS: · Cardiac involvement from MIS-C is much higher than the risk of COVID-19 vaccine-induced myocarditis.. · Neonates and infants have overall been less affected by COVID-19 than adults and older children.. · At this point in time, there is limited research on the cardiac effects of COVID-19 in neonates..
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Affiliation(s)
- Bryanna N Schwartz
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Ashraf S Harahsheh
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anita Krishnan
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Gerard R Martin
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Management of Multisystem Inflammatory Syndrome in Children: Decision-Making Regarding a New Condition in the Absence of Clinical Trial Data. Can J Cardiol 2022:S0828-282X(22)01048-0. [PMID: 36455760 PMCID: PMC9705008 DOI: 10.1016/j.cjca.2022.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a new illness that evolved during the COVID-19 pandemic with initial reports of severe disease including use of extracorporeal membrane oxygenation and death. Institutions rapidly assembled task forces to develop treatment algorithms. At the national/international levels, collaboratives and associations assembled consensus writing groups to draft guidelines. These guidelines and algorithms were initially on the basis of expert opinion and small case series. Some groups used the Delphi approach, and the resultant guidelines often mimicked those for other conditions that resembled MIS-C, like Kawasaki disease (KD). For instance, intravenous immunoglobulin (IVIG), a known effective treatment for KD, was recommended for MIS-C. Early in the pandemic many favoured IVIG over steroids as first-line therapy. As evidence evolved so did some guidelines, which now endorse the dual use of IVIG with steroids as first-line therapy. In contrast, withholding immunotherapy became an option for some MIS-C patients with mild symptoms. Herein, we review guidelines and discuss the evidence informing early recommendations, how this has evolved, the role and limitations of expert opinion and observational data, and the importance of leveraging existing research infrastructures, such as the intensive care unit collaborative (Overcoming COVID-19 surveillance registry), and the International Kawasaki Disease Registry. Finally, we discuss strategies to rapidly develop, deploy, and adapt clinical trials evaluating the treatment of such rare conditions in children, which might include alternatives to conventional clinical trial design. The emergence of MIS-C during the COVID-19 pandemic has highlighted unmet needs regarding research of a new condition.
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14
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Cardiovascular injury and clinical features of multisystem inflammatory syndrome in children (MIS-C) related to Covid-19 in Vietnam. Pediatr Neonatol 2022; 63:569-574. [PMID: 35871994 PMCID: PMC9262642 DOI: 10.1016/j.pedneo.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aimed to describe the cardiovascular injury and clinical features of multisystem inflammatory syndrome in children (MIS-C) related to coronavirus disease 2019 (COVID-19) in Ho Chi Minh City, Vietnam. METHODS This was a retrospective cohort study of children with MIS-C (from September 1, 2021 to February 28, 2022) in Children's Hospital 1, Ho Chi Minh City. Demographics, clinical history, significant underlying conditions, clinical manifestations, laboratory investigations, and medical management were analyzed. RESULTS A total of 76 patients were included (median age, 5.9 years old, 2 months-16 years). The male/female ratio was 1.6/1. Most patients (75/76) had no previous medical conditions. The mean time from acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to symptom onset was 39 days. During an acute SARS-CoV-2 infection, these patients are either asymptomatic or mildly symptomatic. In addition to fever, gastrointestinal symptoms were also prominent, as observed in our study, with 75%, 73.7%, and 72.3% of patients presenting with abdominal pain, vomiting, and loose stools, respectively. The levels of inflammatory markers increased upon admission and returned to normal levels after treatment. Echocardiography revealed decreased myocardial contractility and coronary injury in 16 (21.1%) and 32 (42.1%) patients, respectively. Most cases (72/76) had no fever within 3 days of intravenous immunoglobulin (IVIG) and methylprednisolone treatment. No deaths occurred in this study. The mean duration of hospitalization was 7.2 days. CONCLUSION Cardiovascular involvement was observed in approximately 53.9% of the patients. Anti-inflammatory treatment with IVIG and methylprednisolone had a favorable short-term outcome. However, long-term follow-up studies on post-discharge MIS-C cases are needed to make appropriate treatment recommendations in the acute phase.
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15
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Hillegass E, Lukaszewicz K, Puthoff M. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022. Phys Ther 2022; 102:6585463. [PMID: 35567347 DOI: 10.1093/ptj/pzac057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key action statements (KAS), including guidance on upper extremity DVT, pulmonary embolism, and special populations. This document will guide physical therapist practice in the prevention of and screening for VTE and in the management of patients who are at risk for or who have been diagnosed with VTE. Through a systematic review of published studies and a structured appraisal process, KAS were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms based on the KAS were developed that can assist with clinical decision-making. Physical therapists, along with other members of the health care team, should implement these KAS to decrease the incidence of VTE, improve the diagnosis and acute management of VTE, and reduce the long-term complications of VTE.
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Affiliation(s)
- Ellen Hillegass
- Department of Physical Therapy, Mercer University, Atlanta, Georgia, USA
| | | | - Michael Puthoff
- Physical Therapy Department, St Ambrose University, Davenport, Iowa, USA
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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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Arab Y, Choueiter N, Dahdah N, El-Kholy N, Abu Al-Saoud SY, Abu-Shukair ME, Agha HM, Al-Saloos H, Al Senaidi KS, Alzyoud R, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, ELrugige N, Fitouri Z, Ladj MS, Mouawad P, Salih AF, Rojas RG, Harahsheh AS. Kawasaki Disease Arab Initiative [Kawarabi]: Establishment and Results of a Multicenter Survey. Pediatr Cardiol 2022; 43:1239-1246. [PMID: 35624313 PMCID: PMC9140321 DOI: 10.1007/s00246-022-02844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Studies on Kawasaki disease (KD) in Arab countries are scarce, often providing incomplete data. This along with the benefits of multicenter research collaboratives led to the creation of the KD Arab Initiative [Kawarabi] consortium. An anonymous survey was completed among potential collaborative Arab medical institutions to assess burden of KD in those countries and resources available to physicians. An online 32-item survey was distributed to participating institutions after conducting face validity. One survey per institution was collected. Nineteen physicians from 12 countries completed the survey representing 19 out of 20 institutions (response rate of 95%). Fifteen (79%) institutions referred to the 2017 American Heart Association guidelines when managing a patient with KD. Intravenous immunoglobulin (IVIG) is not readily available at 2 institutions (11%) yet available in the country. In one center (5%), IVIG is imported on-demand. The knowledge and awareness among countries' general population was graded (0 to 10) at median/interquartiles (IQR) 3 (2-5) and at median/IQR 7 (6-8) in the medical community outside their institution. Practice variations in KD management and treatment across Arab countries require solid proactive collaboration. The low awareness and knowledge estimates about KD among the general population contrasted with a high level among the medical community. The Kawarabi collaborative will offer a platform to assess disease burden of KD, among Arab population, decrease practice variation and foster population-based knowledge.
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Affiliation(s)
- Yousra Arab
- University of Sherbrooke, Sherbrooke, QC Canada
| | - Nadine Choueiter
- Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Nermeen El-Kholy
- Pediatric Cardiology Department, AlJalila Children’s Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sima Y. Abu Al-Saoud
- Department of Pediatrics, Makassed Hospital, Faculty of Medicine, Al- Quds University, East-Jerusalem, Palestine
| | | | - Hala M. Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | | | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, Amman, Jordan
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Mona M. El Ganzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M. Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Najat ELrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, 1007 Djebel Lakhedher Bab Saadoun, Tunis, Tunisia
| | - Mohamed S. Ladj
- Pediatric Department, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F. Salih
- Pediatric Cardiology Department/Children’s Heart Hospital- Sulaimani College of Medicine- Sulaimani University, Al-Sulaimaniyah, Iraq
| | - Rocio G. Rojas
- Clinical Research Program, Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC H3T 1C5 Canada
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC 20010 USA
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Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children. Cardiol Young 2022; 32:718-726. [PMID: 34348808 PMCID: PMC8816963 DOI: 10.1017/s1047951121003024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. OBJECTIVES To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. METHODS Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher's exact, and Wilcoxon rank sum. RESULTS Thirty-nine children with median (interquartile range) age 7.8 (3.6-12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26-61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). CONCLUSION Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.
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Harahsheh AS. Kawasaki Disease Outcomes: It's Not Just the Heart! Hosp Pediatr 2022; 12:e110-e112. [PMID: 35102392 DOI: 10.1542/hpeds.2021-006466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Bonilla Gonzalez C, Hincapié Echeverría M, Plazas Pachón R, Mora Umaña P, Diaz Gómez BL, Gualdron Barreto N. Case Report: Fatal Acute Liver Failure With Giant Cell Transformation in a Pediatric Patient Associated With MIS-C. Front Pediatr 2022; 9:780258. [PMID: 35127589 PMCID: PMC8815702 DOI: 10.3389/fped.2021.780258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: We describe the first pediatric case of a 10-month-old boy with MIS-C who developed fulminant acute liver failure with associated giant cell transformation and a fatal outcome, after ruling out other infectious, metabolic, genetic, and autoimmune causes of liver failure following the usual algorithms for approaching the etiology. Although the patient received the main treatment strategies for liver failure, he had a fatal outcome. A clinical autopsy was considered as part of the diagnostic approach, which showed evidence of giant cell transformation.
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Affiliation(s)
- Carolina Bonilla Gonzalez
- Pediatric Intensive Care Unit, Department of Pediatrics, Fundación Santafe of Bogotá, Bogotá, Colombia
| | | | - Rocio Plazas Pachón
- Pediatric Residents Andes University, Fundación Santafe of Bogotá, Bogotá, Colombia
| | - Paola Mora Umaña
- Pediatric Residents Andes University, Fundación Santafe of Bogotá, Bogotá, Colombia
| | | | - Nathalie Gualdron Barreto
- Pediatric Intensive Care Unit, Department of Pediatrics, Fundación Santafe of Bogotá, Bogotá, Colombia
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21
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Harahsheh AS, Sharron MP, Bost JE, Ansusinha E, Wessel D, DeBiasi RL. Comparison of First and Second Wave Cohorts of Multisystem Inflammatory Disease Syndrome IN Children. Pediatr Infect Dis J 2022; 41:e21-e25. [PMID: 34889874 PMCID: PMC8658056 DOI: 10.1097/inf.0000000000003388] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
Comparing first and second wave MIS-C cohorts at our quaternary pediatric institution, second wave were older, presented more frequently with shortness of breath, higher maximum troponin and N-terminal BNP, and more frequently required advanced respiratory and inotropic support. Despite increased severity in the second cohort, both cohorts had similar rates of coronary artery abnormalities, systolic dysfunction, and length of stay.
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Affiliation(s)
- Ashraf S. Harahsheh
- From the Division of Cardiology, Children’s National Hospital, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Matthew P. Sharron
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
- Division of Critical Care Medicine
| | - James E. Bost
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
- Division of Biostatistics
| | - Emily Ansusinha
- Division of Infectious Diseases, Children’s National Hospital, Washington, DC
| | - David Wessel
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
- Division of Critical Care Medicine
| | - Roberta L. DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
- Division of Infectious Diseases, Children’s National Hospital, Washington, DC
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC
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22
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Zhou C, Zhao Y, Wang X, Huang Y, Tang X, Tang L. Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease. Pediatr Pulmonol 2021; 56:3688-3698. [PMID: 34583417 DOI: 10.1002/ppul.25687] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/26/2021] [Accepted: 09/18/2021] [Indexed: 12/19/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers, and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels. In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and erythrocyte sedimentation rate (ESR). In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of N-terminal pro-brain natriuretic peptide, troponin and aspartate aminotransferase were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and alanine aminotransferase and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.
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Affiliation(s)
- Chunling Zhou
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Yan Zhao
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Xia Wang
- Department of Pediatrics, Chongqing Youyoubaobei Women and Children's Hospital, Chongqing, China
| | - Ying Huang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuewen Tang
- Department of Cardiology, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Lei Tang
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
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23
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Ganguly M, Nandi A, Banerjee P, Gupta P, Sarkar SD, Basu S, Pal P. A comparative study of IL-6, CRP and NT-proBNP levels in post-COVID multisystem inflammatory syndrome in children (MISC) and Kawasaki disease patients. Int J Rheum Dis 2021; 25:27-31. [PMID: 34750969 PMCID: PMC8652561 DOI: 10.1111/1756-185x.14236] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
Background Post‐COVID multisystem hyperinflammatory syndrome in children (MISC) has clinical and laboratory similarities with Kawasaki disease (KD). Inflammatory markers like C‐reactive protein (CRP), interleukin 6 (IL6) as well as N‐terminal probrain natriuretic peptide (NT‐proBNP) are elevated in both. This study attempts a comparative analysis of the 3 markers in an attempt at early differentiation for planning appropriate management. Methodology This analytical study conducted at the Institute of Child Health, Kolkata, India compared the levels of the above 3 markers at admission between 72 patients with KD, 30% of whom had coronary artery lesions (CALs) collected over a period of 18 months (Jan 2017‐June 2018), with 71 MISC patients over a period of 6 months (July 2020‐December 2020). The non‐parametric Mann‐Whitney U test was used to test for similarity in distributions of the samples of CRP, NT‐proBNP and IL6 in KD and MISC patients using correction factor for similar ranks. The 3 parameters were compared using receiver operating characteristic (ROC) curve analysis. Results Mean IL6 value in KD was 83.22 pg/mL and in MISC 199.91 pg/mL, which was not found to be statistically significant (P = .322 > .05).However mean NT‐proBNP (914.91 pg/mL) with CRP level (96.32 mg/L) in KD was significantly lower (P < .05 for both cases) than that in MISC (9141.16 pg/mL and 145.66 mg/L respectively). ROC analysis showed NT‐proBNP has the best sensitivity and specificity in predicting MISC. Conclusion NT‐proBNP and CRP are significantly higher among MISC patients; ROC analysis shows levels >935.7 pg/mL and >99.55 mg/L respectively might act as a guide to differentiate between them.
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Affiliation(s)
- Mimi Ganguly
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, India
| | - Alolika Nandi
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, India
| | - Paramita Banerjee
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, India
| | - Purbasha Gupta
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, India
| | | | - Surupa Basu
- Department of Biochemistry, Institute of Child Health, Kolkata, India
| | - Priyankar Pal
- Department of Pediatric Rheumatology, Institute of Child Health, Kolkata, India
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24
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Arízaga-Ballesteros V, Gutierrez-Mendoza MA, Villanueva-Sugishima KR, Santos-Guzmán J. Pediatric Inflammatory Multisystem Syndrome or Multisystem Inflammatory Syndrome in Children: A New Thread in Pandemic Era. Glob Pediatr Health 2021; 8:2333794X211050311. [PMID: 34734104 PMCID: PMC8559205 DOI: 10.1177/2333794x211050311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
After the perturbing effects of the COVID-19 Pandemic, we observed intense public health efforts in a global-scale to prevent, control, and treat the SARS-CoV-2. Hundreds of clinical center researched for adequate treatments, other were devoted to the development the COVID-19 vaccines and other studied the nature and the effects of this mutant coronavirus SARS-CoV-2. As time goes by, the pediatric inflammatory multisystem syndrome has been recently defined and associated the COVID-19 past infection and is now considered a shot to middle-term complication of COVID-19. In this paper, we review the actual concepts of PIMS in children, the epidemiology, the clinical presentation, and evolution, the recommended laboratory and other testing. The recommended specialties interconsultation for hospitalized patients and a full discussion on the appropriate treatment of these patients. We include the Latin-American experience with PIMS and a final discussion on the outcome of this disease.
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25
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Kline JN, Isbey SC, McCollum NL, Falk MJ, Gutierrez CE, Guse SE, Harahsheh AS, Brown KM, Chamberlain JM, Breslin KA. Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency department. Am J Emerg Med 2021; 51:69-75. [PMID: 34688203 DOI: 10.1016/j.ajem.2021.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/07/2021] [Accepted: 10/04/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare clinical and laboratory features of children with Multisystem Inflammatory Syndrome in Children (MIS-C) to those evaluated for MIS-C in the Emergency Department (ED). METHODS We conducted a retrospective review of the medical record of encounters with testing for inflammatory markers in an urban, tertiary care Pediatric ED from March 1, 2020 to July 31, 2020. We abstracted demographic information, laboratory values, selected medications and diagnoses. We reviewed the record for clinical presentation for the subset of patients admitted to the hospital for suspected MIS-C. We then used receiver operating curves and logistic regression to evaluate the utility of candidate laboratory values to predict MIS-C status. RESULTS We identified 32 patients with confirmed MIS-C and 15 admitted and evaluated for MIS-C but without confirmation of SARS CoV-2 infection. We compared these patients to 267 encounters with screening laboratories for MIS-C. Confirmed MIS-C patients had an older median age, higher median fever on presentation and were predominantly of Hispanic and non-Hispanic Black race/ethnicity. All children with MIS-C had a C-reactive protein (CRP) >4.5 mg/dL, were more likely to have Brain Natriuretic Peptide >400 pg/mL (OR 10.50, 95%CI 4.40-25.04), D-Dimer >3 μg/mL (7.51, [3.18-17.73]), and absolute lymphocyte count (ALC) <1.5 K/mcL (21.42, [7.19-63.76]). We found CRP >4.5 mg/dL and ALC <1.5 K/mcL to be 86% sensitive and 91% specific to identify MIS-C among patients screened in our population. CONCLUSIONS We identified that elevated CRP and lymphopenia was 86% sensitive and 91% specific for identification of children with MIS-C.
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Affiliation(s)
- Jaclyn N Kline
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Sarah C Isbey
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Nichole L McCollum
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Michael J Falk
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Camilo E Gutierrez
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Sabrina E Guse
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Ashraf S Harahsheh
- Division of Cardiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
| | - Kristen A Breslin
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
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26
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Hejazi OI, Loke YH, Harahsheh AS. Short-term Cardiovascular Complications of Multi-system Inflammatory Syndrome in Children (MIS-C) in Adolescents and Children. CURRENT PEDIATRICS REPORTS 2021; 9:93-103. [PMID: 34703656 PMCID: PMC8531914 DOI: 10.1007/s40124-021-00258-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review We provide the readers with a review of cardiac complications in children with multi-system inflammatory syndrome in children (MIS-C) and its short-term outcomes. Recent Findings Recent reports described the acute cardiac manifestations of MIS-C in children and provided a glimpse of the short-term outcomes. Summary Children with MIS-C have been reported to acutely have variable degrees of cardiac findings including abnormal cardiac enzymes, abnormal electrocardiographs, decreased systolic function, coronary artery abnormalities from coronary dilation to giant aneurysms, mitral valve regurgitation, tricuspid valve regurgitation, aortic valve insufficiency, pericardial effusion, diastolic dysfunction, abnormal cardiac strain, and abnormal cardiac MRI. The majority of these abnormalities resolved during short-term follow-up. Further studies are needed to assess if transient or persistent cardiac complications are associated with long-term adverse cardiac events in children with MIS-C. Supplementary Information The online version contains supplementary material available at 10.1007/s40124-021-00258-5.
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Affiliation(s)
- Omar I Hejazi
- School of Medicine, University of Jordan, Amman, Jordan
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC 20010 USA.,Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC 20052 USA
| | - Ashraf S Harahsheh
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC 20010 USA.,Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC 20052 USA
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27
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Multisystem Inflammatory Syndrome of Children: Subphenotypes, Risk Factors, Biomarkers, Cytokine Profiles, and Viral Sequencing. J Pediatr 2021; 237:125-135.e18. [PMID: 34181987 DOI: 10.1016/j.jpeds.2021.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess demographic, clinical, and biomarker features distinguishing patients with multisystem inflammatory syndrome in children (MIS-C); compare MIS-C sub-phenotypes; identify cytokine biosignatures; and characterize viral genome sequences. STUDY DESIGN We performed a prospective observational cohort study of 124 children hospitalized and treated under the institutional MIS-C Task Force protocol from March to September 2020 at Children's National, a quaternary freestanding children's hospital in Washington, DC. Of this cohort, 63 of the patients had the diagnosis of MIS-C (39 confirmed, 24 probable) and 61 were from the same cohort of admitted patients who subsequently had an alternative diagnosis (controls). RESULTS Median age and sex were similar between MIS-C and controls. Black (46%) and Latino (35%) children were over-represented in the MIS-C cohort, with Black children at greatest risk (OR 4.62, 95% CI 1.151-14.10; P = .007). Cardiac complications were more frequent in critically ill patients with MIS-C (55% vs 28%; P = .04) including systolic myocardial dysfunction (39% vs 3%; P = .001) and valvular regurgitation (33% vs 7%; P = .01). Median cycle threshold was 31.8 (27.95-35.1 IQR) in MIS-C cases, significantly greater (indicating lower viral load) than in primary severe acute respiratory syndrome coronavirus 2 infection. Cytokines soluble interleukin 2 receptor, interleukin [IL]-10, and IL-6 were greater in patients with MIS-C compared with controls. Cytokine analysis revealed subphenotype differences between critically ill vs noncritically ill (IL-2, soluble interleukin 2 receptor, IL-10, IL-6); polymerase chain reaction positive vs negative (tumor necrosis factor-α, IL-10, IL-6); and presence vs absence of cardiac abnormalities (IL-17). Phylogenetic analysis of viral genome sequences revealed predominance of GH clade originating in Europe, with no differences comparing patients with MIS-C with patients with primary coronavirus disease 19. Treatment was well tolerated, and no children died. CONCLUSIONS This study establishes a well-characterized large cohort of MIS-C evaluated and treated following a standardized protocol and identifies key clinical, biomarker, cytokine, viral load, and sequencing features. Long-term follow-up will provide opportunity for future insights into MIS-C and its sequelae.
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28
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Kawasaki Disease Shock Syndrome vs Classical Kawasaki Disease: A Meta-analysis and Comparison With SARS-CoV-2 Multisystem Inflammatory Syndrome. Can J Cardiol 2021; 37:1619-1628. [PMID: 34090979 PMCID: PMC8180353 DOI: 10.1016/j.cjca.2021.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The emergence of increasing reports worldwide of a severe inflammatory process and shock in pediatric patients resembling Kawasaki disease (KD)-and, more specifically, Kawasaki disease shock syndrome (KDSS)-prompted us to explore KDSS in a preamble of a systematic comparison between the 2 conditions. METHODS We completed a systematic review of KDSS and performed a meta-analysis comparison between reported KDSS cases and KD controls. RESULTS A total of 10 case-control series were included in the meta-analysis. Patients with KDSS were older (38.4 ± 30.6 vs 21.9 ± 19.5 months; P < 0.001) compared with standard KD with equal sex distribution and completeness of clinical diagnostic criteria. KDSS present higher C-reactive protein (59.4 ± 29.2 mg/dL vs 20.8 ± 14.8 mg/dL; P < 0.001), lower albumin (2.7 ± 0.5 g/dL vs 3.3 ± 0.5 g/dL; P < 0.01), and lower platelets (255 ± 149 109/L vs 394 ± 132 109/L; P < 0.001) but only borderline higher white blood cells (P = 0.06). Differences in alanine transaminase, aspartate aminotransferase, and erythrocyte sedimentation rate were nonsignificant. The odds of intravenous immunoglobulin resistance (44.4% vs 9.6%; (P < 0.001) and the hospital length of stay (10.9 ± 5.8 vs 5.0 ± 3.0 days; P < 0.001) were higher in KDSS, as were the odds of coronary-artery abnormalities (33.9% vs 8.6%; P < 0.001). CONCLUSIONS This first meta-analysis on KDSS vs KD represents a basis for future works on KDSS and opens the opportunity for future multicentre studies in the search of causal relationships between presenting elements and the eventual complications of KDSS. The similarities between SARS-CoV-2 multisystem inflammatory syndrome in children and KDSS open new horizons to the understanding of the etiology and pathophysiology related to KDSS.
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29
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Waseem M, Shariff MA, Tay ET, Mortel D, Savadkar S, Lee H, Kondamudi N, Liang T. Multisystem Inflammatory Syndrome in Children. J Emerg Med 2021; 62:28-37. [PMID: 34538678 PMCID: PMC8445772 DOI: 10.1016/j.jemermed.2021.07.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 12/15/2022]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is a newly recognized condition affecting children with recent infection or exposure to coronavirus disease 2019 (COVID-19). MIS-C has symptoms that affect multiple organs systems, with some clinical features resembling Kawasaki disease (KD) and toxic shock syndrome (TSS). Objective of the Review Our goal was to review the current literature and describe the evaluation and treatment algorithms for children suspected of having MIS-C who present to the emergency department. Discussion MIS-C has a wide clinical spectrum and diagnosis is based on a combination of both clinical and laboratory findings. The exact mechanism of immune dysregulation of MIS-C is not well understood. Physical findings may evolve and do not necessarily appear at the same time. Gastrointestinal, cardiac, inflammatory, and coagulopathy manifestations and dysfunction are seen frequently in MIS-C. Conclusions The diagnosis of MIS-C is based on clinical presentation and specific laboratory findings. In the emergency setting, a high level of suspicion for MIS-C is required in patients exposed to COVID-19. Early diagnosis and prompt initiation of therapy offer the best chance for optimal outcomes.
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Affiliation(s)
- Muhammad Waseem
- Department of Emergency Medicine, NYC Health + Hospitals/Lincoln, Bronx, New York; Weill Cornell Medicine New York and New York Medical College, Valhalla, New York.
| | - Masood A Shariff
- Department of Emergency Medicine, NYC Health + Hospitals/Lincoln, Bronx, New York
| | - Ee Tein Tay
- Department of Emergency Medicine, NYU Langone Health/Bellevue Hospital Center, New York, New York
| | - David Mortel
- Department of Emergency Medicine, Harlem Hospital, New York, New York
| | - Shivraj Savadkar
- Department of Emergency Medicine, Harlem Hospital, New York, New York
| | - Horton Lee
- Department of Emergency Medicine-Pediatrics, NYC Health + Hospitals/Elmhurst Hospital, Queens, New York
| | - Noah Kondamudi
- Department of Pediatrics, The Brooklyn Hospital Center, Brooklyn, New York
| | - Tian Liang
- Department of Emergency Medicine, NYU Langone Health/Bellevue Hospital Center, New York, New York
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30
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Gosnell HL, Grider DJ. Urticarial vasculitis: A potential signpost for multisystem inflammatory syndrome in children. J Cutan Pathol 2021; 49:163-166. [PMID: 34523756 DOI: 10.1111/cup.14134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare and serious complication of Sars-Cov-2 infection. Dermatologic manifestations are present in the majority of patients. Skin lesions found in children with MIS-C are classified into four categories: morbilliform, reticulated, scarlatiniform, and urticarial lesions. Clinicopathologic characterization within these categories is limited. Thus, we present a clear example of an urticarial lesion in the context of MIS-C with well-documented clinicopathologic phenomena. A previously healthy 16-year-old female presented with 3 weeks of an itchy, burning rash initially presenting on her right forearm (and lasting greater than 24 hours without migration) before spreading diffusely. She also reported fever, cough, myalgias, nausea, and vomiting of 4 weeks' duration. Physical examination revealed an edematous, maculopapular, nonblanching, erythematous rash covering the patient's upper extremities, abdomen, back, anterior thighs, and face. The patient tested positive for COVID-19. A low-grade leukocytoclastic vasculitis was noted along with intraluminal fibrin and rare microthrombi in vessels of the mid to deep dermis. The patient was diagnosed with MIS-C and urticarial vasculitis. She was treated with steroids and naproxen for subsequent MIS-C flares. Dapsone treatment was started for the urticarial vasculitis.
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Affiliation(s)
- Hailey L Gosnell
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Douglas J Grider
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA.,Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA
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31
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Türe M, Kan A, Akın A, Yılmaz K, Şen V. Multisystem inflammatory syndrome in children: A single-center experience. Pediatr Int 2021; 63:1062-1068. [PMID: 34227711 DOI: 10.1111/ped.14742] [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: 02/15/2021] [Revised: 03/28/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This case series aims to evaluate the presenting symptoms, laboratory data, systemic findings, and response to early treatment in patients who were followed up with the diagnosis of multisystemic inflammatory syndrome associated with novel coronavirus disease 2019 (COVID-19). METHODS The presentation, laboratory findings, and responses to treatment of patients hospitalized and diagnosed with multisystemic inflammatory syndrome were evaluated retrospectively. RESULTS A total of 32 patients were included in the study. The median age was 90 (1.5-204) months and 62.5% of the patients were male; 59.4% of the cases were non-specific disease, 31.2% typical (complete) Kawasaki, and 9.4% had phenotypic characteristics of atypical (incomplete) Kawasaki. Most of the patients were found to have low albumin and elevated C-reactive protein, sedimentation rate, and d-dimer, and all patients had elevated N-terminal pro-B-type natriuretic peptide, and procalcitonin. Lymphopenia was detected in 25 patients (78.1%) and serum ferritin levels were elevated in 25 patients (78.1%). Eleven (34.4%) patients responded well only to intravenous immunoglobulin treatment. Twenty patients (62.5%) received intravenous immunoglobulin and steroid therapy (second-line therapy). Only one patient (3.1%) received third-line therapy (intravenous immunoglobulin + steroid +anakinra + plasmapheresis). None of the patients died. CONCLUSIONS Most patients had mild clinical symptoms and responded well to intravenous immunoglobulin and / or steroid therapies as first- and second-line therapies. Only one of our patients was clinically stabilized after third-line treatment because he did not respond to intravenous immunoglobulin and steroid therapy. We think that all of our patients diagnosed with multisystem inflammatory syndrome in children recovered because we had recommended quickly medical intervention. Treatment should therefore be started immediately in patients diagnosed with multisystem inflammatory syndrome in children. If there is no response after 24 h to the initial treatment, the next treatment protocol should be started.
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Affiliation(s)
- Mehmet Türe
- Department of Pediatric Cardiology, Dicle University Hospital, Diyarbakır, Turkey
| | - Ahmet Kan
- Department of Pediatric allergy and immunology, Dicle University Hospital, Diyarbakır, Turkey
| | - Alper Akın
- Department of Pediatric Cardiology, Dicle University Hospital, Diyarbakır, Turkey
| | - Kamil Yılmaz
- Department of Pediatrics, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Velat Şen
- Department of Pediatrics, Dicle University Medical Faculty, Diyarbakır, Turkey
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Cardiac Manifestations in COVID-19 Patients: A Focus on the Pediatric Population. ACTA ACUST UNITED AC 2021; 2021:5518979. [PMID: 34326911 PMCID: PMC8287458 DOI: 10.1155/2021/5518979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Background SARS-CoV-2 is a new strain of the coronavirus family that emerged by the end of 2019 and led to the unpreceded COVID-19 pandemic. The virus affects multiple organs simultaneously and leads to a high rate of morbidity and mortality in all age groups. The cardiovascular system is one of the major affected organ systems. Various mechanisms including direct myocardial injury contribute to the cardiac manifestations of COVID-19 patients. Methods We performed a comprehensive and updated search on the cardiac manifestations of COVID-19. Our search included laboratory and imaging evaluations. In addition, we added a unique section on the effect of SARS-CoV-2 on the cardiovascular system in the pediatric population. Results COVID-19 might have an effect on the cardiovascular system at various levels leading to myocardial ischemia, arrhythmia, heart failure, myocarditis, and multisystem inflammatory syndrome in children. The incidence of cardiovascular complications varies among patients. This paper also provides a comprehensive summary of all the reported pediatric cases with cardiac manifestations. Conclusion Multidisciplinary teams are crucial for adequate management of patients with COVID-19 regardless of age. Timely diagnosis is critical in reducing mortality.
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Bukulmez H. Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease. Curr Rheumatol Rep 2021; 23:58. [PMID: 34216296 PMCID: PMC8254432 DOI: 10.1007/s11926-021-01028-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this article, I have reviewed current reports that explore differences and similarities between multisystem inflammatory syndrome in children (MIS-C) and other known multisystem inflammatory diseases seen in children, particularly Kawasaki disease. RECENT FINDINGS Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a human coronavirus causing the COVID-19 disease which emerged in China in December 2019 and spread rapidly to the entire country and quickly to other countries. Currently, there is a pandemic of SARS-CoV-2 infection that results in 20% of patients admitted to hospital with illness, with 3% developing intractable acute respiratory distress syndrome (ARDS) with high mortality. However, pediatric COVID-19 is still reported to be a mild disease, affecting only 8% of children. Pathogenesis in children is comparable to adults. There are suggested impaired activation of IFN-alpha and IFN regulator 3, decreased cell response causing impaired viral defense, yet the clinical course is mild, and almost all children recover from the infection without major complications. Interestingly, there is a subset of patients that develop a late but marked immunogenic response to COVID-19 and develop MIS-C. Clinical features of MIS-C resemble certain pediatric rheumatologic diseases, such as Kawasaki disease (mucocutaneous lymph node syndrome) which affects small-medium vessels. Other features of MIS-C resemble those of macrophage activation syndrome (MAS). However, recent research suggests distinct clinical and laboratory differences between MIS-C, Kawasaki disease, and MAS. Since the start of the SARS-CoV-2 pandemic, MIS-C has become the candidate for the most common cause of acquired heart disease in children.
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Affiliation(s)
- Hulya Bukulmez
- Department of Pediatrics, Division of Pediatric Rheumatology, Metro Health Medical Center, Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
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Aung HH, Nulman O, Nadroo I, Chhabra M. Case Series of Clinical Findings of Multi-System Inflammatory Syndrome in Children in Contrast to Kawasaki Disease. Cureus 2021; 13:e16446. [PMID: 34422477 PMCID: PMC8369860 DOI: 10.7759/cureus.16446] [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] [Accepted: 07/17/2021] [Indexed: 11/05/2022] Open
Abstract
Several months into the coronavirus disease 2019 (COVID-19) pandemic, there is growing concern over an increase in the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-linked Kawasaki-like disease in the pediatric population. The pediatric patients presented to the emergency room with impending shock in the setting of an atypical Kawasaki picture. On May 14, 2020, the CDC Health Alert Network released a case definition for this evolving syndrome and named it multi-system inflammatory syndrome in children (MIS-C). We report three cases of MIS-C associated with SAR-COV2 who presented to our emergency room. Persistent fever was present in all three patients and mucocutaneous and gastrointestinal symptoms were the most common associations. All three patients were found to have antibodies to COVID-19. MIS-C is a similar but distinct entity as compared to Kawasaki disease. High inflammatory markers are supportive of the diagnosis, and cardiac evaluation is crucial in MIS-C. High suspicion for the diagnosis and low threshold for workup will prevent delayed treatment.
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Affiliation(s)
- Htay H Aung
- Pediatric Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Oksana Nulman
- Pediatric Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Iram Nadroo
- Pediatric Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Manoj Chhabra
- Pediatric Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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Ghodsi A, Sarabi M, Malek A, Khakshour A. Current Treatment Guidelines of SARS-CoV-2 Related Multisystem Inflammatory Syndrome in Children: A Literature Review and Expert Opinion. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1731077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractMultisystem inflammatory syndrome in children (MIS-C) is a systemic disorder that seems to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since April 2020, there have been multiple reports about children with this new condition worldwide, including Europe, Asia, Latin America, and North America. The symptoms of this syndrome mimic the clinical manifestations of Kawasaki disease; therefore, the treatment of Kawasaki disease, as well as supportive care, was the management of choice in children with MIS-C in the early days of recognizing it. It is important to precisely ascertain the risk of COVID-19 infection and its severity in children and to acknowledge the management of this syndrome, with reliable data from cohorts, trials, and experts' opinions. In the current review, we summarize the current management guidelines for MIS-C and present our own protocol to answer some clinical questions regarding MIS-C management during the COVID-19 pandemic.
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Affiliation(s)
- Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Sarabi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Malek
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Khakshour
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Hasan MR, Al Zubaidi K, Diab K, Hejazi Y, Bout-Tabaku S, Al-Adba B, Al Maslamani E, Janahi M, Roscoe D, Lopez AP, Tang P. COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar. BMC Pediatr 2021; 21:267. [PMID: 34103044 PMCID: PMC8185322 DOI: 10.1186/s12887-021-02743-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar. METHODS Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed. RESULTS The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70-100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors. CONCLUSIONS Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.
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Affiliation(s)
- Mohammad Rubayet Hasan
- Sidra Medicine, PO BOX 26999, Doha, Qatar. .,Weill Cornell Medical College in Qatar, Doha, Qatar.
| | | | - Karim Diab
- Sidra Medicine, PO BOX 26999, Doha, Qatar
| | | | - Sharon Bout-Tabaku
- Sidra Medicine, PO BOX 26999, Doha, Qatar.,Weill Cornell Medical College in Qatar, Doha, Qatar
| | | | | | | | | | - Andres Perez Lopez
- Sidra Medicine, PO BOX 26999, Doha, Qatar.,Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Patrick Tang
- Sidra Medicine, PO BOX 26999, Doha, Qatar.,Weill Cornell Medical College in Qatar, Doha, Qatar
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Verrotti A, Mazzocchetti C, Iannetti P. Definitive pathognomonic signs and symptoms of paediatric neurological COVID-19 are still emerging. Acta Paediatr 2021; 110:1774-1777. [PMID: 33641209 PMCID: PMC8013208 DOI: 10.1111/apa.15827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/05/2021] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
Children with COVID-19 tend to show milder symptoms than adults during the pandemic, but growing evidence of neurological involvement has emerged. Some studies have reported neurological symptoms in children with COVID-19, which include multisystem inflammatory syndrome, a disease that shares some, but not all, of the characteristics of Kawasaki disease. This review presents, and discusses, the evidence to date. Our initial findings suggest that neurological manifestations can be considered to be the direct result of central nervous system viral invasion or post-infection immuno-mediated disease.
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38
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Tran VL, Parsons S, Nuibe A. The Trilogy of SARS-CoV-2 in Pediatrics (Part 2): Multisystem Inflammatory Syndrome in Children. J Pediatr Pharmacol Ther 2021; 26:318-338. [PMID: 34035676 DOI: 10.5863/1551-6776-26.4.318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) was first recognized as a novel illness in 2020 with manifestations similar to other hyperinflammatory syndromes, such as Kawasaki disease or macrophage activation syndrome. Severity varies from a self-limited febrile illness to shock requiring inotropes and mechanical ventilation. Gastrointestinal symptoms and persistent fevers are the most common clinical symptoms, with the addition of cardiac manifestations inclusive of ventricular dysfunction and coronary artery aneurysms. With no controlled trials or comparative effectiveness studies evaluating treatment of MIS-C to date, current treatment with immunomodulatory agents has mainly been derived from previous experience treating Kawasaki disease. This article provides a comprehensive review summarizing published data for the evaluation and management of MIS-C, with a focus on pharmacotherapy treatment considerations.
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39
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Iughetti L. Pediatric inflammatory multisystem disease in children with COVID-19 - Reply. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021017. [PMID: 33988157 PMCID: PMC8182617 DOI: 10.23750/abm.v92i2.10801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Lorenzo Iughetti
- Pediatric Unit, Departmente of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia.
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40
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Alkan G, Sert A, Oz SKT, Emiroglu M, Yılmaz R. Clinical features and outcome of MIS-C patients: an experience from Central Anatolia. Clin Rheumatol 2021; 40:4179-4189. [PMID: 33956250 PMCID: PMC8100744 DOI: 10.1007/s10067-021-05754-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/16/2022]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is a new clinical condition characterized by signs of inflammation and multiorgan dysfunction due to cytokine storm associated with SARS-CoV-2. The clinical spectrum of MIS-C ranges from mild to severe, and even to mortal multisystem involvement. To guide clinicians, we evaluated detailed demographic characteristics, clinical features, laboratory findings, and outcomes of MIS-C cases. Methods We performed a retrospective study of patients with MIS-C who were managed in the Department of Pediatric Infectious Disease in the Selcuk University Faculty of Medicine, Konya, Turkey. MIS-C patients were divided into three clinical severity groups (mild, moderate, and severe) and separated into three age groups (< 5 years, 5–10 years, > 10 years). We compared the characteristics of MIS-C cases according to the severity of the disease and by age groups. Result Thirty-six children with MIS-C were evaluated (52.8% male, median age of 7.8 years). A clinical spectrum overlapping with Kawasaki disease (KD) was the most common presentation (69.4%) in all age groups. The most common clinical symptoms were fever (100%), mucocutaneous rash (69.4%), and gastrointestinal symptoms (66.6%). There was no statistically significant difference in echocardiographic abnormality between KD-like and the other clinical spectra (p > 0.05). All life-threatening rhythm disturbances were observed in severe cases. No patients died. Conclusion It is important to increase the awareness of physicians about the MIS-C disease, which can present with different combinations of different systemic findings, so that patients can be diagnosed and treated in a timely manner.
Key Points • A single tertiary centre study shows that children with MIS-C can present with different clinic spectra other than Kawasaki diseases. • Electrocardiographic and echocardiographic evaluation is important in early diagnosis of children with MIS-C. • Pro-BNP can be used as a screening test in the emergency room for children with prolonged and unexplained fever for determine early cardiac involvement of MIS-C. • The lack of require biological agents and favourable outcomes in children with MIS-C may be related with administration of steroid therapy with IVIG in early stage of disease. |
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Affiliation(s)
- Gulsum Alkan
- Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Konya, Turkey.
| | - Ahmet Sert
- Department of Pediatric Cardiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Sadiye Kubra Tuter Oz
- Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Melike Emiroglu
- Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Resul Yılmaz
- Department of Pediatric Critical Care, Selcuk University Faculty of Medicine, Konya, Turkey
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Ramphul K, Ramphul Y, Park Y, Lohana P, Dhillon BK, Sombans S. A comprehensive review and update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19): what do we know now in 2021? Arch Med Sci Atheroscler Dis 2021; 6:e5-e13. [PMID: 34027207 PMCID: PMC8117074 DOI: 10.5114/amsad.2021.105065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
It has been more than a year since the new virus called severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China. The disease it causes was named Coronavirus disease 2019 (COVID-19), and on 11 March 2020 it was declared a pandemic. As the virus continues to spread, the number of patients worldwide has already crossed the 100 million mark with more than 2 million deaths. We sought to provide an update on the progress made in identifying the virus, its pathophysiology, risk factors such as hypertension, diabetes, and smoking, as well as various methods of treatment. Our review also provided an overview of the different vaccines.
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Affiliation(s)
- Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yogeshwaree Ramphul
- Department of Medicine, Sir Seewoosagur Ramgoolam National Hospital, Pamplemousses, Mauritius
| | - Yun Park
- Department of Orthodontics, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Petras Lohana
- Department of Medicine, Liaquat University of Medical and Health Sciences Hospital Jamshoro, Pakistan
| | | | - Shaheen Sombans
- Department of Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
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42
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Zhao Y, Yin L, Patel J, Tang L, Huang Y. The inflammatory markers of multisystem inflammatory syndrome in children (MIS-C) and adolescents associated with COVID-19: A meta-analysis. J Med Virol 2021; 93:4358-4369. [PMID: 33739452 PMCID: PMC8250955 DOI: 10.1002/jmv.26951] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022]
Abstract
To conduct a systematic review and meta‐analysis to characterize inflammatory markers in comparisons of multisystem inflammatory syndrome in children (MIS‐C) versus severe/non‐severe COVID‐19, severe MIS‐C versus non‐severe MIS‐C, and among age groups of MIS‐C. Nine databases were searched for studies on inflammatory markers of MIS‐C. After quality checks, data were pooled using a fixed or random effects model. Inflammatory markers included white blood cell count (WBC) or leukocytes, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), platelet count (PLT), C‐reactive protein (CRP), procalcitonin (PCT), ferritin, D‐dimer, lactate dehydrogenase (LDH), fibrinogen, and erythrocyte sedimentation rate (ESR) for comparisons by severity and age. Twenty‐one studies with 1735 participants yielded 787 MIS‐C patients. Compared to non‐severe COVID‐19 patients, MIS‐C patients had lower ALC and higher ANC, CRP, and D‐dimer levels. Compared to severe COVID‐19 patients, MIS‐C patients had lower LDH and PLT counts and higher ESR levels. Severe MIS‐C patients had higher levels of WBC, ANC, CRP, D‐dimer, and ferritin than non‐severe MIS‐C patients. For MIS‐C, younger children (0–5 years) had lower CRP and ferritin levels than middle‐aged/older children/adolescents. Measurement of inflammatory markers might assist clinicians in accurate evaluation and diagnosis of MIS‐C and the associated disorders. To conduct a comprehensive characterization of the inflammatory markers of MIS‐C during the COVID‐19 pandemic. This meta‐analysis summarized the available data and demonstrated significant implications by characterizing the laboratory inflammatory markers of MIS‐C that has widely emerged as a major complication among children with COVID‐19. The results indicated that inflammatory markers, including WBC, ALC, ANC, PLT, CRP, PCT, ferritin, D‐dimer, LDH, fibrinogen, and ESR, were different while comparing MIS‐C versus severe/non‐severe COVID‐19, severe MIS‐C versus non‐severe MIS‐C, and age groups of MIS‐C.
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Affiliation(s)
- Yan Zhao
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Lijuan Yin
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Children's Hospital of Chongqing Medical University, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jenil Patel
- Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA.,Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lei Tang
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Ying Huang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
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Synowiec A, Szczepański A, Barreto-Duran E, Lie LK, Pyrc K. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): a Systemic Infection. Clin Microbiol Rev 2021; 34:e00133-20. [PMID: 33441314 PMCID: PMC7849242 DOI: 10.1128/cmr.00133-20] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To date, seven identified coronaviruses (CoVs) have been found to infect humans; of these, three highly pathogenic variants have emerged in the 21st century. The newest member of this group, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected at the end of 2019 in Hubei province, China. Since then, this novel coronavirus has spread worldwide, causing a pandemic; the respiratory disease caused by the virus is called coronavirus disease 2019 (COVID-19). The clinical presentation ranges from asymptomatic to mild respiratory tract infections and influenza-like illness to severe disease with accompanying lung injury, multiorgan failure, and death. Although the lungs are believed to be the site at which SARS-CoV-2 replicates, infected patients often report other symptoms, suggesting the involvement of the gastrointestinal tract, heart, cardiovascular system, kidneys, and other organs; therefore, the following question arises: is COVID-19 a respiratory or systemic disease? This review aims to summarize existing data on the replication of SARS-CoV-2 in different tissues in both patients and ex vivo models.
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Affiliation(s)
- Aleksandra Synowiec
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Artur Szczepański
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
- Microbiology Department, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Emilia Barreto-Duran
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Laurensius Kevin Lie
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Krzysztof Pyrc
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
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Mahmoud S, Fouda EM, Kotby A, Ibrahim HM, Gamal M, El Gendy YG, Zaky EA, Amr NH, El-Ghoneimy DH, Alsharkawy AA, Omar A, El-Meteini M, Elhodhod M. The "Golden Hours" Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C). Glob Pediatr Health 2021; 8:2333794X21990339. [PMID: 33614843 PMCID: PMC7868488 DOI: 10.1177/2333794x21990339] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/19/2020] [Accepted: 01/04/2021] [Indexed: 01/10/2023] Open
Abstract
The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.
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Affiliation(s)
- Sanaa Mahmoud
- Pikeville Osteopathic School of Medicine, Pikeville, KY, USA.,Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | - Eman M Fouda
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | - Alyaa Kotby
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | - Hanan M Ibrahim
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
| | | | | | | | | | | | | | | | | | - Mostafa Elhodhod
- Ain Shams University, Cairo, Egypt.,Children's Hospital, Cairo, Egypt
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45
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Lakota K, Perdan-Pirkmajer K, Hočevar A, Sodin-Semrl S, Rotar Ž, Čučnik S, Žigon P. COVID-19 in Association With Development, Course, and Treatment of Systemic Autoimmune Rheumatic Diseases. Front Immunol 2021; 11:611318. [PMID: 33574819 PMCID: PMC7870870 DOI: 10.3389/fimmu.2020.611318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
Autoimmune diseases and infections are often closely intertwined. Patients with autoimmune diseases are more susceptible to infections due to either active autoimmune disease or the medications used to treat them. Based on infections as environmental triggers of autoimmunity, an autoimmune response would also be expected in COVID-19. Although some studies have shown the occurance of autoantibodies and the possible development of autoimmune diseases after SARS-CoV-2 infection, current data suggest that the levels of autoantibodies following SARS-CoV-2 infection is comparable to that of some other known infections and that the autoantibodies might only be transient. The risk of SARS-CoV-2 infection in patients with a systemic autoimmune rheumatic disease (SARD) appears slightly higher compared to the general population and the course of COVID-19 disease does not seem to be very different, however, specific therapies such as glucocorticoids and anti-TNF might modulate the risk of hospitalization/death. Cytokine release syndrome is a severe complication in COVID-19. Many drugs used for the treatment of SARD are directly or indirectly targeting cytokines involved in the cytokine release syndrome, therefore it has been suggested that they could also be effective in COVID-19, but more evidence on the use of these medications for the treatment of COVID-19 is currently being collected.
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Affiliation(s)
- Katja Lakota
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Mathematics, Natural Sciences and Information Technologies (FAMNIT), University of Primorska, Koper, Slovenia
| | - Katja Perdan-Pirkmajer
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Snezna Sodin-Semrl
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Mathematics, Natural Sciences and Information Technologies (FAMNIT), University of Primorska, Koper, Slovenia
| | - Žiga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Žigon
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Mathematics, Natural Sciences and Information Technologies (FAMNIT), University of Primorska, Koper, Slovenia
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46
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Generalić A, Davidović M, Kos I, Vrljičak K, Lamot L. Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature. Front Pediatr 2021; 9:760070. [PMID: 34778150 PMCID: PMC8579050 DOI: 10.3389/fped.2021.760070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C). Published definition and criteria of MIS-C include persistent fever, multisystem involvement, and elevated markers of inflammation, without obvious microbial inflammation or other plausible diagnosis. However, the aim of this case report is to emphasize the diversity of symptoms of MIS-C, beyond the defined criteria. Case Presentation: We present a 10-year-old boy with 8p23.1 microdeletion syndrome and multiple comorbidities who initially came to our attention due to hematuria, persistent fever, rash, and elevated markers of inflammation. Within the next 2 days, his condition worsened despite the broad-spectrum antibiotic therapy. Assuming his past history of SARS-CoV-2 exposure, MIS-C was suspected. A high level of clinical suspicion was further supported by significant clinical features (vomiting, abdominal pain, conjunctivitis, arrhythmia, and mild left ventricular systolic dysfunction with pleural effusion) along with laboratory findings (elevated ESR, CRP, proBNP, D-dimers and fibrinogen, positive IgG SARS-CoV-2 antibodies, and negative microbiological cultures). The patient was given intravenous immunoglobulin (IVIG) and began to show instantaneous clinical and laboratory improvement. Conclusion: Despite numerous reports of MIS-C cases in children, there are still many uncertainties regarding the clinical presentation and laboratory findings, as well as mechanisms beyond this intriguing disorder. In our case, for the first time hematuria is reported as an early symptom of MIS-C. We strongly believe that reporting various manifestations and outcomes in MIS-C patients will lead to improved diagnosis, treatment, and overall understanding of this novel inflammatory condition.
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Affiliation(s)
- Ana Generalić
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia.,General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Maša Davidović
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivanka Kos
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Kristina Vrljičak
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Lovro Lamot
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia.,Department of Pediatrics, School of Medicine, University of Zagreb, Zagreb, Croatia
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47
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Multisystem Inflammatory Syndrome Associated with COVID-19 Anti-thrombosis Guideline of Care for Children by Action. Pediatr Cardiol 2021; 42:1635-1639. [PMID: 34076713 PMCID: PMC8169785 DOI: 10.1007/s00246-021-02651-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/22/2021] [Indexed: 12/19/2022]
Abstract
With growing number of pediatric cases of COVID-19, a unique hyper-inflammatory syndrome, linked to SARS-CoV-2 infection, has emerged in children referred to as multisystem inflammatory syndrome in children (MIS-C). This Kawasaki Disease (KD)-like illness has been described across the world. This syndrome shares features of KD, toxic shock syndrome, and macrophage activation syndrome and is associated with significantly elevated inflammatory markers. Everyday there are new data emerging improving the care of these patients. The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is a collaborative network designed to improve the outcomes of pediatric patients with end-stage heart failure and involves centers from across North America. The committee gathered information concerning COVID-19 anticoagulation practices at various centers and harmonized the data to formulate a set of recommendations.
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48
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Chang L, Yang HW, Lin TY, Yang KD. Perspective of Immunopathogenesis and Immunotherapies for Kawasaki Disease. Front Pediatr 2021; 9:697632. [PMID: 34350146 PMCID: PMC8326331 DOI: 10.3389/fped.2021.697632] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Kawasaki Disease (KD) is an acute inflammatory illness that mostly occurs in children below 5 years of age, with intractable fever, mucocutaneous lesions, lymphadenopathy, and lesions of the coronary artery (CAL). KD is sharing clinical symptoms with systemic inflammatory syndrome in children (MIS-C) which is related to COVID-19. Certain genes are identified to be associated with KD, but the findings usually differ between countries and races. Human Leukocyte Antigen (HLA) allele types and toll-like receptor (TLR) expression are also correlated to KD. The acute hyperinflammation in KD is mediated by an imbalance between augmented T helper 17 (Th17)/Th1 responses with high levels of interleukin (IL)-6, IL-10, IL-17A, IFN-γ, and IP-10, in contrast to reduced Th2/Treg responses with lower IL-4, IL-5, FoxP3, and TGF-β expression. KD has varying phenotypic variations regarding age, gender, intravenous immunoglobulin (IVIG) resistance, macrophage activation and shock syndrome. The signs of macrophage activation syndrome (MAS) can be interpreted as hyperferritinemia and thrombocytopenia contradictory to thrombocytosis in typical KD; the signs of KD with shock syndrome (KDSS) can be interpreted as overproduction of nitric oxide (NO) and coagulopathy. For over five decades, IVIG and aspirin are the standard treatment for KD. However, some KD patients are refractory to IVIG required additional medications against inflammation. Further studies are proposed to delineate the immunopathogenesis of IVIG-resistance and KDSS, to identify high risk patients with genetic susceptibility, and to develop an ideal treatment regimen, such as by providing idiotypic immunoglobulins to curb cytokine storms, NO overproduction, and the epigenetic induction of Treg function.
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Affiliation(s)
- Lung Chang
- Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan.,Division of Infectious Disease, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Horng-Woei Yang
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Tang-Yu Lin
- Division of Allergy-Immunology-Rheumatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Kuender D Yang
- Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Allergy-Immunology-Rheumatology, MacKay Children's Hospital, Taipei, Taiwan.,Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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49
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Abdel-Haq N, Asmar BI, Deza Leon MP, McGrath EJ, Arora HS, Cashen K, Tilford B, Charaf Eddine A, Sethuraman U, Ang JY. SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment. Eur J Pediatr 2021; 180:1581-1591. [PMID: 33452570 PMCID: PMC7810600 DOI: 10.1007/s00431-021-03935-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children's Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)-like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered.Conclusion: MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) manifestations include fever, gastrointestinal symptoms, shock, and occasional features of Kawasaki disease (KD). • Treatment includes immunomodulatory agents, most commonly IVIG and corticosteroids. What is New: • Spectrum of MIS-C varies from mild to severe inflammation and coronary artery dilatation occurred in 5/22 (23%) critically ill patients. • IVIG and infliximab therapy were associated with a favorable outcome including resolution of coronary dilatation; only 2/33 received corticosteroids.
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Affiliation(s)
- Nahed Abdel-Haq
- Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. .,Wayne State University, Detroit, MI, USA. .,Central Michigan University, Mount Pleasant, MI, USA.
| | - Basim I. Asmar
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Maria P. Deza Leon
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA
| | - Eric J. McGrath
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA
| | - Harbir S. Arora
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Katherine Cashen
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Bradley Tilford
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Ahmad Charaf Eddine
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Usha Sethuraman
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Jocelyn Y. Ang
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
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50
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Jafarpour S, Abedini M, Saburi A. Kawasaki disease and COVID-19; a pretext for a hot topic. J Formos Med Assoc 2020; 120:1279-1281. [PMID: 33328133 PMCID: PMC7713591 DOI: 10.1016/j.jfma.2020.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Shahin Jafarpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoumeh Abedini
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amin Saburi
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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