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Sütçü M, Kara EM, Yıldız F, Gül D, Yıldız R, Yılmaz D, Atik F, Özkaya O. MIS-C Treatment: Is glucocorticoid monotherapy enough for mild cases? Am J Emerg Med 2024; 83:95-100. [PMID: 39002497 DOI: 10.1016/j.ajem.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND The effectiveness of using only glucocorticoids (GCs) in mild multisystem inflammatory syndrome (MIS-C) cases was compared with combined treatment [GCs + Intravenous immune globulin (IVIG)]. METHODS This retrospective cohort study was conducted between June 1, 2020, and June 1, 2022, in a tertiary care center in Istanbul, Turkey. Clinical and investigational data of the MIS-C patients were analyzed. The patients were divided into two groups: those who received only GCs and those who received the GCs + IVIG combination. The primary outcome focused on assessing the deterioration of the patient's clinical condition, the occurrence of shock, admission to the pediatric intensive care unit (PICU), and the need for additional immunosuppressive medication. Secondary outcomes included evaluating the course of cardiovascular and infection-related complications observed at the one-year follow-up. RESULTS Ninety-seven MIS-C patients with a median age of 41 (3- 214) months were enrolled. Fifty-six (57.7%) patients were male. All the patients had fever at admission with a temperature of 39 °C (37.5 °C-40.1 °C). Thirty-two patients (33%) had cardiac findings on echocardiography [left ventricular dysfunction (n= 13, 13.5%), coronary artery involvement (n= 11, 11.3%), and dilation of cardiac cavities and/or increased cardiac muscle thickness (n= 8, 8.2%)]. Thirteen patients (13.5%) required intensive care. All patients received GCs [only GCs (group I; n= 65, 67%)], and 32 patients (33%) with severe manifestations and/or cardiac involvement received GCs + IVIG (group II). No mortality was observed. None of the patients had any complaints at the one-year follow-up, and all echocardiography findings were normal. CONCLUSION This study provides preliminary evidence that GC monotherapy is a safe treatment alternative for mild MIS-C cases without cardiac involvement.
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Affiliation(s)
- Murat Sütçü
- Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Emine Manolya Kara
- Yeditepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Funda Yıldız
- Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Doruk Gül
- Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Raif Yıldız
- Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Department of Pediatric Emergency, Turkey
| | - Duygu Yılmaz
- Yeditepe University Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey.
| | - Fatih Atik
- Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Cardiology, Istanbul, Turkey
| | - Ozan Özkaya
- Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
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Alkan F, Bircan O, Bal A, Bayturan S, Zengin N, Coskun S. Comparison of early characteristics of multisystemic inflammatory syndrome and Kawasaki disease in children and the course of Kawasaki disease in the pandemic. BMC Pediatr 2024; 24:485. [PMID: 39080588 PMCID: PMC11290103 DOI: 10.1186/s12887-024-04966-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: 03/27/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Multisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. In this study, the clinical findings, organ involvements, similarities, and differences in laboratory and imaging of the children with MIS-C and KD at the time of admission will be revealed in detail, and the treatment methods and follow-up results will be revealed. MATERIAL AND METHOD Our study was a single-center study and included pediatric patients who were treated with a diagnosis of MIS-C between March 2020 and July 2023 in the pediatric cardiology, pediatric emergency, pediatric infection, and pediatric intensive care clinics at Celal Bayar University and who were treated with a diagnosis of KD (complete/incomplete) between January 2015 and July 2023. MIS-C diagnosis was made according to the Turkish Ministry of Health COVID-19 guidelines. Sociodemographic characteristics, clinical, laboratory, and echocardiography findings, treatments given, and clinical course of all patients included in the study were evaluated. RESULTS The median age was 30 months (7-84) in KD and 96 months (6-204) in MIS-C, and it was significantly higher in the MIS-C group (p = 0.000). Symptom duration was significantly longer in the MIS-C group (p = 0.000). In terms of clinical features, gastrointestinal syndrome findings (nausea, vomiting, abdominal pain) and respiratory findings (dyspnea) were significantly higher in the MIS-C group (p = 0.007, p = 0.000, p = 0.002, respectively). Regarding cardiovascular system involvement, coronary involvement was significantly higher in the KD group. However, valvular involvement, left ventricular systolic dysfunction, and pericardial effusion were significantly higher in the MIS-C group (p = 0.000, p = 0.001, p = 0.003, p = 0.023, respectively). In terms of laboratory findings, white blood cell count was higher in KD (p = 0.000), absolute lymphocyte count, platelet level, blood sodium, and albumin levels were lower in MIS-C group (p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.003, respectively), ferritin and troponin levels were significantly higher in MIS-C group. These results were statistically significant (p = 0.000, p = 0.000, respectively). D-dimer and fibrinogen levels were high in both groups, and no significant statistical difference was detected between the two groups. There was no significant difference between the two groups regarding the length of hospitalization and mortality, but steroid use was significantly higher in the MIS-C group (p = 0.000). CONCLUSION In conclusion, this study has demonstrated the similarities and differences between MIS-C and KD regarding clinical findings, organ involvement, and laboratory and imaging results. The results of our study have important implications in terms of contributing to the data in the existing literature on these two diseases and for the correct diagnosis and better management of pediatric patients presenting with these disorders. WHAT IS KNOWN Multisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. WHAT IS NEW Although MIS-C and KD have many similarities, their symptoms, disease processes, possible complications, and treatment regimens may differ.
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Affiliation(s)
- Fatos Alkan
- Division of Pediatrics Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, 45030, Türkiye, Turkey.
| | - Onur Bircan
- Division of Pediatrics Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, 45030, Türkiye, Turkey
| | - Alkan Bal
- Division of Pediatric Emergency Care, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Semra Bayturan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Neslihan Zengin
- Division of Pediatric Intensive Care, Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Senol Coskun
- Division of Pediatrics Cardiology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, 45030, Türkiye, Turkey
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Freeman A, Golding E, Gardner J, Berger Z. Paediatric Post-Traumatic Stress Risk for Young People and Parents following Acute Admission for Paediatric Multisystem Inflammatory Syndrome: Retrospective Analysis of Psychological Screening and Support. CHILDREN (BASEL, SWITZERLAND) 2024; 11:858. [PMID: 39062307 PMCID: PMC11276350 DOI: 10.3390/children11070858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Paediatric Multisystem Inflammatory Syndrome (PIMS-TS) is a novel condition that was identified for the first time during the COVID-19 pandemic. Limited research exists that describes the psychological needs of children and young people (CYP) following an acute hospital admission for PIMS-TS. METHODS A retrospective cohort study was conducted to explore both psychological need and access to psychology services for CYP and their families who were admitted to a paediatric tertiary hospital in London, UK, for PIMS-TS between April 2020 and May 2021. RESULTS We included 121 CYP and a parent/caregiver for each. In total, 23.3% of the CYP were at risk of developing a traumatic stress response and 11.6% were at risk of experiencing emotional disturbance. Of the parents screened, 40.5% also scored above clinical cut-off for a trauma response. There was a significant relationship observed between CYP and parents identified as having a trauma risk. CONCLUSIONS The importance of proactive screening for both trauma and emotional distress in CYP and their parents/caregivers following acute hospital admission is highlighted. In addition, there is a need to think about a CYP as part of a system of care and to ensure that clinicians pay attention to parental wellbeing and mental health when understanding the psychological impact on a child.
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Affiliation(s)
- Anita Freeman
- Great Ormond Street Hospital, NHS Foundation Trust, London WC1N 3JH, UK; (E.G.); (Z.B.)
| | - Emily Golding
- Great Ormond Street Hospital, NHS Foundation Trust, London WC1N 3JH, UK; (E.G.); (Z.B.)
| | | | - Zoe Berger
- Great Ormond Street Hospital, NHS Foundation Trust, London WC1N 3JH, UK; (E.G.); (Z.B.)
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Alam A, Andriyani FM, Peryoga SU. Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study. Int J Emerg Med 2024; 17:85. [PMID: 38992604 PMCID: PMC11242006 DOI: 10.1186/s12245-024-00658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Severe multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management. METHODS Medical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital's PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses. RESULTS Seventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients. CONCLUSION Age, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.
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Affiliation(s)
- Anggraini Alam
- Infection & Tropical Diseases Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Fina Meilyana Andriyani
- Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Stanza Uga Peryoga
- Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia
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Tran DM, Pham DV, Cao TV, Hoang CN, Nguyen HTT, Nguyen GD, Le CN, Thieu QQ, Ta TA, Dau HV, Le CQ, Le QH, Luong NT, Tran MT, Nguyen PH, Nguyen NT, Phan PH. Severity predictors for multisystemic inflammatory syndrome in children after SARS-CoV-2 infection in Vietnam. Sci Rep 2024; 14:15810. [PMID: 38982132 PMCID: PMC11233495 DOI: 10.1038/s41598-024-66891-4] [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: 02/13/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024] Open
Abstract
Multisystemic inflammatory syndrome in children (MIS-C) might manifest in a broad spectrum of clinical scenarios, ranging from mild features to multi-organ dysfunction and mortality. However, this novel entity has a heterogenicity of data regarding prognostic factors associated with severe outcomes. The present study aimed to identify independent predictors for severity by using multivariate regression models. A total of 391 patients (255 boys and 136 girls) were admitted to Vietnam National Children's Hospital from January 2022 to June 2023. The median age was 85 (range: 2-188) months, and only 12 (3.1%) patients had comorbidities. 161 (41.2%) patients required PICU admission, and the median PICU LOS was 4 (2-7) days. We observed independent factors related to PICU admission, including CRP ≥ 50 (mg/L) (OR 2.52, 95% CI 1.39-4.56, p = 0.002), albumin ≤ 30 (g/L) (OR 3.18, 95% CI 1.63-6.02, p = 0.001), absolute lymphocyte count ≤ 2 (× 109/L) (OR 2.18, 95% CI 1.29-3.71, p = 0.004), ferritin ≥ 300 (ng/mL) (OR 2.35, 95% CI 1.38-4.01), p = 0.002), and LVEF < 60 (%) (OR 2.48, 95% CI 1.28-4.78, p = 0.007). Shock developed in 140 (35.8%) patients, especially for those decreased absolute lymphocyte ≤ 2 (× 109/L) (OR 2.48, 95% CI 1.10-5.61, p = 0.029), albumin ≤ 30 (g/L) (OR 2.53, 95% CI 1.22-5.24, p = 0.013), or LVEF < 60 (%) (OR 2.24, 95% CI 1.12-4.51, p = 0.022). In conclusion, our study emphasized that absolute lymphocyte count, serum albumin, CRP, and LVEF were independent predictors for MIS-C severity. Further well-designed investigations are required to validate their efficacy in predicting MIS-C severe cases, especially compared to other parameters. As MIS-C is a new entity and severe courses may progress aggressively, identifying high-risk patients optimizes clinicians' follow-up and management to improve disease outcomes.
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Affiliation(s)
- Dien M Tran
- Surgical Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
- Department of Pediatrics, Faculty of Medicine & Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Dem V Pham
- Department of Pediatrics, Faculty of Medicine & Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tung V Cao
- Cardiovascular Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Canh N Hoang
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Ha T T Nguyen
- Department of Immunology, Allergy, and Rheumatology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Giang D Nguyen
- Department of Immunology, Allergy, and Rheumatology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Cuong N Le
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Quan Q Thieu
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tuan A Ta
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Hung V Dau
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Chi Q Le
- Department of Immunology, Allergy, and Rheumatology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Quang H Le
- Cardiovascular Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Nghiem T Luong
- Department of Hematology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Mai T Tran
- Department of Biochemistry, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Phu H Nguyen
- Training and Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Nhung T Nguyen
- Training and Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
- Department of Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Phuc H Phan
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.
- Training and Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam.
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Caorsi R, Consolaro A, Speziani C, Sozeri B, Ulu K, Faugier-Fuentes E, Menchaca-Aguayo H, Ozen S, Sener S, Akhter Rahman S, Imnul Islam M, Haerynck F, Simonini G, Mastri MV, Avcin T, Sršen S, de Albuquerque Pedrosa Fernandes T, Stanevicha V, Vojinovic J, Sobh A, Fingerhutova S, Minxova L, Gagro A, Rodrigues Fonseca A, Pandya D, Varbanova B, Sánchez-Manubens J, Ganeva M, Montin D, Boyarchuk O, Minghini A, Bracaglia C, Brogan P, Candotti F, Cattalini M, Meyts I, Minoia F, Taddio A, Wouters C, De Benedetti F, Bovis F, Ravelli A, Ruperto N, Gattorno M, Bilginer Y, Laila K, Islam MM, Meertens B, Hoste L, Dehoorne J, Schelstraete P, Vandekerckhove K, Willems J, Matthijs I, Filocamo E Gisella Beatrice Beretta G, Magalhaes CS, Chubata O, Ricci F, Vukovic A, Temelkova K, Avramovic MZ, Emersic N, Bizjak M, Vesel T, Rodrigues MF, Gasparello de Almeida R, Lukjanovica K, Elnagdy MH, Soliman A, Terifajova E, Brejchova I, Magner M, Myrup C, Vougiouka O, Jelusic M, La Torre F, Rigante D, Maggio MC, Verdoni L, Rubio-Perez N, Cornejo GV, Villarreal Trevino AV, Brito I, Oliveira-Ramos F, Alexeeva E, Chasnyk V, Arkachaisri T, Boyko Y, Vyzhga Y, Samsonenko S. The HyperPed-COVID international registry: Impact of age of onset, disease presentation and geographical distribution on the final outcome of MIS-C. J Autoimmun 2024; 147:103265. [PMID: 38838452 DOI: 10.1016/j.jaut.2024.103265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The aim of the study was to establish an international multicenter registry to collect data on patients with Multisystem Inflammatory Syndrome in Children (MIS-C), in order to highlight a relationship between clinical presentation, age of onset and geographical distribution on the clinical outcome. STUDY DESIGN Multicenter retrospective study involving different international societies for rare immunological disorders.1009 patients diagnosed with MIS-C between March and September 2022, from 48 centers and 22 countries were collected. Five age groups (<1, 1-4, 5-11, 12-16, >16 years) and four geographic macro-areas, Western Europe, Central-Eastern Europe, Latin America, Asian-African resource-limited countries (LRC), were identified. RESULTS Time to referral was significantly higher in LRC. Intensive anti-inflammatory treatment, including biologics, respiratory support and mechanic ventilation were more frequently used in older children and in European countries. The mortality rate was higher in very young children (<1 year), in older patients (>16 years of age) and in LRC. Multivariate analysis identified the residence in LRC, presence of severe cardiac involvement, renal hypertension, lymphopenia and non-use of heparin prophylaxis, as the factors most strongly associated with unfavorable outcomes. CONCLUSIONS The stratification of patients by age and geographic macro-area provided insights into the clinical presentation, treatment and outcome of MIS-C. The mortality and sequelae rates exhibited a correlation with the age and geographical areas. Patients admitted and treated in LRC displayed more severe outcomes, possibly due to delays in hospital admission and limited access to biologic drugs and to intensive care facilities.
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Affiliation(s)
- Roberta Caorsi
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Alessandro Consolaro
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy; Università Degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Genoa, Italy
| | - Camilla Speziani
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Betul Sozeri
- Health Sciences University, Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Kadir Ulu
- Health Sciences University, Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Enrique Faugier-Fuentes
- Hospital Infantil de México Federico Gómez, Medicina Interna y Reumatologia, Mexico City, Mexico
| | - Hector Menchaca-Aguayo
- Hospital Infantil de México Federico Gómez, Medicina Interna y Reumatologia, Mexico City, Mexico
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Seher Sener
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | | | - Mohammad Imnul Islam
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Paediatrics, Dhaka, Bangladesh
| | | | - Gabriele Simonini
- IRCCS Meyer Children's Hospital, Rheumatology Unit, ERN-ReCONNECT Center, Florence, Italy
| | - Mariel Viviana Mastri
- Hospital Interzonal de Agudos Especializado en Pediatría, Sor María Ludovica. Sala de Reumatologia La Plata, Argentina
| | - Tadej Avcin
- University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia
| | - Saša Sršen
- University Hospital Centre Split, Department of Pediatrics, Split, Croatia
| | | | - Valda Stanevicha
- Riga Stradins University, Children University Hospital, Riga, Latvia
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, University Clinical Center Nis, Clinic of Pediatrics, Department of Pediatric Rheumatology, Nis, Serbia
| | - Ali Sobh
- Mansoura University Children's Hospital, Faculty of Medicine Mansoura University, Mansura, Egypt
| | - Sarka Fingerhutova
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Minxova
- University Hospital Hradec Kralove, Department of Pediatrics, Hradec Kralove, Czech Republic
| | - Alenka Gagro
- Children's Hospital Zagreb, Department of Pulmonology, Allergology, Clinical Immunology and Rheumatology, The University of Zagreb School of Medicine, Zagreb, Croatia
| | - Adriana Rodrigues Fonseca
- Universidade Federal Do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Rio de Janeiro, Brazil
| | | | - Boriana Varbanova
- Varna Medical University, Department of Pediatrics First Pediatric Clinic, Varna, Bulgaria
| | - Judith Sánchez-Manubens
- Hospital Parc Taulí de Sabadell, Reumatologia Pediàtrica - Servei de Medicina Pediàtrica, Barcelona, Spain
| | - Margarita Ganeva
- University Children Hospital, Department of Paediatric Rheumatology, Sofia, Bulgaria
| | - Davide Montin
- Regina Margherita Children Hospital, Immunology and Rheumatology Unit, Turin, Italy
| | - Oksana Boyarchuk
- I.Horbachevsky Ternopil National Medical University, Department of Children's Diseases and Pediatric Surgery, Ternopil, Ukraine
| | - Andrea Minghini
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Claudia Bracaglia
- IRCCS Ospedale Pediatrico Bambino Gesù, Division of Rheumatology, Rome, Italy
| | - Paul Brogan
- UCL GOS Institute of Child Health, London, UK
| | - Fabio Candotti
- Division of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Francesca Minoia
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Pediatria e Immunoreumatologia2 Milan, Italy
| | - Andrea Taddio
- Institute of Child and Maternal Health - IRCCS "Burlo Garofolo" and University of Trieste, Trieste, Italy
| | - Carine Wouters
- UZ Leuven - Universitair Ziekenhuis, Leuven, Belgium; KU Leuven - University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, Leuven, Belgium
| | | | - Francesca Bovis
- University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - Angelo Ravelli
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOC Servizio di Sperimentazioni Cliniche Pediatriche, PRINTO, Genoa, Italy
| | - Marco Gattorno
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy.
| | - Yelda Bilginer
- Hacettepe University Children's Hospital, Ankara, Turkey
| | - Kamrul Laila
- Bangabandhu Sheikh Mujib Medical Universit, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | - Oksana Chubata
- Ternopil Regional Children's Hospital, Ternopil, Ukraine
| | - Francesca Ricci
- Clinica Pediatrica Dell'Università di Brescia, Spedali Civili, Brescia, Italy
| | | | | | - Mojca Zajc Avramovic
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Emersic
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Masa Bizjak
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Vesel
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | - Eva Terifajova
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Martin Magner
- Thomayer University Hospital, Prague, Czech Republic
| | | | | | - Marija Jelusic
- University Hospital Centre Zagreb, University School of Medicine, Zagreb, Croatia
| | - Francesco La Torre
- Ospedale Pediatrico Giovanni XXIII - Azienda Ospedaliero-Universitaria Consorziale-Policlinico, Bari, Italy
| | | | | | | | - Nadina Rubio-Perez
- Hospital Universitario Dr. J. E. Gonzalez, Universidad, Autónoma de Nuevo León, Monterrey, NL, Mexico
| | | | | | | | | | - Ekaterina Alexeeva
- State Institution Scientific Center of Children Health of Rams Moscow, Moscow, Russian Federation
| | - Vyacheslav Chasnyk
- Saint-Petersburg State Pediatric Medical Academy, Saint-Petersburg, Russian Federation
| | | | - Yaryna Boyko
- Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Yulia Vyzhga
- National Pirogov Memorial Medical University, Vinnytsia, Ukraine
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Reynolds-Herbst T, Lowe D, Lozano JM, Maniaci V. The Association Between Early Initiation of Systemic Corticosteroids and the Hospital Length of Stay in Patients With Multisystem Inflammatory Syndrome in Children. Pediatr Emerg Care 2024; 40:536-540. [PMID: 38718820 DOI: 10.1097/pec.0000000000003196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Patients with multisystem inflammatory syndrome in children (MIS-C) often require hospital admission. Treatment of MIS-C has included intravenous immunoglobulin, systemic corticosteroids, and/or immunomodulators. There is no standardized approach to when steroids should be initiated during treatment. The study objective was to determine whether early initiation of steroids in patients with MIS-C is associated with the duration of hospital length of stay (LOS). METHODS This is a single-center retrospective cohort study of patients younger than 21 years who were hospitalized with MIS-C between March 2020 and September 2021 and received steroids. Cases were obtained from an institutional MIS-C log. Patients with culture proven sepsis and/or those who received intravenous immunoglobulin or steroids within the previous 30 days were excluded. We used a multivariable linear regression model, controlling for potential confounders, to assess the association between early steroids and LOS. RESULTS A total of 56 patients hospitalized with MIS-C were identified; 38 received systemic corticosteroids and were included in the study. The mean time from admission to steroid administration was 9.8 hours (SD = 7.7) in the early group and 44.6 hours (SD = 14.2) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early versus late steroids in initial C-reactive peptide, procalcitonin, brain natriuretic peptide, and cardiac dysfunction. After controlling for confounders, initiating steroids within 24 hours of admission for MIS-C was associated with a decreased hospital LOS: in patients treated with early steroids, LOS was 58.3 hours less (95% confidence interval, -100.0 to -16.6; P = 0.007) than in those who received late steroids. CONCLUSIONS Among patients with MIS-C, initiating systemic corticosteroids within 24 hours of admission was associated with decreased hospital LOS.
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Affiliation(s)
| | - David Lowe
- From the Department of Emergency Medicine, Nicklaus Children's Hospital
| | - Juan M Lozano
- Division of Medical and Population Health Sciences Research, Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Vincenzo Maniaci
- From the Department of Emergency Medicine, Nicklaus Children's Hospital
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8
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Bhimraj A, Morgan RL, Shumaker AH, Baden L, Cheng VCC, Edwards KM, Gallagher JC, Gandhi RT, Muller WJ, Nakamura MM, O’Horo JC, Shafer RW, Shoham S, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (September 2022). Clin Infect Dis 2024; 78:e250-e349. [PMID: 36063397 PMCID: PMC9494372 DOI: 10.1093/cid/ciac724] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023] Open
Abstract
There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer.
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Affiliation(s)
- Adarsh Bhimraj
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Amy Hirsch Shumaker
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | | | - Vincent Chi Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center,Nashville, Tennessee
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania
| | - Rajesh T Gandhi
- Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - William J Muller
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, Illinois
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John C O’Horo
- Division of Infectious Diseases, Joint Appointment Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
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9
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Abbas Q, Ali H, Amjad F, Hussain MZH, Rahman AR, Khan MH, Padhani ZA, Abbas F, Imam D, Alikhan Z, Belgaumi SM, Mohsin S, Sattar F, Siddiqui A, Lassi ZS, Das JK. Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): a systematic review. BMJ Paediatr Open 2024; 8:e002344. [PMID: 38844384 PMCID: PMC11163633 DOI: 10.1136/bmjpo-2023-002344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/16/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC). METHODS We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study. RESULTS A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC. CONCLUSION MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC. PROSPERO REGISTRATION NUMBER CRD42020195823.
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Affiliation(s)
- Qalab Abbas
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Haider Ali
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Fatima Amjad
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | | | - Abdu R Rahman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Maryam Hameed Khan
- Institute for Global Health and Development, The Aga Khan University, Karachi, Sind, Pakistan
| | - Zahra A Padhani
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Fatima Abbas
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Danyal Imam
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Zuviya Alikhan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Sameer M Belgaumi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Shazia Mohsin
- Department of Pediatric cardiology, Division of cardiothoracic sciences, Sindh institute of Urology and Transplantation (SIUT), Karachi, Sind, Pakistan
| | - Faiza Sattar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Arsalan Siddiqui
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
| | - Zohra S Lassi
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
- Institute for Global Health and Development, The Aga Khan University, Karachi, Sind, Pakistan
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10
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Opoka-Winiarska V, Grywalska E, Morawska-Michalska I, Korona-Głowniak I, Kądziołka O, Gosik K, Majchrzak A, Rahnama-Hezavah M, Niedźwiedzka-Rystwej P. Programmed Cell Death Protein-1 Regulation in Response to SARS-CoV-2 in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2: A Prospective Cohort Study. Int J Mol Sci 2024; 25:5968. [PMID: 38892153 PMCID: PMC11172628 DOI: 10.3390/ijms25115968] [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: 04/12/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
The role of programmed death cell protein 1 (PD-1) has already been described in a range of various diseases, including COVID-19. This study provides new, innovative data, related to the expression of PD-1 and the risk of Paediatric Inflammatory Multisystem Syndrome, temporally associated with SARS-CoV-2 infection (PIMS-TS)-a rare, but potentially life-threatening complication of COVID-19. In this study, we evaluated the expression of PD-1 protein in patients with PIMS. Blood samples were taken from patients at the time of diagnosis (n = 33), after 6 weeks (n = 33), 3 months (n = 24), 6 months (n = 24) and 12 months (n = 8). The immunophenotypes were evaluated in flow cytometry. The control group consisted of 35 healthy children with negative SARS-CoV-2 antigen/PCR test, who were asymptomatic and had no history of allergic, autoimmune or oncological diseases. The associations between immunophenotypes, biochemical findings and clinical data were analysed. Significant increases in the expression of PD-1 for CD4+ and CD8+ T cells, compared to the control group, were observed in the day of admission, with a gradual decrease during the first weeks from initiation of treatment. This study sheds new light on the pathogenesis of PIMS-TS, emphasizing the role of PD-1 protein. Future research is essential for early risk prediction in SARS-CoV-2 patients and for devising effective clinical prevention and management strategies.
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Affiliation(s)
- Violetta Opoka-Winiarska
- Department of Pediatric Pulmonology and Rheumatology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (E.G.); (K.G.)
| | | | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Olga Kądziołka
- Department of Paediatric Pulmonology and Rheumatology, University Children’s Hospital of Lublin, 20-093 Lublin, Poland;
| | - Krzysztof Gosik
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (E.G.); (K.G.)
| | - Adam Majchrzak
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland;
| | - Mansur Rahnama-Hezavah
- Chair and Department of Oral Surgery, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Paulina Niedźwiedzka-Rystwej
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland
- Center for Experimental Immunology and Immunobiology in Infectious Diseases and Cancer, University of Szczecin, 71-412 Szczecin, Poland
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11
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Güneş M, Özdemir Ö. COVID-19 and cardiac complications: Myocarditis and multisystem inflammatory syndrome in children. World J Cardiol 2024; 16:260-268. [PMID: 38817651 PMCID: PMC11135331 DOI: 10.4330/wjc.v16.i5.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/19/2024] [Accepted: 04/12/2024] [Indexed: 05/23/2024] Open
Abstract
Coronavirus is an important pathogen causing disease in humans and animals. At the end of 2019, an investigation into an increase in pneumonia cases in Wuhan, Hubei Province, China, found that the cause was a new coronavirus. This disease, which spread rapidly across China and caused an outbreak worldwide, resulted in a pandemic. Although this virus has previously been referred to as 2019-nCoV, which causes coronavirus disease 2019 (COVID-19), later it was named severe acute respiratory syndrome coronavirus 2. Children were usually asymptomatic and rarely severely affected. In April 2020, reports from the United Kingdom indicated that children may have Kawasaki disease or a clinical condition similar to toxic shock syndrome. This clinical picture was later defined as multisystem inflammatory syndrome in children. Since then, similarly affected children as well as cases with other cardiac complications have been reported in other parts of the world. In this review, we aimed to evaluate COVID-19 in terms of cardiac involvement by reviewing the literature.
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Affiliation(s)
- Muhammed Güneş
- Department of Pediatric Cardiology, Research and Training Hospital of Sakarya, Adapazarı 54100, Sakarya, Türkiye
| | - Öner Özdemir
- Department of Pediatric Allergy and Immunology, Research and Training Hospital of Sakarya, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Türkiye.
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12
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Liu CT, Luxton GWG, Sung CC, Wang FM, Chang CN, Hu CF. Successful infliximab treatment for refractory COVID-19-associated multisystem inflammatory syndrome in two Taiwanese children: An experience from a medical center. Pediatr Neonatol 2024; 65:305-307. [PMID: 38169192 DOI: 10.1016/j.pedneo.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Chun-Ting Liu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - G W Gant Luxton
- Department of Molecular and Cellular Biology, University of California-Davis, Davis, CA, USA
| | - Chia-Cheng Sung
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fu-Min Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Ning Chang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chih-Fen Hu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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13
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Tong T, Jin YH, Wang M, Gong FQ. Treatment of multisystem inflammatory syndrome in children. World J Pediatr 2024; 20:325-339. [PMID: 38509432 DOI: 10.1007/s12519-024-00798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), a relatively uncommon but severe pediatric complication, is associated with coronavirus disease 2019 (COVID-19). A variety of treatment approaches, including intravenous immunoglobulins (IVIGs), glucocorticoids (GCs) and biologic agents, such as anakinra and infliximab, have been described for the management of COVID-19-related MIS-C. Anticoagulant therapy is also important. However, a well-developed treatment system has not been established, and many issues remain controversial. Several recently published articles related to the treatment of MIS-C have been released. Hence, in this review, we identified relevant articles published recently and summarized the treatment of MIS-C more comprehensively and systematically. DATA SOURCES We reviewed the literature on the treatment of MIS-C through 20 September 2023. The PubMed/Medline, Web of Science, EMBASE, and Cochrane Library databases were searched with the combination of the terms "multisystem inflammatory syndrome", "MIS-C", "PIMS-TS", "therapy", "treatment", "drug", "IVIG", "GCs", "intravenous immunoglobulin", "corticosteroids", "biological agent", and "aspirin". RESULTS The severity of MIS-C varies, and different treatment schemes should be used according to the specific condition. Ongoing research and data collection are vital to better understand the pathophysiology and optimal management of MIS-C. CONCLUSIONS MIS-C is a disease involving multiple systems and has great heterogeneity. With the accumulation of additional experience, we have garnered fresh insights into its treatment strategies. However, there remains a critical need for greater standardization in treatment protocols, alongside the pressing necessity for more robust and meticulously conducted studies to deepen our understanding of these protocols. Supplementary file1 (MP4 208044 kb).
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Affiliation(s)
- Tong Tong
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China
| | - Yi-Hua Jin
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China
| | - Min Wang
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China
| | - Fang-Qi Gong
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China.
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14
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Lee S, Erdem G, Yasuhara J. Multisystem inflammatory syndrome in children associated with COVID-19: from pathophysiology to clinical management and outcomes. Minerva Pediatr (Torino) 2024; 76:268-280. [PMID: 37284807 DOI: 10.23736/s2724-5276.23.07205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome (PIMS), is a new postinfectious illness associated with COVID-19, affecting children after SARS-CoV-2 exposure. The hallmarks of this disorder are hyperinflammation and multisystem involvement, with gastrointestinal, cardiac, mucocutaneous, and hematologic disturbances seen most commonly. Cardiovascular involvement includes cardiogenic shock, ventricular dysfunction, coronary artery abnormalities, and myocarditis. Now entering the fourth year of the pandemic, clinicians have gained some familiarity with the clinical presentation, initial diagnosis, cardiac evaluation, and treatment of MIS-C. This has led to an updated definition from the Centers for Disease Control and Prevention in the USA driven by increased experience and clinical expertise. Furthermore, the available evidence established expert consensus treatment recommendations supporting a combination of immunoglobulin and steroids. However, the pathophysiology of the disorder and answers to what causes this remain under investigation. Fortunately, long-term outcomes continue to look promising, although continued follow-up is still needed. Recently, COVID-19 mRNA vaccination is reported to be associated with reduced risk of MIS-C, while further studies are warranted to understand the impact of COVID-19 vaccines on MIS-C. We review the findings and current literature on MIS-C, including pathophysiology, clinical features, evaluation, management, and medium- to long-term follow-up outcomes.
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Affiliation(s)
- Simon Lee
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guliz Erdem
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jun Yasuhara
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA -
- Center for Cardiovascular Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Cardiology, Royal Children's Hospital, Parkville, Australia
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15
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Rizzi M, Avellis V, Messina A, Germano C, Tavella E, Dodaro V, Vitale R, Revelli A, Zola P, Picone S, Paolillo PM, Mondì V, Masturzo B, Manzoni P, Sainaghi PP. Vitamin D Supplementation in Neonatal and Infant MIS-C Following COVID-19 Infection. Int J Mol Sci 2024; 25:3712. [PMID: 38612523 PMCID: PMC11011671 DOI: 10.3390/ijms25073712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
To date, the SARS-CoV-2 pandemic still represents a great clinical challenge worldwide, and effective anti-COVID-19 drugs are limited. For this reason, nutritional supplements have been investigated as adjuvant therapeutic approaches in disease management. Among such supplements, vitamin D has gained great interest, due to its immunomodulatory and anti-inflammatory actions both in adult and pediatric populations. Even if there is conflicting evidence about its prevention and/or mitigation effectiveness in SARS-CoV-2 infection, several studies demonstrated a strict correlation between hypovitaminosis D and disease severity in acute COVID-19 and MIS-C (multisystem inflammatory syndrome in children). This narrative review offers a resume of the state of the art about vitamin D's role in immunity and its clinical use in the context of the current pandemic, specially focusing on pediatric manifestations and MIS-C. It seems biologically reasonable that interventions aimed at normalizing circulating vitamin D levels could be beneficial. To help clinicians in establishing the correct prophylaxis and/or supportive therapy with vitamin D, well-designed and adequately statistically powered clinical trials involving both adult and pediatric populations are needed. Moreover, this review will also discuss the few other nutraceuticals evaluated in this context.
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Affiliation(s)
- Manuela Rizzi
- Department of Health Sciences (DiSS), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Vincenzo Avellis
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Alessandro Messina
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Chiara Germano
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Elena Tavella
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Valentina Dodaro
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Raffaele Vitale
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Alberto Revelli
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Paolo Zola
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Simonetta Picone
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy
| | - Pier Michele Paolillo
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy
| | - Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy
| | - Bianca Masturzo
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Paolo Manzoni
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Pier Paolo Sainaghi
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
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16
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Díaz F, Cruces P. Airway Management of Critically Ill Pediatric Patients with Suspected or Proven Coronavirus Disease 2019 Infection: An Intensivist Point of View. J Pediatr Intensive Care 2024; 13:1-6. [PMID: 38571985 PMCID: PMC10987222 DOI: 10.1055/s-0041-1732345] [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: 05/08/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
Advanced airway management of critically ill children is crucial for novel coronavirus disease 2019 (COVID-19) management in the pediatric intensive care unit, whether due to shock and hemodynamic collapse or acute respiratory failure. In this article, intubation is challenging due to the particularities of children's physiology and the underlying disease's pathophysiology, especially when an airborne pathogen, like COVID-19, is present. Unfortunately, published recommendations and guidelines for COVID-19 in pediatrics do not address in-depth endotracheal intubation in acutely ill children. We discussed the caveats and pitfalls of intubation in critically ill children.
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Affiliation(s)
- Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital el Carmen de Maipú, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
| | - Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Hospital el Carmen de Maipú, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
- Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
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17
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Jiang RM, Xie ZD, Jiang Y, Lu XX, Jin RM, Zheng YJ, Shang YX, Xu BP, Liu ZS, Lu G, Deng JK, Liu GH, Wang XC, Wang JS, Feng LZ, Liu W, Zheng Y, Shu SN, Lu M, Luo WJ, Liu M, Cui YX, Ye LP, Shen AD, Liu G, Gao LW, Xiong LJ, Bai Y, Lin LK, Wei Z, Xue FX, Wang TY, Zhao DC, Shao JB, Ng DKK, Wong GWK, Zhao ZY, Li XW, Yang YH, Shen KL. Diagnosis, treatment and prevention of severe acute respiratory syndrome coronavirus 2 infection in children: experts' consensus statement updated for the Omicron variant. World J Pediatr 2024; 20:272-286. [PMID: 37676610 DOI: 10.1007/s12519-023-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Rong-Meng Jiang
- Diagnosis and Treatment Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Zheng-De Xie
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yi Jiang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiao-Xia Lu
- Department of Respiratory, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Run-Ming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yue-Jie Zheng
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Yun-Xiao Shang
- Department of Pediatric Respiratory, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Bao-Ping Xu
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Ji-Kui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Guang-Hua Liu
- Department of Pediatrics, Fujian Branch of Shanghai Children's Medical Center, Fujian Children's Hospital, Fuzhou, 350005, China
| | - Xiao-Chuan Wang
- Department of Clinical Immunology and Allergy, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, 201102, China
| | - Jian-She Wang
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, 201102, China
| | - Lu-Zhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Children's Hospital of Tianjin University, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Yi Zheng
- Beijing Key Laboratory of Diagnosis and Treatment of Mental Disorders, National Clinical Research Center for Mental and Psychological Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Lu
- Department of Respiratory, Shanghai Children's Hospital, Shanghai, 200062, China
| | - Wan-Jun Luo
- Office of Infection Management, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Miao Liu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yu-Xia Cui
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Le-Ping Ye
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - A-Dong Shen
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li-Wei Gao
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Li-Juan Xiong
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan Bai
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li-Kai Lin
- Hospital Management Institute of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhuang Wei
- Children's Health Care Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Feng-Xia Xue
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Tian-You Wang
- Hematology and Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Dong-Chi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jian-Bo Shao
- Department of Radiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Daniel Kwok-Keung Ng
- Department of Pediatrics, Hong Kong Sanatorium & Hospital, Hong Kong, 999077, China
| | - Gary Wing-Kin Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Zheng-Yan Zhao
- Department of Developmental Behavior, Children's Hospital, Zhejiang University College of Medicine, Hangzhou, 310051, China.
| | - Xing-Wang Li
- Diagnosis and Treatment Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
| | - Yong-Hong Yang
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, 518038, China.
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China.
| | - Kun-Ling Shen
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, 518038, China.
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China.
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18
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Song P, Adeloye D, Acharya Y, Bojude DA, Ali S, Alibudbud R, Bastien S, Becerra-Posada F, Berecki M, Bodomo A, Borrescio-Higa F, Buchtova M, Campbell H, Chan KY, Cheema S, Chopra M, Cipta DA, Castro LD, Ganasegeran K, Gebre T, Glasnović A, Graham CJ, Igwesi-Chidobe C, Iversen PO, Jadoon B, Lanza G, Macdonald C, Park C, Islam MM, Mshelia S, Nair H, Ng ZX, Htay MNN, Akinyemi KO, Parisi M, Patel S, Peprah P, Polasek O, Riha R, Rotarou ES, Sacks E, Sharov K, Stankov S, Supriyatiningsih W, Sutan R, Tomlinson M, Tsai AC, Tsimpida D, Vento S, Glasnović JV, Vokey LB, Wang L, Wazny K, Xu J, Yoshida S, Zhang Y, Cao J, Zhu Y, Sheikh A, Rudan I. Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output. J Glob Health 2024; 14:04054. [PMID: 38386716 PMCID: PMC10869134 DOI: 10.7189/jogh.14.04054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background In this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries. Methods The International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals. Results Key priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences. Conclusions Priority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.
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Affiliation(s)
- Peige Song
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, China
| | - Davies Adeloye
- School of Health & Life Sciences, Teesside University, UK
| | - Yubraj Acharya
- Department of Health Policy and Administration, The Pennsylvania State University, USA
| | | | - Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Rowalt Alibudbud
- Department of Sociology and Behavioral Sciences, De La Salle University, Manila, Philippines
| | | | | | | | | | | | - Marie Buchtova
- Olomouc University Social Health Institute, Palacký University, Olomouc, Czechia
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
- School of Social Sciences, Monash University, Australia
| | | | | | | | - Lina Diaz Castro
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | - Teshome Gebre
- The Task force for Global Health, Addis Ababa, Ethiopia
| | - Anton Glasnović
- Croatian Institute for Brain Research, Zagreb University School of Medicine, Zagreb, Croatia
| | - Christopher J Graham
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | | | - Bismeen Jadoon
- Egyptian Representative, Committee of Fellows of Obstetrics and Gynaecology, Oxford, UK, and Royal Berkshire Hospital, NHS, UK
| | - Giuseppe Lanza
- Oasi Research Institute-IRCCS, Troina, Italy
- University of Catania, Italy
| | - Calum Macdonald
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Chulwoo Park
- Department of Public Health and Recreation, San José State University, San Jose, California, USA
| | | | | | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Zhi Xiang Ng
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Mila Nu Nu Htay
- Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Melaka, Malaysia
| | | | | | - Smruti Patel
- Editor, Journal of Global Health Reports, Washington, USA
| | - Prince Peprah
- Social Policy Research Centre/Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Ozren Polasek
- Croatian Science Foundation, Zagreb, Croatia
- Algebra University College, Zagreb, Croatia
| | - Renata Riha
- Royal Infirmary of Edinburgh, University of Edinburgh, UK
| | | | - Emma Sacks
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Konstantin Sharov
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, Russia
| | | | | | - Rosnah Sutan
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Dialechti Tsimpida
- Department of Public Health, Policy and Systems, The University of Liverpool, UK
| | | | | | - Laura B Vokey
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Liang Wang
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Kerri Wazny
- Children's Investment Fund Foundation, London, UK
| | - Jingyi Xu
- School of Health Humanities, Peking University, Beijing, China
| | | | | | - Jin Cao
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, China
| | - Yajie Zhu
- School of Information Science and Technology, Hangzhou Normal University, Hangzhou, China
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
- Croatian Science Foundation, Zagreb, Croatia
| | - International Society of Global Health (ISoGH)
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, China
- School of Health & Life Sciences, Teesside University, UK
- Department of Health Policy and Administration, The Pennsylvania State University, USA
- Gombe State University, Gombe, Nigeria
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
- Department of Sociology and Behavioral Sciences, De La Salle University, Manila, Philippines
- Norwegian University of Life Sciences, Ås, Norway
- Public Health Development Organization, El Paso, USA
- School of Medicine, University of Zagreb, Croatia
- African Studies, University of Vienna, Austria
- Universidad Adolfo Ibañez, Santiago, Chile
- Olomouc University Social Health Institute, Palacký University, Olomouc, Czechia
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
- School of Social Sciences, Monash University, Australia
- Weill Cornell Medicine – Qatar, Doha, Qatar
- The World Bank, Washington, USA
- Universitas Pelita Harapan, Jakarta, Indonesia
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Seberang Jaya Hospital, Ministry of Health, Malaysia
- The Task force for Global Health, Addis Ababa, Ethiopia
- Croatian Institute for Brain Research, Zagreb University School of Medicine, Zagreb, Croatia
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- University of Bradford, UK
- University of Nigeria, Enugu Campus, Nigeria
- Department of Nutrition, University of Oslo, Norway
- Egyptian Representative, Committee of Fellows of Obstetrics and Gynaecology, Oxford, UK, and Royal Berkshire Hospital, NHS, UK
- Oasi Research Institute-IRCCS, Troina, Italy
- University of Catania, Italy
- Department of Public Health and Recreation, San José State University, San Jose, California, USA
- University of Dhaka, Bangladesh
- Jos University Teaching Hospital, Nigeria
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
- Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Melaka, Malaysia
- Lagos State University, Ojo, Lagos, Nigeria
- Clemson University, USA
- Editor, Journal of Global Health Reports, Washington, USA
- Social Policy Research Centre/Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- Croatian Science Foundation, Zagreb, Croatia
- Algebra University College, Zagreb, Croatia
- Royal Infirmary of Edinburgh, University of Edinburgh, UK
- Universidad San Sebastián, Santiago, Chile
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, Russia
- Pasteur Institute, Novi Sad, Novi Sad, Serbia
- Children and Mother Health Movement Action, Yogyakarta, Indonesia
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Stellenbosch University, Cape Town, South Africa
- Massachusetts General Hospital, Boston, USA
- Department of Public Health, Policy and Systems, The University of Liverpool, UK
- University of Puthisastra, Phnom Penh, Cambodia
- Department of Hematology, Dubrava University Hospital, Zagreb, Croatia
- Guangdong Provincial People’s Hospital, Guangzhou, China
- Children's Investment Fund Foundation, London, UK
- School of Health Humanities, Peking University, Beijing, China
- World Health Organization, Geneva, Switzerland
- Capital Institute of Pediatrics, Beijing, China
- School of Information Science and Technology, Hangzhou Normal University, Hangzhou, China
- Usher Institute, University of Edinburgh, UK
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19
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Avrusin IS, Abramova NN, Belozerov KE, Bregel LV, Efremova OS, Vilnits AA, Konstantinova JE, Isupova EA, Kornishina TL, Masalova VV, Kalashnikova OV, Chasnyk VG, Aleksandrovich YS, Ivanov DO, Kostik MM. Using HScore for Evaluation of Hemophagocytosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children. Biomedicines 2024; 12:294. [PMID: 38397896 PMCID: PMC10886863 DOI: 10.3390/biomedicines12020294] [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: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Hemophagocytic syndrome is a key point in the pathogenesis of severe forms of multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C). The factors associated with hemophagocytosis in patients with MIS-C were assessed in the present study of 94 boys and 64 girls ranging in age from 4 months to 17 years, each of whose HScore was calculated. In accordance with a previous analysis, patients with HScore ≤ 91 (n = 79) and HScore > 91 (n = 79) were compared. Patients with HScore > 91 had a higher frequency of symptoms such as cervical lymphadenopathy, dry cracked lips, bright mucous, erythema/swelling of hands and feet, peeling of fingers, edematous syndrome, hepatomegaly, splenomegaly, and hypotension/shock. They also had a higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and D-dimer levels, and a tendency to anemia, thrombocytopenia, and hypofibrinogenemia. They more often needed acetylsalicylic acid and biological treatment and were admitted to ICU in 70.9% of cases. Conclusion: The following signs of severe MIS-C were associated with HScore > 91: myocardial involvement, pericarditis, hypotension/shock, and ICU admission.
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Affiliation(s)
- Ilia S. Avrusin
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Natalia N. Abramova
- Intensive Care Unit Department, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (N.N.A.); (Y.S.A.)
| | - Konstantin E. Belozerov
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Liudmila V. Bregel
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia; (L.V.B.); (O.S.E.)
- Department of Cardiology, Irkutsk Regional Children’s Hospital, Irkutsk 664022, Russia
| | - Olesya S. Efremova
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia; (L.V.B.); (O.S.E.)
- Department of Cardiology, Irkutsk Regional Children’s Hospital, Irkutsk 664022, Russia
| | - Alla A. Vilnits
- Pediatric Infectious Department, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia;
- Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia;
| | - Julia E. Konstantinova
- Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia;
| | - Eugenia A. Isupova
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Tatiana L. Kornishina
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Vera V. Masalova
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Olga V. Kalashnikova
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Vyacheslav G. Chasnyk
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
| | - Yuriy S. Aleksandrovich
- Intensive Care Unit Department, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (N.N.A.); (Y.S.A.)
| | - Dmitri O. Ivanov
- Neonatology Department, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Mikhail M. Kostik
- Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia; (K.E.B.); (E.A.I.); (T.L.K.); (V.V.M.); (O.V.K.); (V.G.C.)
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20
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Zacharias J, Mandalia U, Palman J, Kagalwala F, Colaco CB, Pillai JK. Phalangeal microgeodic syndrome: a paediatric case series. Skeletal Radiol 2024:10.1007/s00256-024-04581-y. [PMID: 38244062 DOI: 10.1007/s00256-024-04581-y] [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: 04/01/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1 years, ranging from 10.4 to 16.6 years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.
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Affiliation(s)
- Jasmine Zacharias
- West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, England
| | - Uday Mandalia
- West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, England
| | - Jason Palman
- West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, England
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21
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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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22
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Henderson LA. COVID-19-Related Multi-systemic Inflammatory Syndrome in Children (MIS-C). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:409-425. [PMID: 39117830 DOI: 10.1007/978-3-031-59815-9_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infections in children. This syndrome manifests about a month after the initial viral infection and is characterized by fever, multiorgan dysfunction, and systemic inflammation. This chapter will review the emergence, epidemiology, clinical characteristics, diagnosis, pathophysiology, immunomodulatory treatment, prognosis, outcomes, and prevention of MIS-C. While the pathophysiology of MIS-C remains to be defined, it is a post-infection, hyperinflammatory syndrome of childhood with elevated inflammatory cytokines.
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Affiliation(s)
- Lauren A Henderson
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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23
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Abdeladim B, Massilia B, Aziza E, Zohair E, Ayad G, Maria R. Multisystem Inflammatory Syndrome in Children (MIS-C) in a Low-income Country: What Treatment Should be Adopted in Case of a Lack of Immunoglobulin? Rev Recent Clin Trials 2024; 19:150-157. [PMID: 38151848 DOI: 10.2174/0115748871257131231204114803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION In multisystem inflammatory syndrome (MIS-C), children typically present high-grade fever, gastrointestinal symptoms, Kawasaki-like symptoms, and even a toxic shock-like syndrome days to weeks after recovering from SARS-CoV-2 infection. It is important to raise awareness of this condition in order to have early diagnosis and immediate treatment of patients. We have, herein, reported 44 cases of MIS-C with various risk factors and symptoms. Furthermore, we have emphasized the efficacy of experience in treating children with MIS-C with high-dose corticosteroids as an alternative to immunoglobulin in low-income countries. METHODS We conducted a targeted survey of MIS-C from early May 2020 to October 2022 on 44 children and adolescents with characteristics of multisystem inflammatory syndrome admitted to the pediatric department of the university hospital center in Oujda, Morocco, to which patients diagnosed with MIS-C were referred. The case definition included six criteria: serious illness leading to hospitalization, age under 18 years, fever of at least 24 hours, laboratory evidence of inflammation, multi-organ involvement, biological inflammatory syndrome, and evidence of coronavirus infection based on polymerase chain reaction, antibody testing or exposure to people with COVID-19 in the past month. The criteria used to diagnose myocarditis were impaired left ventricular function, central mitral leak, and elevation of BNP or pro-BNP. Coronary involvement was assessed by the z-score and the criteria for its presence was a z-score equal to or greater than 2.5. RESULTS Our study included 44 children and adolescents with MIS-C in our hospital, with male predominance (79%) and a median age of six years. Cardiovascular involvement was present in 91%, mucocutaneous in 78%, gastrointestinal in 70%, hematologic in 84%, and respiratory in 2% of patients. Coronary abnormalities (z-score ≥ 2.5) were documented in 21 cases (48%). Glucocorticoids were frequently used in comparison to immunoglobulin, which were uncommonly available and expensive. CONCLUSION The therapeutic protocol that was adopted was high doses of short-term prednisone (Cortancyl) at 4mg/kg/day for 4 days. Favorable outcome was noted in all patients over a 2-year period.
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Affiliation(s)
| | - Bouhmidi Massilia
- Department of Pediatrics, University Hospital Center Mohamed VI OUJDA, Morocco
| | - Elouali Aziza
- Department of Pediatrics, University Hospital Center Mohamed VI OUJDA, Morocco
| | - Elhaddar Zohair
- Department of Pediatrics, University Hospital Center Mohamed VI OUJDA, Morocco
| | - Ghanam Ayad
- Department of Pediatrics, University Hospital Center Mohamed VI OUJDA, Morocco
| | - Rkain Maria
- Department of Pediatrics, University Hospital Center Mohamed VI OUJDA, Morocco
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24
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Andre MC, Sanchez C, Bressieux-Degueldre S, Perez MH, Wütz D, Blanchard-Rohner G, Grazioli S, Schöbi N, Trück J, Welzel T, Atkinson A, Schlapbach LJ, Bielicki J. Cardiac assessment and inflammatory markers in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV2 (PIMS-TS) treated with methylprednisolone versus intravenous immunoglobulins: 6-month follow-up outcomes of the randomised controlled Swissped RECOVERY trial. EClinicalMedicine 2024; 67:102358. [PMID: 38107550 PMCID: PMC10722439 DOI: 10.1016/j.eclinm.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Previous findings from the Swissped RECOVERY trial showed that patients with Pediatric Inflammatory Multisystem Syndrome-Temporally Associated with SARS-CoV-2 (PIMS-TS) who were randomly assigned to intravenous immunoglobulins or methylprednisolone have a comparable length of hospital stay. Here, we report the 6-month follow-up outcomes of cardiac pathologies and normalisation of clinical or laboratory signs of inflammation from this study population. Methods This pre-planned follow-up of patients with PIMS-TS included the Swissped RECOVERY Trial reports on the 6-month outcomes of the cohort after randomisation, with a focus on cardiac, haematological, and biochemical findings. The trial was an investigator-initiated randomised multicentre open-label two-arm trial in children and adolescents hospitalised with PIMS-TS at ten hospitals in Switzerland. Cardiological assessments and laboratory analyses were prospectively collected in the intention-to-treat analysis on pre-defined intervals after hospital discharge. Differences between randomised arms were investigated using Chi-square test for categorical and Wilcoxon test for continuous variables. The trial is registered with the Swiss National Clinical Trials Portal (SNCTP000004720) and ClinicalTrials.gov (NCT04826588). Findings Between May 21, 2021 and April 15, 2022, 75 patients with a median age of 9.1 years (IQR 6.2-12.2) were included in the intention-to-treat population (37 in the methylprednisolone group and 38 in the intravenous immunoglobulin group). During follow-up, the incidence of abnormal left ventricular systolic function, coronary artery aneurysms (CAA), and other signs of inflammation were comparable in both groups. However, we detected cardiac abnormalities with low incidence and a mild degree grade of pathology. CAAs were observed in 2/38 children (5.3%) in the IVIG group and 1/37 children (2.7%) in the methylprednisolone group at 6-month follow-up (difference proportion 0.75; 95% confidence interval (CI) -0.05 to 1.0; p = 0.39). Interpretation Methylprednisolone alone may be an acceptable first-line treatment as left ventricular systolic dysfunction and clinical/laboratory evidence for inflammation quickly resolved in all children. However, our findings need further confirmation through larger studies as our sample size is likely to be of insufficient power to address rare clinically relevant adverse outcomes. Funding NOMIS, Vontobel, and Gaydoul Foundation.
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Affiliation(s)
- Maya C Andre
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Department of Pediatric Haematology and Oncology, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Carlos Sanchez
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Sabrina Bressieux-Degueldre
- Paediatric Cardiology Unit, Department of Women-Mother-Child, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland
| | - Marie-Helene Perez
- Paediatric Intensive and Intermediate Care Units, Department of Women-Mother-Child, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland
| | - Daniela Wütz
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Geraldine Blanchard-Rohner
- Pediatric Immunology and Vaccinology Unit, Division of General Pediatrics, Department of Child, Woman and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Department of Child, Woman and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nina Schöbi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Trück
- Divisions of Allergy and Immunology and Children's Research Center, University Children's Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Tatjana Welzel
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrew Atkinson
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Paediatric Intensive Care Unit, Child Health Research Centre, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia
| | - Julia Bielicki
- Paediatric Research Centre, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Centre for Neonatal and Paediatric Infection, St George's University, London, United Kingdom
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25
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Karas T, Scala M, Biebl A, Steiner J, Fellner F, Tulzer G, Tulzer A. Cardiac MRI six months after the onset of multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19: A retrospective follow-up study. Cardiol Young 2024; 34:183-188. [PMID: 38031446 DOI: 10.1017/s1047951123004110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND In 2020, reports revealed cases called multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 or multisystem inflammatory syndrome in children. A small proportion of patients suffer from persistent left ventricular dysfunction at discharge. The primary aim was to investigate if myocardial impairment persists during follow-up in these patients. METHODS Children fulfilling the criteria for multisystem inflammatory syndrome in children with cardiac involvement hospitalized between December 2020 and February 2022 were included in this retrospective single centre study. Cardiac MRI was performed six months after the onset of symptoms to evaluate possible persistent myocardial damage. RESULTS Fifteen patients (80% male) with a median age of 8 years (interquartile range 4.5 - 13.5 years) were included. Upon admission, eight patients (53%) presented with reduced left ventricular function, with a median left ventricular ejection fraction of 54% (interquartile range 49.5%-61.5%) on transthoracic echocardiography. Elevated levels of cardiac-specific markers were found in 14 patients (93%). Cardiac MRI was performed in 12 patients at a median of 190.5 days after the onset of symptoms. Nine patients (75%) had normal left ventricular function, with a median left ventricular ejection fraction of 59.45%, while the remaining patients showed mildly to moderately reduced values. None of the patients showed signs of late gadolinium enhancement, indicating the absence of persistent myocardial scarring. CONCLUSION During a follow-up of 6.2 months, mild to moderate cardiac impairment was revealed in 25% of patients evaluated by cardiac MRI. Although a majority of patients do not show signs of cardiac impairment, close follow-ups should be performed in a proportion of patients.
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Affiliation(s)
- Thomas Karas
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Mario Scala
- Central Radiology Institute, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Ariane Biebl
- Department of Paediatrics, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Jürgen Steiner
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
| | - Franz Fellner
- Central Radiology Institute, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Gerald Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Andreas Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital Linz, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
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26
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Edwards KM. The Therapy of SARS-CoV-2 Infection in Children. J Clin Med 2023; 13:120. [PMID: 38202127 PMCID: PMC10779459 DOI: 10.3390/jcm13010120] [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: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
The impact of SARS-CoV-2 infections in children has fortunately been lower than what has been seen in adults. However, even previously healthy children have developed severe disease, sometimes with subsequent mortality, and those who are infants or adolescents, are from racial and ethnic minority groups, or have certain chronic conditions are at higher risk of these outcomes. During the pandemic, extensive studies of therapeutic agents, including antivirals and immunomodulators, were conducted in adults. Few trials included children, and most were in older children and adolescents. Thus, the potential benefits of therapies in children must be extrapolated from adult evidence. Despite these limitations, advisory committees of the National Institute of Health (NIH), the Infectious Disease Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) were constituted, and expert consensus guidelines were developed. This review provides a synthesis of those comprehensive recommendations for therapy in children. These address treatment during the early infectious period with antiviral agents, including remdesivir and nirmatrelvir/ritonavir, as well as treatment in the later period of immune dysregulation with corticosteroids and immunomodulators. In addition, the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C), also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is also provided.
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Affiliation(s)
- Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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27
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Grabot C, Brard M, Hilaire D, Drame M, Gbaguidi GN, Elenga N, Tuttle S, Hatchuel Y, Levy M, Flechelles O, Felix A. Description and outcomes of Afro-Caribbean children treated for multisystem inflammatory syndrome in the French West Indies. Heliyon 2023; 9:e22642. [PMID: 38046139 PMCID: PMC10687232 DOI: 10.1016/j.heliyon.2023.e22642] [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: 05/26/2023] [Revised: 10/06/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Several studies have reported a higher frequency and greater morbidity and mortality of multisystem inflammatory syndrome in children (MIS-C) of black African descent. Objectives We aimed to describe the clinical, laboratory and echocardiographic characteristics as well as outcomes of children with MIS-C requiring admission to a pediatric intensive care unit (PICU) in the French West Indies (FWI), where the majority of the population is Afro-Caribbean. Methods Ambidirectional observational cohort study between April 1, 2020 and August 31, 2022. Children (age ≤18 years) with MIS-C and organ failure were included. Every patient was monitored and treated following the same protocol, with repeated biological tests, echocardiography, intravenous steroids and polyvalent immunoglobulins. The primary outcomes were clinical, laboratory and echocardiography characteristics. Results Forty children (median age 7 years, range: 5-11) were included. The majority (77 %) were included prospectively. Thirty-five (87 %) had gastrointestinal symptoms, 30 (75 %) presented initial heart failure (with persisting diastolic dysfunction at day 7) and 18 (45 %) had pericarditis. Sixteen (40 %) were in cardiogenic shock and required inotropic support. Median duration of inotropic support and hospitalization in PICU were respectively 4 and 5 days. The evolution curves of the inflammatory variables matched after treatment. The clinical outcomes were favorable. The Delta variant was associated with the highest incidence of MIS-C. Conclusion This is the first description of MIS-C course among children of Afro-Caribbean descent. The outcomes were good, without any death or cardiac sequelae. Our work does not support an ethnic susceptibility for severity of MIS-C in Afro-Caribbean population.
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Affiliation(s)
- Charlène Grabot
- Pediatric Intensive Care Unit, University Hospital of Martinique, Fort-de-France, France
| | - Mélanie Brard
- Antilles-Guyane M3C Pediatric Cardiology Center, University Hospital of Martinique, Fort-de-France, Martinique, France
| | - Daphnée Hilaire
- Department of Pediatrics, Guadeloupe University Hospital, Pointe-à-Pitre, France
| | - Moustapha Drame
- Department of Clinical Research and Innovation, Martinique University Hospital, Fort-de-France, France
| | - Gwladys Nadia Gbaguidi
- Scientific Researcher (EMERGEN Referent), Santé publique France Antilles, Guyane, France
| | - Narcisse Elenga
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Saskia Tuttle
- Antilles-Guyane M3C Pediatric Cardiology Center, University Hospital of Martinique, Fort-de-France, Martinique, France
| | - Yves Hatchuel
- Department of General Pediatrics, Competence Center for Rheumatic, Autoimmune and Systemic diseases in Children (RAISE) Antilles-Guyane, Martinique University Hospital, Fort-de France, France
| | - Michaël Levy
- Pediatric Intensive Care Unit, University Hospital Robert-Debré, Paris Cité University, Paris, France
| | - Olivier Flechelles
- Pediatric Intensive Care Unit, University Hospital of Martinique, Fort-de-France, France
| | - Arthur Felix
- Department of General Pediatrics, Competence Center for Rheumatic, Autoimmune and Systemic diseases in Children (RAISE) Antilles-Guyane, Martinique University Hospital, Fort-de France, France
- Department of Pediatrics, Reference Center for RAISE, University Hospital Robert-Debré, Paris, France
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28
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Amonkar PS, Kharche SN, Madave AA, Gavhane JB. Multisystem Inflammatory Syndrome in Children: Experience from October 2020 to January 2021 at a Tertiary Hospital in Navi Mumbai, India. J Pediatr Intensive Care 2023; 12:319-324. [PMID: 37970146 PMCID: PMC10631844 DOI: 10.1055/s-0041-1735494] [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: 04/29/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022] Open
Abstract
Although presentation of multisystem inflammatory syndrome (MIS-C) in children is typically with fever and symptoms like diarrhea, vomiting, rash, conjunctival injection, or shock, the spectrum of associated multisystem involvement is wide. Here, we present an account of patients with MIS-C that presented at a tertiary hospital in Navi Mumbai, India in the latter half of the pandemic from October 2020 to January 2021. We retrospectively studied the clinical features of 12 patients satisfying World Health Organization criteria for MIS-C. Eleven (91.6%) required PICU admission. Median age was 7 years and two had comorbidity. At the time of presentation, eight (66.6%) had respiratory failure, four (33.3%) had shock, and one (8.3%) had renal failure. The most common system involved was respiratory (75%) followed by mucocutaneous manifestations (66.6%). Seven patients (58.3%) showed involvement of >4 systems. Atypical presentations included a 14-year-old male with COVID-19 like pulmonary involvement on computed tomography, and a 20-month-old male with gross hematuria, nephrotic range proteinuria, and rapidly progressive renal failure. Elevated N-terminal-pro B-type natriuretic peptide was seen in 75% patients and abnormal two-dimensional echo in 50%. All patients were treated with intravenous methylprednisolone at 30 mg/kg/day for 5 days. Death occurred in three (25%), all of whom had hypotensive shock at presentation. In the wake of an ongoing pandemic, any febrile child with nonspecific symptoms suggestive of multisystem involvement warrants suspicion of MIS-C and should be evaluated with the help of markers of systemic inflammation and organ involvement, after ruling out other obvious causes. We report good response to methylprednisolone in patients without hypotensive shock at presentation and its use as firstline drug may be considered in settings with financial constraints.
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Affiliation(s)
- Priyanka S. Amonkar
- Department of Pediatrics, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Suhas N. Kharche
- Department of Pediatrics, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Amol A. Madave
- Department of Pediatrics, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Jeetendra B. Gavhane
- Department of Pediatrics, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
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29
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Scarduelli L, De Guillebon De Resnes JM, Ducreux D, Bernardor J, Afanetti M, Dupont A, Barthelemy S, Gondon E, Leporati J, Giovannini-Chami L, Moceri P. Cardiac manifestations of MIS-C: cardiac magnetic resonance and speckle-tracking data. Front Cardiovasc Med 2023; 10:1288176. [PMID: 38028482 PMCID: PMC10657844 DOI: 10.3389/fcvm.2023.1288176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cardiac involvement is central in MIS-C and represents the main cause of morbidity. In this study, we aimed to assess myocardial damage in patients with MIS-C using cardiac magnetic resonance (CMR) during the acute phase, as well as left ventricular and atrial longitudinal strain on admission, at discharge, and after 3 months. Methods We performed a single-center prospective cohort study and case-control study. Between September 2020 and February 2022, we enrolled 39 patients hospitalized for MIS-C at our center. We performed left ventricular and atrial longitudinal 2D strain analysis on admission and during follow-up; echocardiographic data were compared to a matched control population. Patients above 4 years old with increased troponin underwent CMR. Results Of 24 patients (mean age: 8.2 ± 4.9 years) who underwent CMR, 14 (58%) presented myocardial edema and 6 (25%) late gadolinium enhancement (LGE). LGE was associated with older age (p < 0.01), increased BMI (p = 0.03), increased ferritin levels (p < 0.001), lower left ventricular (LV) ejection fraction (p < 0.001), LV longitudinal strain (p = 0.004), left atrial (LA) strain (p = 0.05), and prolonged hospital stay (p = 0.02). On admission, LV ejection fraction, LV longitudinal strain, and LA strain were impaired, but each improved gradually over time; LVEF was the fastest to recover, while global LV longitudinal strain was still impaired as compared to controls after 3 months (p = 0.01). Conclusion Our study demonstrates that myocardial injury is present in a quarter of MIS-C patients, and impaired LA and LV myocardial deformation persist for at least several weeks after the acute phase. CMR and LV/LA strain could help us to individualize follow-up of MIS-C patients.
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Affiliation(s)
- Lorenzo Scarduelli
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
- UR2CA, Faculté de Médecine, Equipe CARRES, Université Côte d’Azur, Nice, France
| | | | - Dorothée Ducreux
- Service de Radiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Julie Bernardor
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
- Faculté de Médecine, Université Côte d’Azur, Nice, France
| | - Mickael Afanetti
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Audrey Dupont
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | | | - Emmanuelle Gondon
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Julien Leporati
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Lisa Giovannini-Chami
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
- Faculté de Médecine, Université Côte d’Azur, Nice, France
| | - Pamela Moceri
- UR2CA, Faculté de Médecine, Equipe CARRES, Université Côte d’Azur, Nice, France
- Faculté de Médecine, Université Côte d’Azur, Nice, France
- Service de Cardiologie, Centre Hospitalier Universitaire de Nice, Nice, France
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30
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Chaudhuri M, Tomar M, Shankar B. Unveiling post-MIS-N cardiomyopathy by longitudinal multimodality global cardiac assessment from neonatal insult to 16-month follow-up. Ann Pediatr Cardiol 2023; 16:463-467. [PMID: 38817253 PMCID: PMC11135888 DOI: 10.4103/apc.apc_114_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 06/01/2024] Open
Abstract
A full-term male neonate presented on the 11th day of life with late-onset multisystem inflammatory syndrome-neonate (MIS-N) (cardioneurological compromise). Immediate anti-inflammatory modulation led to a gradual recovery of neurological and coronary lesions. However, temporal evaluation unmasked silent myocardial dysfunction in echocardiography validated further by elevated biomarkers, myocardial fibrosis in cardiac magnetic resonance imaging, and abnormal strain study persisting till 16 months of follow-up. This revealed a hitherto unknown and rare progression of MIS-N into dilated cardiomyopathy.
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Affiliation(s)
- Maitri Chaudhuri
- Consultant, Department of Pediatric Cardiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Munesh Tomar
- Director, Department of Pediatric Cardiology and Congenital Heart Diseases, Max Super Speciality Hospital, New Delhi, India
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31
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Le Guen C, Leroy E, Pennetier M, Launay É, Bichali S, Prot-Labarthe S. [Illustrated case study of a patient with pediatric multisystem inflammatory syndrome]. SOINS. PEDIATRIE, PUERICULTURE 2023; 44:42-47. [PMID: 37980161 DOI: 10.1016/j.spp.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Between November 2020 and June 2021, twelve children were treated at a university hospital in western France for pediatric multisystem inflammatory syndrome (PIMS). While the clinical presentation may have been reminiscent of Kawasaki disease, PIMS, a new nosological entity, was mentioned in the media in the context of the Covid-19 pandemic. In 2023, research into this syndrome will continue in France and Europe.
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Affiliation(s)
- Camille Le Guen
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France.
| | - Estelle Leroy
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - Martine Pennetier
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - Élise Launay
- Pédiatrie générale, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France; Faculté de médecine, université de Nantes, 1 rue Gaston-Veil, 44000 Nantes, France
| | - Saïd Bichali
- Maladies chroniques de l'enfant et unité de soins continus, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - Sonia Prot-Labarthe
- Pharmacie clinique, centre hospitalier universitaire de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France; Faculté de pharmacie, université de Nantes, 9 rue Bias, 44000 Nantes, France; Inserm U1123, Eceve, site Villemin, 10 avenue de Verdun, 75010 Paris, France
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32
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Vaňková L, Bufka J, Křížková V. Pathophysiological and clinical point of view on Kawasaki disease and MIS-C. Pediatr Neonatol 2023; 64:495-504. [PMID: 37453902 PMCID: PMC10286520 DOI: 10.1016/j.pedneo.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/24/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023] Open
Abstract
This article compares two important pathophysiological states, Kawasaki disease, and multisystem inflammatory syndrome, in children associated with COVID-19 (MIS-C). Both occur predominantly in children, have a temporal association with an infectious agent, and are associated with immune-system alteration and systemic inflammation under certain circumstances. The two share common pathophysiology, including enhancement of interleukin-1 neutrophils, activation of the inflammasome, pyroptosis, or NETosis. Moreover, the clinical presentation of the diseases overlaps. However, they are indeed two separate diseases, proven by the differences in the epidemiological and etiological aspects and the pathophysiological processes involved in the development and frequency of some clinical signs. This article highlights potentially exciting areas that have not yet been studied in detail, which could help better understand the development of these diseases.
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Affiliation(s)
- Lenka Vaňková
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
| | - Jiří Bufka
- Department of Pediatrics, Teaching Hospital in Pilsen, Czech Republic
| | - Věra Křížková
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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33
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Jonat B, Geneslaw AS, Capone CA, Shah S, Bartucca L, Sewell TB, Acker KP, Mitchell E, Cheung EW. Early Treatment of Multisystem Inflammatory Syndrome in Children. Pediatrics 2023; 152:e2023061297. [PMID: 37534417 PMCID: PMC10471509 DOI: 10.1542/peds.2023-061297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory illness occurring after severe acute respiratory syndrome coronavirus 2 infection. The optimal treatment of MIS-C is unknown, although prior studies have indicated benefits of intravenous immunoglobulin (IVIG) and glucocorticoids. We hypothesize that early treatment with glucocorticoids is associated with shorter hospital length of stay (LOS). METHODS This study is a multicenter retrospective cohort study of patients hospitalized with MIS-C over a roughly 1-year period. The primary outcome was hospital LOS comparing subjects who received glucocorticoids within 48 hours of arrival to the treating hospital to those who did not. Secondary outcomes included ICU LOS. Unadjusted and adjusted analyses were performed. RESULTS The final analysis included 131 subjects. Subjects who received early glucocorticoids were more likely to receive early IVIG and to require ICU admission. Early glucocorticoid administration was associated with shorter ICU LOS (4 vs 9 days, P = .004) in the unadjusted analysis. In the adjusted analysis, early glucocorticoid administration and early IVIG administration were both independently associated with shorter hospital LOS (incidence rate ratio 0.75, P = .025; incidence rate ratio 0.56, P = .026, respectively). CONCLUSIONS Glucocorticoids and intravenous immunoglobulin were independently associated with shorter hospital length of stay when given early in hospitalization to MIS-C patients after accounting for potential confounding factors. The optimal dose and duration of treatment require further investigation, but this study supports early combination therapy with both IVIG and glucocorticoids for all children hospitalized with MIS-C.
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Affiliation(s)
- Brian Jonat
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Andrew S. Geneslaw
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Christine A. Capone
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Medical Center, Northwell Health, New Hyde Park
| | - Sareen Shah
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Medical Center, Northwell Health, New Hyde Park
| | - Lisa Bartucca
- Department of Pediatrics, Weill Cornell Medical Center, NewYork-Presbyterian Komansky Children’s Hospital, New York, New York
| | - Taylor B. Sewell
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Karen P. Acker
- Department of Pediatrics, Weill Cornell Medical Center, NewYork-Presbyterian Komansky Children’s Hospital, New York, New York
| | - Elizabeth Mitchell
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Medical Center, Northwell Health, New Hyde Park
| | - Eva W. Cheung
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
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Nagem Lopes LP, da Cunha LG, Silva ARO, Land MGP, Fonseca AR, Lopes LC, Lima EC. Multisystem inflammatory syndrome drug treatment in countries with different income profiles: a scoping review. Front Pharmacol 2023; 14:1228986. [PMID: 37680713 PMCID: PMC10481533 DOI: 10.3389/fphar.2023.1228986] [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: 05/25/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Objective: The purpose of this study was to map and describe the studies that have investigated therapeutic alternatives for the management of paediatric multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Considering the origin of the studies performed (low-, middle- and high-income countries), a systematic scoping review was conducted with primary studies that reported the use of medications for the treatment of patients with MIS-C. Sources: The searches were performed in MEDLINE, Embase, Lilacs, Epistemonikos, CINAHL, and CENTRAL, in the grey literature (theses and dissertations from CAPES, ProQuest, and PROSPERO) and in clinical trial databases until May 2022. The selection and extraction of studies were performed independently by two reviewers. Summary of the findings: A total of 173 studies were included, most of which were published as case reports or series. No randomized controlled clinical trials (RCTs) were identified. The investigated drugs were immunoglobulins, glucocorticoids, monoclonal antibodies, anticoagulants, and antiplatelet agents. Conclusion: The dosages, when reported, were heterogeneous among the studies. The ethnicity and comorbidity of the participants were poorly reported. Monoclonal antibodies, drugs with higher costs, were mostly described in studies of high-income countries.
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Affiliation(s)
| | | | | | | | - Adriana Rodrigues Fonseca
- Post-Graduate Program in Saúde Materno Infantil, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciane Cruz Lopes
- Post-Graduate Program in Pharmaceutical Sciences, University of Sorocaba, São Paulo, Brazil
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Brown RL, Benjamin L, Lunn MP, Bharucha T, Zandi MS, Hoskote C, McNamara P, Manji H. Pathophysiology, diagnosis, and management of neuroinflammation in covid-19. BMJ 2023; 382:e073923. [PMID: 37595965 DOI: 10.1136/bmj-2022-073923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately. Although good evidence has been found for neurovirulence, the neuroinvasive and neurotropic potential of SARS-CoV-2 is limited. The pathophysiology of most complications is immune mediated and vascular, or both. A significant proportion of patients have developed long covid, which can include neuropsychiatric presentations. The mechanisms of long covid remain unclear. The longer term consequences of infection with covid-19 on the brain, particularly in terms of neurodegeneration, will only become apparent with time and long term follow-up.
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Affiliation(s)
- Rachel L Brown
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Immunity and Transplantation, London, UK
| | - Laura Benjamin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Laboratory of Molecular and Cell Biology, London, UK
| | - Michael P Lunn
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Tehmina Bharucha
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Biochemistry, University of Oxford, UK
| | - Michael S Zandi
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Chandrashekar Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Patricia McNamara
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hadi Manji
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Avrusin IS, Abramova NN, Belozerov KE, Kondratiev GV, Bregel LV, Efremova OS, Vilnits AA, Konstantinova JE, Isupova EA, Kornishina TL, Masalova VV, Felker EY, Kalashnikova OV, Chasnyk VG, Aleksandrovich YS, Kostik MM. Determination of Risk Factors for Severe Life-Threatening Course of Multisystem Inflammatory Syndrome Associated with COVID-19 in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1366. [PMID: 37628366 PMCID: PMC10453228 DOI: 10.3390/children10081366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a life-threatening condition that often requires intensive care unit (ICU) admission. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. The study included 166 patients (99 boys, 67 girls) aged 4 months-17 years (median 8.2 years). The criterion of severity was the fact of ICU admission. To conduct a comparative analysis, MIS-C patients were divided into two groups: patients hospitalized in the ICU (n = 84, 50.6%) and those who did not need ICU admission (n = 82, 49.4%). Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, and neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin, and D-dimer levels. Additionally, the presence of macrophage activation syndrome was higher in patients admitted to the ICU. Conclusion: Nineteen predictors of severe course of MIS-C were found, out of which hepatomegaly, splenomegaly, D-dimer > 2568 ng/mL, troponin > 10 pg/mL were mainly associated with the probability of being classified as early predictors of severe MIS-C requiring ICU admission.
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Affiliation(s)
- Ilia S. Avrusin
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Natalia N. Abramova
- Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Konstantin E. Belozerov
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Gleb V. Kondratiev
- Pediatric Oncology Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Liudmila V. Bregel
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia
- Department of Cardiology, Irkutsk Regional Children’s Hospital, Irkutsk 664022, Russia
| | - Olesya S. Efremova
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia
- Department of Cardiology, Irkutsk Regional Children’s Hospital, Irkutsk 664022, Russia
| | - Alla A. Vilnits
- Pediatric Infectious Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
- The Research Department of Intensive Care of Emergency Conditions, Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia
| | - Julia E. Konstantinova
- The Research Department of Vaccination and Adverse Event Follow Immunization, Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg 197022, Russia
| | - Eugenia A. Isupova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Tatiana L. Kornishina
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Vera V. Masalova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Eugeniy Yu. Felker
- Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Olga V. Kalashnikova
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Vyacheslav G. Chasnyk
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Yuriy S. Aleksandrovich
- Intensive Care Unite Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Mikhail M. Kostik
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
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Chang JC, Young CC, Muscal E, Sexson Tejtel SK, Newhams MM, Kucukak S, Crandall H, Maddux AB, Rowan CM, Halasa NB, Harvey HA, Hobbs CV, Hall MW, Kong M, Aguiar CL, Schuster JE, Fitzgerald JC, Singh AR, Wellnitz K, Nofziger RA, Cvijanovich NZ, Mack EH, Schwarz AJ, Heidemann SM, Newburger JW, Zambrano LD, Campbell AP, Patel MM, Randolph AG, Son MBF. Variation in Early Anakinra Use and Short-Term Outcomes in Multisystem Inflammatory Syndrome in Children. Arthritis Rheumatol 2023; 75:1466-1476. [PMID: 36908050 PMCID: PMC10495537 DOI: 10.1002/art.42495] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/03/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Evidence regarding effectiveness of interleukin-1 receptor antagonism in multisystem inflammatory syndrome in children (MIS-C) is lacking. We characterized variation in initial treatment with anakinra and evaluated cardiovascular outcomes associated with adding anakinra to standard initial therapy. METHODS We conducted a retrospective cohort study of MIS-C cases in a US surveillance registry from November 2020 to December 2021. Day 0 was the first calendar day of immunomodulatory treatment. Factors associated with initial anakinra use (days 0-1) were identified. We compared cases in patients ages 2-20 years receiving intravenous immunoglobulin (IVIG) and glucocorticoids versus anakinra plus IVIG and/or glucocorticoids on days 0-1, using inverse probability weighting to balance disease severity. Primary outcomes were vasopressor requirement on day 3 and impaired left ventricular ejection fraction on days 3-4. The secondary outcome was 50% reduction in C-reactive protein on day 3. RESULTS Among 1,516 MIS-C cases at 44 sites, 193 (13%) patients received anakinra alone or with other immunomodulators as initial treatment (range 0-74% by site). Site accounted for 59% of residual variance in anakinra use. After balancing disease severity, initial treatment with anakinra plus IVIG and/or glucocorticoids (n = 121) versus IVIG plus glucocorticoids (n = 389) was not associated with significant differences in vasopressor requirement (25.6% versus 20.1%, respectively; risk ratio [RR] 1.27 [95% confidence interval (95% CI) 0.88-1.84]), ventricular dysfunction (33.7% versus 25.7%, respectively; RR 1.31 [95% CI 0.98-1.75]), or C-reactive protein reduction. CONCLUSION We identified substantial variation in initial anakinra use in a real-world population of children with MIS-C, but no average short-term improvement in cardiovascular outcomes associated with early addition of anakinra to IVIG and/or glucocorticoids compared to IVIG and glucocorticoids alone.
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Affiliation(s)
- Joyce C Chang
- Division of Immunology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cameron C Young
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Eyal Muscal
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Sara K Sexson Tejtel
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas
| | - Margaret M Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Suden Kucukak
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Hillary Crandall
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - Aline B Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Courtney M Rowan
- Division of Pediatric Critical Care Medicine and Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Helen A Harvey
- Department of Critical Care Medicine, Rady Children's Hospital-San Diego, San Diego, California
| | - Charlotte V Hobbs
- Division of Infectious Disease, Department of Pediatrics, University of Mississippi Medical Center, Jackson
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Cassyanne L Aguiar
- Department of Pediatric Rheumatology, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk
| | - Jennifer E Schuster
- Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Aalok R Singh
- Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City
| | - Ryan A Nofziger
- Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio
| | - Natalie Z Cvijanovich
- Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Elizabeth H Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Adam J Schwarz
- Division of Critical Care Medicine, Children's Hospital Orange County, Orange, California
| | - Sabrina M Heidemann
- Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Central Michigan University, Detroit
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, and Departments of Pediatrics and Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth F Son
- Division of Immunology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Rassi CE, Zareef R, Honeini R, Latouf C, Bitar F, Arabi M. Multisystem inflammatory syndrome in children: another COVID-19 sequel. Cardiol Young 2023; 33:1418-1428. [PMID: 37409933 DOI: 10.1017/s1047951123001579] [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] [Indexed: 07/07/2023]
Abstract
With the rapid expansion of the COVID-19 pandemic, the disease burden and its consequences on the paediatric population has been progressively recognised. Although COVID-19 infection in children presents as asymptomatic to mild illness, instances of hyperinflammation and multi-organ involvement following the viral infection have been described. This condition, known as the multisystem inflammatory syndrome in children (MIS-C), has gained a wide global attention. Despite the global efforts to uncover the disease characteristics and management, a clear pathogenesis and a unified treatment regimen have not been reached yet. This paper tackles the epidemiology of the MIS-C, discusses its suggested pathogenesis, drives through its varying clinical presentations, and evaluates the different treatment regimens employed in managing MIS-C.
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Affiliation(s)
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawan Honeini
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Latouf
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
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39
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Reis BCSD, Soares Faccion R, de Carvalho FAA, Moore DCBC, Zuma MCC, Plaça DR, Salerno Filgueiras I, Leandro Mathias Fonseca D, Cabral-Marques O, Bonomo AC, Savino W, Freitas FCDP, Faoro H, Passetti F, Robaina JR, de Oliveira FRC, Novaes Bellinat AP, Zeitel RDS, Salú MDS, de Oliveira MBG, Rodrigues-Santos G, Prata-Barbosa A, de Vasconcelos ZFM. Rare genetic variants involved in multisystem inflammatory syndrome in children: a multicenter Brazilian cohort study. Front Cell Infect Microbiol 2023; 13:1182257. [PMID: 37588055 PMCID: PMC10426286 DOI: 10.3389/fcimb.2023.1182257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/23/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Despite the existing data on the Multisystem Inflammatory Syndrome in Children (MIS-C), the factors that determine these patients evolution remain elusive. Answers may lie, at least in part, in genetics. It is currently under investigation that MIS-C patients may have an underlying innate error of immunity (IEI), whether of monogenic, digenic, or even oligogenic origin. Methods To further investigate this hypothesis, 30 patients with MIS-C were submitted to whole exome sequencing. Results Analyses of genes associated with MIS-C, MIS-A, severe covid-19, and Kawasaki disease identified twenty-nine patients with rare potentially damaging variants (50 variants were identified in 38 different genes), including those previously described in IFNA21 and IFIH1 genes, new variants in genes previously described in MIS-C patients (KMT2D, CFB, and PRF1), and variants in genes newly associated to MIS-C such as APOL1, TNFRSF13B, and G6PD. In addition, gene ontology enrichment pointed to the involvement of thirteen major pathways, including complement system, hematopoiesis, immune system development, and type II interferon signaling, that were not yet reported in MIS-C. Discussion These data strongly indicate that different gene families may favor MIS- C development. Larger cohort studies with healthy controls and other omics approaches, such as proteomics and RNAseq, will be precious to better understanding the disease dynamics.
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Affiliation(s)
- Bárbara Carvalho Santos Dos Reis
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Departamento de Imunologia, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Roberta Soares Faccion
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Flavia Amendola Anisio de Carvalho
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Departamento de Imunologia, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Daniella Campelo Batalha Cox Moore
- Unidade de Pacientes Graves, Departamento de Pediatria, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ, Brazil
| | - Maria Celia Chaves Zuma
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Desirée Rodrigues Plaça
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas (FCF), Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Programa de Pós-Graduação em Farmácia (Fisiopatologia e Toxicologia), FCF, USP, São Paulo, SP, Brazil
| | - Igor Salerno Filgueiras
- Departamento de Imunologia, Instituto de Ciências Biomédicas (ICB), USP, São Paulo, SP, Brazil
| | - Dennyson Leandro Mathias Fonseca
- Programa Interunidades de Pós-graduação em Bioinformática, Instituto de Matemática e Estatística (IME), USP, São Paulo, SP, Brazil
| | - Otavio Cabral-Marques
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas (FCF), Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Departamento de Imunologia, Instituto de Ciências Biomédicas (ICB), USP, São Paulo, SP, Brazil
- Programa Interunidades de Pós-graduação em Bioinformática, Instituto de Matemática e Estatística (IME), USP, São Paulo, SP, Brazil
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), São Paulo, Brazil
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
- Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Adriana Cesar Bonomo
- Laboratoírio de Pesquisas Sobre o Timo, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Instituto National de Ciencia e Tecnologia em Neuroimunomodulação (INCT/NIM), IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede FAPERJ de Pesquisa em Neuroinflamação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede INOVA-IOC em Neuroimunomodulação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Wilson Savino
- Laboratoírio de Pesquisas Sobre o Timo, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Instituto National de Ciencia e Tecnologia em Neuroimunomodulação (INCT/NIM), IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede FAPERJ de Pesquisa em Neuroinflamação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede INOVA-IOC em Neuroimunomodulação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Helisson Faoro
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas (ICC), FIOCRUZ, Curitiba, PR, Brazil
| | - Fabio Passetti
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas (ICC), FIOCRUZ, Curitiba, PR, Brazil
| | | | | | | | - Raquel de Seixas Zeitel
- Pediatric Intensive Care Unit, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Margarida dos Santos Salú
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira, Salvador, BA, Brazil
| | | | | | - Arnaldo Prata-Barbosa
- Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Pediatric Intensive Care Unit, Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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40
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Rollins CK, Calderon J, Wypij D, Taylor AM, Davalji Kanjiker TS, Rohde JS, Maiman M, Zambrano LD, Newhams MM, Rodriguez S, Hart N, Worhach J, Kucukak S, Poussaint TY, Son MBF, Friedman ML, Gertz SJ, Hobbs CV, Kong M, Maddux AB, McGuire JL, Licht PA, Staat MA, Yonker LM, Mazumdar M, Randolph AG, Campbell AP, Newburger JW. Neurological and Psychological Sequelae Associated With Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2023; 6:e2324369. [PMID: 37466939 PMCID: PMC10357334 DOI: 10.1001/jamanetworkopen.2023.24369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/04/2023] [Indexed: 07/20/2023] Open
Abstract
Importance Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge. Objective To characterize neurological, psychological, and quality of life sequelae after MIS-C. Design, Setting, and Participants This cross-sectional cohort study was conducted in the US and Canada. Participants included children with MIS-C diagnosed from November 2020 through November 2021, 6 to 12 months after hospital discharge, and their sibling or community controls, when available. Data analysis was performed from August 2022 to May 2023. Exposure Diagnosis of MIS-C. Main Outcomes and Measures A central study site remotely administered a onetime neurological examination and in-depth neuropsychological assessment including measures of cognition, behavior, quality of life, and daily function. Generalized estimating equations, accounting for matching, assessed for group differences. Results Sixty-four patients with MIS-C (mean [SD] age, 11.5 [3.9] years; 20 girls [31%]) and 44 control participants (mean [SD] age, 12.6 [3.7] years; 20 girls [45%]) were enrolled. The MIS-C group exhibited abnormalities on neurological examination more frequently than controls (15 of 61 children [25%] vs 3 of 43 children [7%]; odds ratio, 4.7; 95% CI, 1.3-16.7). Although the 2 groups performed similarly on most cognitive measures, the MIS-C group scored lower on the National Institutes of Health Cognition Toolbox List Sort Working Memory Test, a measure of executive functioning (mean [SD] scores, 96.1 [14.3] vs 103.1 [10.5]). Parents reported worse psychological outcomes in cases compared with controls, particularly higher scores for depression symptoms (mean [SD] scores, 52.6 [13.1] vs 47.8 [9.4]) and somatization (mean [SD] scores, 55.5 [15.5] vs 47.0 [7.6]). Self-reported (mean [SD] scores, 79.6 [13.1] vs 85.5 [12.3]) and parent-reported (mean [SD] scores, 80.3 [15.5] vs 88.6 [13.0]) quality of life scores were also lower in cases than controls. Conclusions and Relevance In this cohort study, compared with contemporaneous sibling or community controls, patients with MIS-C had more abnormal neurologic examinations, worse working memory scores, more somatization and depression symptoms, and lower quality of life 6 to 12 months after hospital discharge. Although these findings need to be confirmed in larger studies, enhanced monitoring may be warranted for early identification and treatment of neurological and psychological symptoms.
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Affiliation(s)
- Caitlin K. Rollins
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Johanna Calderon
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- National Institute of Health and Medical Research INSERM U1046, PhyMedExp, Montpellier, France
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
| | - David Wypij
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alex M. Taylor
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | - Julia S. Rohde
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Moshe Maiman
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laura D. Zambrano
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Susan Rodriguez
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Nicholas Hart
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Jennifer Worhach
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Suden Kucukak
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Tina Y. Poussaint
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth F. Son
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Matthew L. Friedman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis
| | - Shira J. Gertz
- Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey
| | - Charlotte V. Hobbs
- Division of Infectious Diseases, Department of Pediatrics, Department of Microbiology, University of Mississippi Medical Center, Jackson
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Aline B. Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Jennifer L. McGuire
- Division of Neurology at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Paul A. Licht
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Mary Allen Staat
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Lael M. Yonker
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Division of Pediatric Pulmonary and Mucosal Immunology and Biology Research Center, Division of Infectious Disease, Massachusetts General Hospital, Boston
| | - Maitreyi Mazumdar
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Adrienne G. Randolph
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Angela P. Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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McGlacken-Byrne SM, Johnson M, Penner J, du Pré P, Katugampola H. Characterising approaches to steroid therapy in paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2. J Paediatr Child Health 2023; 59:890-894. [PMID: 37114744 DOI: 10.1111/jpc.16408] [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: 10/21/2022] [Revised: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
AIM We describe approaches to steroid therapy use in paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and examine the association between steroid therapy and key clinical markers of severity. METHODS We conducted a retrospective review of children (<18 years) admitted to a tertiary paediatric hospital in the UK with PIMS-TS. We collected data on if and why steroid therapy was used; the duration, type and dosing of steroids prescribed; and approaches to hypothalamo-pituitary-adrenal (HPA) axis monitoring, if performed. We examined associations between steroid exposure/total steroid dose (mg/m2 /day) and paediatric intensive care unit admission, mechanical ventilation and inotropic support. RESULTS Steroid therapy was commenced in most children (84.9%, n = 104) with a median total daily steroid dose (hydrocortisone equivalent) of 271.0 mg/m2 /day (interquartile range 232.5-355.5) and treatment length of 26.0 days (interquartile range 19.0-32.0). Dosing regimens predominantly involved a short course of high-dose methylprednisolone followed by tapering oral prednisolone. Basal and/or dynamic testing of the HPA axis was conducted in a minority (11.8%, n = 15) and was normal. Duration of steroid therapy correlated positively with durations of paediatric intensive care unit admission (r = 0.407, P < 0.001) and mechanical ventilation (r = 0.797, P < 0.001). A greater proportion of children receiving steroid therapy also received inotropic support compared to those that did not receive steroid therapy (71.4% vs. 45.5%, P = 0.025). CONCLUSION Prolonged, high-dose steroid therapy is often used in the management of severe PIMS-TS with the potential for HPA axis suppression and should be withdrawn carefully.
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Affiliation(s)
- Sinéad M McGlacken-Byrne
- Department of Endocrinology, Great Ormond Street Hospital, London, United Kingdom
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Mae Johnson
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Justin Penner
- Department of Infectious Disease, Great Ormond Street Hospital, London, United Kingdom
| | - Pascale du Pré
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Harshini Katugampola
- Department of Endocrinology, Great Ormond Street Hospital, London, United Kingdom
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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42
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Rabady S, Hoffmann K, Aigner M, Altenberger J, Brose M, Costa U, Denk-Linnert DM, Gruber S, Götzinger F, Helbok R, Hüfner K, Koczulla R, Kurz K, Lamprecht B, Leis S, Löffler J, Müller CA, Rittmannsberger H, Rommer PS, Sator P, Strenger V, Struhal W, Untersmayr E, Vonbank K, Wancata J, Weber T, Wendler M, Zwick RH. [S1 guidelines for the management of postviral conditions using the example of post-COVID-19]. Wien Klin Wochenschr 2023; 135:525-598. [PMID: 37555900 PMCID: PMC10504206 DOI: 10.1007/s00508-023-02242-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 08/10/2023]
Abstract
These S1 guidelines are an updated and expanded version of the S1 guidelines on long COVID differential diagnostic and management strategies. They summarize the state of knowledge on postviral conditions like long/post COVID at the time of writing. Due to the dynamic nature of knowledge development, they are intended to be "living guidelines". The focus is on practical applicability at the level of primary care, which is understood to be the appropriate place for initial access and for primary care and treatment. The guidelines provide recommendations on the course of treatment, differential diagnostics of the most common symptoms that can result from infections like with SARS-CoV-2, treatment options, patient management and care, reintegration and rehabilitation. The guidelines have been developed through an interdisciplinary and interprofessional process and provide recommendations on interfaces and possibilities for collaboration.
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Affiliation(s)
- Susanne Rabady
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich.
| | - Kathryn Hoffmann
- Leiterin der Abteilung Primary Care Medicine, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martin Aigner
- Abteilung für Psychiatrie und psychotherapeutische Medizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Johann Altenberger
- Pensionsversicherungsanstalt, Rehabilitationszentrum Großgmain, Salzburger Str. 520, 5084, Großgmain, Österreich
| | - Markus Brose
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Ursula Costa
- Ergotherapie und Handlungswissenschaft, fhg - Zentrum für Gesundheitsberufe Tirol GmbH/fh, Innrain 98, 6020, Innsbruck, Österreich
| | - Doris-Maria Denk-Linnert
- Klinische Abteilung für Allgemeine Hals‑, Nasen- und Ohrenkrankheiten, Klin. Abteilung Phoniatrie-Logopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Samuel Gruber
- Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
| | - Florian Götzinger
- Abteilung für Kinderheilkunde, Klinik Ottakring, Montleartstr. 37, 1160, Wien, Österreich
| | - Raimund Helbok
- Universitätsklinik für Neurologie, Johannes Kepler Universität Linz, Standort Neuromed Campus & Med Campus Kepler Universitätsklinikum GmbH, 4020, Linz, Österreich
| | - Katharina Hüfner
- Dep. für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Universitätsklinik für Psychiatrie II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Rembert Koczulla
- Fachbereich Medizin, Klinik für Pneumologie Marburg, Baldingerstr., 35035, Marburg, Deutschland
| | - Katharina Kurz
- Innere Medizin II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Bernd Lamprecht
- Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum, 4020, Linz, Österreich
| | - Stefan Leis
- Universitätsklinik für Neurologie der PMU, MME Universitätsklinikum Salzburg Christian-Doppler-Klinik, Ignaz-Harrer-Str. 79, 5020, Salzburg, Österreich
| | - Judith Löffler
- Innere Medizin II, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Christian A Müller
- Klinische Abteilung für Allgemeine Hals‑, Nasen- und Ohrenkrankheiten, Klin. Abteilung für Allgemeine HNO, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Paulus S Rommer
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Paul Sator
- Dermatologische Abteilung, Klinik Hietzing, Wolkersbergenstr. 1, 1130, Wien, Österreich
| | - Volker Strenger
- Klinische Abteilung für Allgemeinpädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, 8036, Graz, Österreich
| | - Walter Struhal
- Klinische Abteilung für Neurologie, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Eva Untersmayr
- Institut für Pathophysiologie und Allergieforschung Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Karin Vonbank
- Klinische Abteilung für Pulmologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Johannes Wancata
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Thomas Weber
- Kardiologische Abteilung Klinikum Wels-Grieskirchen, Grieskirchnerstr. 42, 4600, Wels, Österreich
| | | | - Ralf-Harun Zwick
- Ludwig Boltzmann Institute for Rehabilitation Research, Kurbadstr. 14, 1100, Wien, Österreich
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Basaran O, Batu ED, Kaya Akca U, Atalay E, Kasap Cuceoglu M, Sener S, Balık Z, Karabulut E, Kesici S, Karagoz T, Ozsurekci Y, Bilginer Y, Cengiz AB, Ozen S. The Effect of Biologics in the Treatment of Multisystem Inflammatory Syndrome in Children (Mis-C): A Single-Center Propensity-Score-Matched Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1045. [PMID: 37371276 DOI: 10.3390/children10061045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition characterized by excessive inflammation that can arise as a complication of SARS-CoV-2 infection in children. While our understanding of COVID-19 and MIS-C has been advancing, there is still uncertainty regarding the optimal treatment for MIS-C. In this study, we aimed to compare the clinical and laboratory outcomes of MIS-C patients treated with IVIG plus corticosteroids (CS) to those treated with IVIG plus CS and an additional biologic drug. We used the propensity score (PS)-matching method to assess the relationships between initial treatment and outcomes. The primary outcome was a left ventricular ejection fraction of less than 55% on day 2 or beyond and/or the requirement of inotrope support on day 2 or beyond. We included 79 MIS-C patients (median age 8.51 years, 33 boys) followed in our center. Among them, 50 children (25 in each group) were allocated to the PS-matched cohort sample. The primary outcome was observed in none of the patients in the IVIG and CS group, while it occurred in eight patients in the IVIG plus CS and biologic group (p = 0.04). MIS-C is a disorder that may progress rapidly and calls for extensive care. For definitive recommendations, further studies, including randomized control trials, are required.
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Affiliation(s)
- Ozge Basaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ummusen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Muserref Kasap Cuceoglu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Seher Sener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Tevfik Karagoz
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ali Bulent Cengiz
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
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Paul T, Klingel K, Tschöpe C, Bertram H, Seidel F. Leitlinie Myokarditis der Deutschen Gesellschaft für
Pädiatrische Kardiologie. KLINISCHE PADIATRIE 2023; 235:e1-e15. [PMID: 37094605 PMCID: PMC10191740 DOI: 10.1055/a-2039-2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
This consensus statement presents updated recommendations on diagnosis and treatment of myocarditis in childhood.
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Affiliation(s)
- Thomas Paul
- Universitätsmedizin Göttingen Klinik für
Pädiatrische Kardiologie und Intensivmedizin, Göttingen,
Deutschland
| | - Karin Klingel
- Universitätshospital Tübingen, Institut für
Pathologie und Neuropathologie, Tübingen, Deutschland
| | - Carsten Tschöpe
- Charité Universitätsmedizin Berlin, Kardiologie,
Berlin, Deutschland
| | - Harald Bertram
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Kardiologie und Pädiatrische Intensivmedizin,
Hannover, Deutschland
| | - Franziska Seidel
- Charité Universitätsmedizn Berlin, Pädiatrische
Kardiologie, Berlin, Deutschland
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Varga P, Balajthy A, Biró E, Bíró B, Reiger Z, Szikszay E, Mogyorósy G, Káposzta R, Szabó T. Multicolored MIS-C, a single-centre cohort study. BMC Pediatr 2023; 23:190. [PMID: 37085781 PMCID: PMC10119512 DOI: 10.1186/s12887-023-03997-0] [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: 09/01/2022] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical and laboratory parameters that can predict the severity of Multisystem Inflammatory Syndrome in Children (MIS-C) at admission. METHODS We conducted a single-center, partly retrospective, partly prospective, observational cohort study between November 1, 2020 and December 31, 2021, which included patients aged from 1 month to 19 years, meeting the diagnostic criteria of MIS-C. We categorized the patients into three subgroups based on clinical and laboratory markers and assessed the predictive value of these factors in terms of ICU administration and cardiac abnormalities. RESULTS 53 patients were classified in the following subgroups: Kawasaki-like disease (group 1) (47.2%, n = 25), shock with or without acute cardiac dysfunction (group 2) (32%, n = 17), fever and inflammation (group 3) (20.8%, n = 11). Subgroup analysis revealed that patients with shock and KD at initial presentation had significantly more severe manifestation of MIS-C requiring intensive care unit (ICU) treatment. Of the initial laboratory values, only CRP showed a significant difference between the 3 clinical groups, being lower in group 3. 52.6% of patients were admitted to the ICU. The median length of ICU stay was 3 days (range 3-20). ICU admission was more likely in patients with shortness of breath, renal failure (AKI) and patients with significantly increased concentrations of ferritin, D-dimer, INR and significantly milder increase concentration of fibrinogen. We found that fibrinogen and ferritin levels are independent risk factors for ICU admission. Cardiac abnormalities were found in 56.6% of total (30/53), with the following findings: decreased left ventricular function (32%), coronary abnormality (11.3%), pericardial effusion (17%), arrhythmia (32.1%) and mitral regurgitation (26.6%). Diarrhea and conjunctivitis at the initial presentation with significantly elevated CRP, Pro-BNP and blood pH concentrations were found to be a potential predisposing factor for decreased cardiac function while Pro-BNP and pH were independent risk factors for MIS-C. Regardless of the initial symptoms of MIS-C, the outcome was generally favorable. CONCLUSIONS Clinical characteristics and baseline laboratory values may help identify patients at increased risk for severe disease outcome, such as need for intensive care, presence of shock and decreased cardiac function. TRIAL REGISTRATION Participation consent was not reqired and ethical considerations were unnecessary, since we did not perform any extra interventions, only the necessary and usual therapeutic and diagnostic methods were used.
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Affiliation(s)
- Petra Varga
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - András Balajthy
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Erika Biró
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Bernadett Bíró
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Zsolt Reiger
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Edit Szikszay
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Gábor Mogyorósy
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Rita Káposzta
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary
| | - Tamás Szabó
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032, Debrecen, Hungary.
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46
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Channon-Wells S, Vito O, McArdle AJ, Seaby EG, Patel H, Shah P, Pazukhina E, Wilson C, Broderick C, D'Souza G, Keren I, Nijman RG, Tremoulet A, Munblit D, Ulloa-Gutierrez R, Carter MJ, Ramnarayan P, De T, Hoggart C, Whittaker E, Herberg JA, Kaforou M, Cunnington AJ, Blyuss O, Levin M. Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study. THE LANCET. RHEUMATOLOGY 2023; 5:e184-e199. [PMID: 36855438 PMCID: PMC9949883 DOI: 10.1016/s2665-9913(23)00029-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health.
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Affiliation(s)
- Samuel Channon-Wells
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ortensia Vito
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew J McArdle
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Eleanor G Seaby
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Genomic Informatics Group, University of Southampton, Southampton, UK
- Translational Genomics Group, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Harsita Patel
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Priyen Shah
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | - Clare Wilson
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Claire Broderick
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Giselle D'Souza
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ilana Keren
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ruud G Nijman
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatric Emergency Medicine, Division of Medicine, St Mary's hospital-Imperial College NHS Healthcare Trust, London, London, UK
| | - Adriana Tremoulet
- Department of Paediatrics, University of California San Diego-Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Daniel Munblit
- Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectologia Pediatrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
- Cátedra de Pediatría, Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Michael J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Padmanabhan Ramnarayan
- Anaesthetics, Pain Medicine, and Intensive Care (APMIC) Division, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tisham De
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Clive Hoggart
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elizabeth Whittaker
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Jethro A Herberg
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Myrsini Kaforou
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Aubrey J Cunnington
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Levin
- Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
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Affiliation(s)
- Cathal Roarty
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Thomas Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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Welzel T, Atkinson A, Schöbi N, Andre MC, Bailey DGN, Blanchard-Rohner G, Buettcher M, Grazioli S, Koehler H, Perez MH, Trück J, Vanoni F, Zimmermann P, Sanchez C, Bielicki JA, Schlapbach LJ. Methylprednisolone versus intravenous immunoglobulins in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): an open-label, multicentre, randomised trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:238-248. [PMID: 36746174 PMCID: PMC9897729 DOI: 10.1016/s2352-4642(23)00020-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The emergence of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) led to the widespread use of anti-inflammatory treatments in the absence of evidence from randomised controlled trials (RCTs). We aimed to assess the effectiveness of intravenous methylprednisolone compared with intravenous immunoglobulins. METHODS This is an open-label, multicentre, two-arm RCT done at ten hospitals in Switzerland in children younger than 18 years hospitalised with PIMS-TS (defined as age <18 years; fever and biochemical evidence of inflammation, and single or multiorgan dysfunction; microbiologically proven or putative contact with SARS-CoV-2; and exclusion of any other probable disease). Patients were randomly assigned 1:1 to intravenous methylprednisolone (10 mg/kg per day for 3 days) or intravenous immunoglobulins (2 g/kg as a single dose). The primary outcome was length of hospital stay censored at day 28, death, or discharge. Secondary outcomes included proportion and duration of organ support. Analyses were done by intention-to-treat. The study was registered with Swiss National Clinical Trials Portal (SNCTP000004720) and ClinicalTrials.gov (NCT04826588). FINDINGS Between May 21, 2021, and April 15, 2022, 75 patients with a median age of 9·1 years (IQR 6·2-12·2) were included in the intention-to-treat population (37 in the methylprednisolone group and 38 in the intravenous immunoglobulins group). The median length of hospital stay was 6·0 days (IQR 4·0-8·0) in the methylprednisolone group and 6·0 days (IQR 5·0-8·8) in the intravenous immunoglobulins group (estimated effect size -0·037 of the log10 transformed times, 95% CI -0·13 to 0·065, p=0·42). Fewer patients in the methylprednisolone group (ten [27%] of 37) required respiratory support compared with the intravenous immunoglobulin group (21 [55%] of 38, p=0·025). Need and duration of inotropes, admission to intensive care units, cardiac events after baseline, and major bleeding and thrombotic events were not significantly different between the study groups. INTERPRETATION In this RCT, treatment with methylprednisolone in children with PIMS-TS did not significantly affect the length of hospital stay compared with intravenous immunoglobulins. Intravenous methylprednisolone could be an acceptable first-line treatment in children with PIMS-TS. FUNDING NOMIS Foundation, Vontobel Foundation, and Gaydoul Foundation.
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Affiliation(s)
- Tatjana Welzel
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland; Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland; Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrew Atkinson
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nina Schöbi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maya C Andre
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland; Department of Pediatric Hematology and Oncology, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Douggl G N Bailey
- Pediatric and Neonatal Intensive Care Unit, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Geraldine Blanchard-Rohner
- Pediatric Immunology and Vaccinology Unit, Division of General Pediatrics, Department of Child, Woman and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Michael Buettcher
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland; Paediatric Infectious Diseases Unit, Department of Pediatrics, Cantonal Hospital Lucerne, Lucerne, Switzerland; Faculty of Health Sciences and Medicine, University Lucerne, Lucerne, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Department of Child, Woman and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Henrik Koehler
- Department of Pediatrics, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Marie-Helene Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Johannes Trück
- Division of Immunology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Federica Vanoni
- Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Carlos Sanchez
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Julia A Bielicki
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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49
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Chew C, Ramanan AV. Immunoglobulin, glucocorticoid, or combined therapy for multisystem inflammatory syndrome in children. THE LANCET. RHEUMATOLOGY 2023; 5:e168-e169. [PMID: 36817950 PMCID: PMC9928483 DOI: 10.1016/s2665-9913(23)00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Athimalaipet V Ramanan
- School of Translational Health Sciences, University of Bristol, Bristol, UK
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
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50
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Differentiating abdominal pain due to COVID-19 associated multisystem inflammatory syndrome from children with acute appendicitis: a score system. Pediatr Surg Int 2023; 39:151. [PMID: 36897476 PMCID: PMC9999317 DOI: 10.1007/s00383-023-05432-y] [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] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Differentiating abdominal pain due to coronavirus disease (COVID-19)-associated multisystem inflammatory syndrome (MIS-C) in children with acute appendicitis (AA) can cause diagnostic dilemmas. This study aimed to evaluate the efficacy of a previously described scoring system and improve its diagnostic ability in differentiating between these diseases. METHODS This study was conducted between March 2020 and January 2022. Patients who had MIS-C with gastrointestinal system (GIS) involvement and patients who underwent surgery for appendicitis were included. First, all patients were evaluated using the new scoring system (NSS). The groups were compared by adding new MISC-specific parameters to NSS. The scoring system was evaluated using propensity score matching (PSM). RESULTS A total of 35 patients with abdominal pain due to GIS involvement in MIS-C (group A) and 37 patients with AA who had ALT, PRC, and D-dimer results at their first admission (group B) were included in the study. The mean age of patients in group A was lower than that of patients in group B (p < 0.001). False NSS positivity was found in 45.7% of the patients with MIS-C. Lymphocyte (p = 0.021) and platelet counts (p = 0.036) were significantly lower in the blood count and serum D-dimer (p = 0.034), C-reactive protein (CRP) (p < 0.001), and procalcitonin (p < 0.001) were significantly higher in the MIS-C group. We created a scoring system called the Appendicitis-MISC Score (AMS) using the NSS and new parameters. The sensitivity and specificity of AMS diagnostic scores were 91.9% and 80%, respectively. CONCLUSION MIS-C with GIS involvement may present as acute abdomen. It is difficult to differentiate this condition from acute appendicitis. AMS has been shown to be useful for this differentiation.
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