1
|
Glazyrina A, Zholobova E, Iakovleva E, Bobkova P, Krasnaya E, Kovygina K, Romanova O, Blyuss O, Tutelman K, Petrova P, Bairashevskaia A, Rumyantsev M, Korsunskiy AA, Kondrikova E, Nargizyan A, Yusupova V, Korobyants E, Sologub A, Kurbanova S, Suvorov A, Sigfrid L, Buonsenso D, Peroni DG, McArdle AJ, Comberiati P, Munblit D. Short-term and medium-term clinical outcomes of multisystem inflammatory syndrome in children: a prospective observational cohort study. Ital J Pediatr 2024; 50:1. [PMID: 38178192 PMCID: PMC10768316 DOI: 10.1186/s13052-023-01569-7] [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: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Even though the incidence of Multisystem Inflammatory Syndrome in children (MIS-C) is decreasing cases are still reported across the world. Studying the consequences of MIS-C enhances our understanding of the disease's prognosis. The objective of this study was to assess short- and medium-term clinical outcomes of MIS-C. METHODS Prospective observational cohort study at Municipal Children's Hospital Morozovskaya, Moscow, Russia. All children meeting the Royal College of Paediatrics and Child Health (RCPCH), Centers for Disease Control and Prevention (CDC), or the World Health Organization (WHO) MIS-C case definition admitted to the hospital between 17 May and 26 October 2020 were included in the study. All survivors were invited to attend a clinic at 2 and 6 weeks after hospital discharge. RESULTS 37 children median age 6 years (interquartile range [IQR] 3.3-9.4), 59.5% (22/37) boys were included in the study. 48.6% (18/37) of patients required ICU care. One child died. All children had increased levels of systemic inflammatory markers during the acute event. Echocardiographic investigations identified abnormal findings in 35.1% (13/37) of children. 5.6% (2/36) of children were presenting with any symptoms six weeks after discharge. By six weeks the inflammatory markers were within the reference norms in all children. The echocardiographic evaluation showed persistent coronary dilatation in one child. CONCLUSIONS Despite the severity of their acute MIS-C, the majority of children in our cohort fully recovered with none having elevated laboratory markers of inflammation at 6 weeks, few (< 10%) reporting persistent symptoms at 6 weeks, and only one with persistent echocardiographic abnormalities.
Collapse
Affiliation(s)
- Anastasia Glazyrina
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Elena Zholobova
- Department of Children Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina Bobkova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Krasnaya
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Karina Kovygina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Olga Romanova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Oleg Blyuss
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Centre for Prevention, Detection and Diagnosis, Queen Mary University of London, London, UK
| | - Konstantin Tutelman
- Veltischev Clinical Pediatric Research Institute of Pirogov Russian National Research Medical University, Moscow, Russia
| | - Polina Petrova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiia Bairashevskaia
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mikhail Rumyantsev
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anatoliy A Korsunskiy
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Kondrikova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anzhelika Nargizyan
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Valeriya Yusupova
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Evgeniya Korobyants
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Anna Sologub
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Seda Kurbanova
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Aleksandr Suvorov
- World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Andrew James McArdle
- Department of Infectious Disease, Section of Pediatric Infectious Disease, Imperial College London, London, UK
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
| |
Collapse
|
2
|
Carmona CA, Kuziez M, Freitas CF, Cyrus JW, Bain J, Karam O. Cardiac manifestations of multisystem inflammatory syndrome of children after SARS-CoV-2 infection: a systematic review and meta-analysis. Cardiol Young 2023; 33:2319-2327. [PMID: 36762563 DOI: 10.1017/s104795112300015x] [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: 02/11/2023]
Abstract
This systematic review and meta-analysis were conducted to evaluate the prevalence of cardiac manifestations associated with multisystem inflammatory syndrome in children worldwide. We conducted electronic searches in Ovid MEDLINE, Ovid EMBASE, and the World Health Organization COVID-19 Literature Database from the inception of the SARS-CoV-2 pandemic to 1 January, 2022. Three authors independently screened the abstracts to determine eligibility, assessed methodology in the full texts, and extracted the data.We identified 2848 citations; 94 studies (14,932 patients) were included. The prevalence of vasopressors was 48.2% (95% CI 45.1%, 51.3%), left ventricular systolic dysfunction occurred in 37.2% (95% CI 34.1%, 40.3%), myocarditis in 34.1% (95% CI 30.5%, 37.8%), electrocardiographic dysrhythmias and abnormalities detected in 23.1% (95% CI 18.8%, 27.6%), coronary abnormalities identified in 18% (95% CI 16%, 20%), extracorporeal membrane oxygenation deployed in 2.2% (95% CI 1.7%, 2.8%), and mortality rate of 2.2% (95% CI 1.7%, 2.7%). A sensitivity analysis was performed after removing eleven studies with high bias, and the adjusted prevalence was not different than the original evaluation.In this meta-analysis of the largest cohort of multisystem inflammatory syndrome in children patients to date, we established the most accurate prevalence of the most common cardiac manifestations. Providers will subsequently have more precise data to anticipate patient outcomes and approach discussions concerning the frequency of monitoring outside the acute hospital period.
Collapse
Affiliation(s)
- Carlos A Carmona
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Mohamed Kuziez
- Division of Pediatric Cardiology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Caio F Freitas
- Division of Pediatrics, Advent Health for Children, Pediatrics Residency, Orlando, FL, USA
| | - John W Cyrus
- Tompkins-McCaw Library for the Health Sciences, VCU Libraries, Virginia Commonwealth University, Richmond, VA, USA
| | - Jesse Bain
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
3
|
Mohamed Hussein AAR, Sayad R, Abdelshafi A, Hammam IA, Kedwany AM, Elkholy SAE, Ibrahim IH. A meta analysis on the utility of Anakinra in severe COVID-19 disease. Cytokine 2023; 169:156311. [PMID: 37536222 DOI: 10.1016/j.cyto.2023.156311] [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: 04/30/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The most important presentation of COVID-19 is hyper inflammatory condition and cytokine storm that occurs due to excessive increase of the inflammatory mediators specially, pro-inflammatory interleukins such as IL-1β, IL-6 and tumor necrosis factor-α which have an important role in the cytokine storm pathway. Up till now there is not a definitive treatment for COVID-19 disease, but according to the pathophysiology of the disease, Anakinra (Interleukin- 1 inhibitor) is an adjuvant treatment option in patients with severe COVID-19 by blocking the effect of IL-1. So, we aimed to summarize the studies that evaluated the safety and efficacy of Anakinra in patients diagnosed with COVID-19. METHODS We performed a search in PubMed, Cochrane Library, Scopus, and Web of Science (WOS) databases from inception till 7 Jan 2022. Additionally, we searched randomized and non-randomized clinical trials, cohort, case series, case control, case report more than 3 patients which contain confirmed cases of COVID-19 who received Anakinra (Interleukin- 1 inhibitor) for the management of hyper-inflammatory condition associated with COVID-19 disease. A meta-analysis was conducted using review manager 5.4. RESULTS We included 44 articles in the systematic review. Ultimately, 23 studies were incorporated in the meta-analysis with a total number of 3179 patients. Our analysis showed statistically significant difference in the following outcomes: duration of ICU stays [MD = -0.65, 95% CI (-1.09, -0.03), p = 0.04], the number of patients who needed invasive mechanical ventilation [RR = 0.57, 95% CI (0.39, 0.84), p = 0.004], and number of deaths [RR = 0.80, 95% CI (0.66, 0.99), p = 0.04]. Our analysis showed no statistically significant difference in the following outcomes: length of hospital stays [MD = -0.16, 95% CI (-0.42, 0.11), p = 0.26], oxygen-free days [MD = -0.81, 95% CI (-3.81, 2.20), p = 0.60], and the number of patients who needed non-invasive mechanical ventilation [RR = 1.09, 95% CI (0.47, 2.52), p = 0.84]. CONCLUSION Anakinra showed some promising results in important outcomes related to COVID-19 as it significantly reduced the rate of mortality and the need of invasive mechanical ventilation. It should be used in severe cases more than mild and moderate cases to avoid possible immunosuppression complications. Anakinra use is safe in cases of COVID-19 at dose less than 100 mg. Another important outcome was significant reduction is the D-dimer level. Anakinra may be effective in the treatment of specific immunocompromised cases, but it should be used cautiously.
Collapse
Affiliation(s)
- Aliae A R Mohamed Hussein
- Pulmonology, Chest Department, Assiut Faculty of Medicine, Assiut, Egypt; Assiut Research Team (ART), Assiut 71515, Egypt.
| | - Reem Sayad
- Assiut Research Team (ART), Assiut 71515, Egypt; Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrahman Abdelshafi
- Assiut Research Team (ART), Assiut 71515, Egypt; Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam Abdelaal Hammam
- Assiut Research Team (ART), Assiut 71515, Egypt; Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Kedwany
- Assiut Research Team (ART), Assiut 71515, Egypt; Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Islam H Ibrahim
- Assiut Research Team (ART), Assiut 71515, Egypt; Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|
4
|
La Torre F, Elicio MP, Monno VA, Chironna M, Moramarco F, Campanozzi A, Civino A, Cecinati V, Vairo U, Giordano M, Milella L, Loconsole D, Cardinale F. Incidence and Prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C) in Southern Italy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050766. [PMID: 37238314 DOI: 10.3390/children10050766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/26/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a pediatric hyperinflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection whose epidemiology is not very well known at present. The objective of the study was to better understand the incidence of MIS-C in the Apulia region in southern Italy. Our primary goal was to estimate the incidence of newly identified cases of MIS-C in children aged 0-18 years, during a period of six months, encompassing the second pandemic wave. We also analyzed the characteristics of our cohort in terms of clinical features, treatment, and outcomes. The cumulative incidence of MIS-C was 3.27 per 100,000 residents between 0 and 18 years of age. In our cohort, gastrointestinal, mucocutaneous, and cardiac involvement were the most common clinical features. With our step-up approach to therapy, no patients required intensive care unit (ICU) admission and no cardiac sequelae after 6 months of onset were found in echocardiograms. Conclusion: Our epidemiological study of MIS-C in southern Italy showed unexpectedly overlapping figures with other US studies.
Collapse
Affiliation(s)
- Francesco La Torre
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| | - Maria Pia Elicio
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| | - Viviana Anna Monno
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, 70123 Bari, Italy
| | - Fulvio Moramarco
- Department of Pediatrics, Antonio Perrino Hospital, 72100 Brindisi, Italy
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, Pediatric Section, University of Foggia, 71122 Foggia, Italy
| | - Adele Civino
- Division of Pediatric Rheumatology and Immunology, Vito Fazzi Hospital, 73100 Lecce, Italy
| | - Valerio Cecinati
- Department of Pediatrics, SS Annunziata Hospital, 74100 Taranto, Italy
| | - Ugo Vairo
- Division of Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Mario Giordano
- Division of Pediatric Nephrology and Dialysis, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Leonardo Milella
- Division of Intensive Care, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Daniela Loconsole
- Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, 70123 Bari, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| |
Collapse
|
5
|
Alsuwaiti M, Alzyoud R, Maaitah H, Aladaileh B, Alnsoor H, Nobani M. Clinical and Laboratory Features of Patients with Multisystem Inflammatory Syndrome in Children (MIS-C): An Experience From Queen Rania Children's Hospital, Jordan. Cureus 2023; 15:e37282. [PMID: 37038378 PMCID: PMC10082549 DOI: 10.7759/cureus.37282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is a new clinical observation that emerged during the coronavirus pandemic of 2019 (COVID-19) and has similar manifestations to Kawasaki disease and toxic shock syndrome. In this study, we aim to describe the characteristics of MIS-C patients in a single center in Jordan. Methods A retrospective analysis of electronic medical records of pediatric patients diagnosed with MIS-C at the pediatric rheumatology division of Queen Rania Children's Hospital, Amman, Jordan, between January 2021 and December 2022. Data collected included age, gender, clinical and laboratory data on presentation, and treatment options, which were compared in two different age groups. Results A total of 80 patients were included in this cohort (53 males and 27 females). The mean age at presentation was 84.4 months (ranging between nine months and 16 years). The most common presenting symptoms included fever (100%), abdominal pain (76.2%), skin rash (75%), conjunctivitis (72.5%), and mucosal changes (62.5%). Lymphopenia was present in 66.2% of patients. The majority of patients (98.7%) showed elevated C-reactive protein (CRP); 72 patients showed elevated erythrocyte sedimentation rate (ESR) (92.5%); ferritin was elevated in 70% of patients; the median fibrinogen level was 390 (interquartile range (IQR) 0.6-20) mg/dL; and the D-dimer level was 3.9 (IQR 0.6-20) mg/dL. Pericardial effusion was present in 23.8% of patients, and five patients (6.3%) had coronary artery dilatation. Conclusion To the best of our knowledge, this study is the first large case series of MIS-C in Jordan, with a wide spectrum of clinical presentation and evidence of hyperinflammation.
Collapse
Affiliation(s)
- Motasem Alsuwaiti
- Immunology, Allergy, and Rheumatology, Queen Rania Children's Hospital, Amman, JOR
| | - Raed Alzyoud
- Immunology, Allergy, and Rheumatology, Queen Rania Children's Hospital, Amman, JOR
| | - Hiba Maaitah
- Immunology, Allergy and Rheumatology, Queen Rania Children's Hospital, Amman, JOR
| | - Bushra Aladaileh
- Immunology, Allergy, and Rheumatology, Queen Rania Children's Hospital, Amman, JOR
| | - Hamzeh Alnsoor
- Immunology, Allergy, and Rheumatology, Queen Rania Children's Hospital, Amman, JOR
| | - Mohammed Nobani
- Immunology, Allergy, and Rheumatology, Queen Rania Children's Hospital, Amman, JOR
| |
Collapse
|
6
|
Lee PI, Hsueh PR. Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:236-245. [PMID: 36720670 PMCID: PMC9841678 DOI: 10.1016/j.jmii.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/07/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 2-6 weeks. The median age of patients with MIS-C is 6-11 years. Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. Respiratory tract, neurological system, musculoskeletal system, and kidney are less frequently affected. Mucocutaneous manifestations and coronary artery abnormalities characteristic for Kawasaki disease (KD) may be observed in a significant proportion of MIS-C patients that may make the differential diagnosis be difficult for some patients, especially in the post-pandemic era. The mortality rate is 1-3%. Management and prognosis of MIS-C are similar to that of KD. MIS-C and KD may share a common pathogenic process. Based on the observation of MIS-C-like illness in uninfected neonates, i.e. multisystem inflammatory syndrome in neonates, both MIS-C and KD may be a consequence of dysregulated, over-exaggerated humoral immune responses triggered by a specific infectious agent.
Collapse
Affiliation(s)
- Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; Ph.D Program for Aging, School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
7
|
Arantes Junior MAF, Conegundes AF, Branco Miranda BC, Radicchi Campos ASR, França Vieira AL, Faleiro MD, Campos MA, Kroon EG, Bentes AA. Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection: Systematic review and meta-analysis. Rev Med Virol 2023; 33:e2432. [PMID: 36807958 DOI: 10.1002/rmv.2432] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/21/2023] [Accepted: 02/01/2023] [Indexed: 02/20/2023]
Abstract
According to the World Health Organisation, as of October 2022, there have been 55,560,329 reported cases of SARS-COV-2 in patients under 19 years old. It is estimated that about 0.06% of these patients may develop MIS-C, representing more than 2 million children worldwide. This systematic review and meta-analysis examined the pooled prevalence of cardiovascular manifestation and cardiac complications in children hospitalised with MIS-C. The PROSPERO register number is CRD42022327212. We included case-report studies, case-control studies, cohort studies, and cross-sectional studies, as well as clinical trials or studies describing cardiac manifestations of MIS-C and its sequelae in a paediatric population. Initially, 285 studies were selected, but there were 154 duplicates, and 81 were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, and 30 were included in the meta-analysis. A total sample size of 1445 children was included. The combined prevalence of myocarditis or pericarditis was 34.3% (95% CI: 25.0%-44.2%). The combined prevalence for echocardiogram anomalies was 40.8% (95% CI: 30.5%-51.5%), that of Kawasaki disease presentation was 14.8% (95% CI: 7.5%-23.7%), and that of coronary dilation was 15.2% (95% CI: 11.0%-19.8%). The rate of electrocardiogram anomalies was 5.3% (95% CI: 0.8%-12.3%), and the mortality rate was 0.5% (CI 95%: 0%-1.2%). Furthermore, 186 children still had complications at discharge, with a combined prevalence of such long-lasting manifestations of 9.3% (95% CI: 5.6%-13.7%). Studies that assess whether these children will have an increased cardiovascular risk with a greater chance of acute myocardial infarction, arrhythmias, or thrombosis will be essential for healthcare planning.
Collapse
Affiliation(s)
| | - Ana Flávia Conegundes
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bárbara Castello Branco Miranda
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ana Luiza França Vieira
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Matheus Daniel Faleiro
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco Antônio Campos
- Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Aline Almeida Bentes
- Hospital Infantil João Paulo II, FHEMIG, Belo Horizonte, Minas Gerais, Brazil.,Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
8
|
Sezer M, Çelikel E, Tekin ZE, Aydın F, Kurt T, Tekgöz N, Karagöl C, Coşkun S, Kaplan MM, Öner N, Polat MC, Gül AEK, Parlakay AÖ, Acar B. Multisystem inflammatory syndrome in children: clinical presentation, management, and short- and long-term outcomes. Clin Rheumatol 2022; 41:3807-3816. [PMID: 36018446 PMCID: PMC9411826 DOI: 10.1007/s10067-022-06350-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In this study, it was aimed to evaluate the demographic, clinical and laboratory characteristics of MIS-C patients in our hospital, to share our treatment approach, and to assess the outcomes of short- and long-term follow-up. METHODS MIS-C patients who were admitted and treated in our hospital between July 2020 and July 2021 were evaluated. Demographic, clinical, laboratory, and follow-up data were collected from patient records retrospectively. RESULTS A total of 123 patients with MIS-C (median age, 9.6 years) were included the study. Nineteen (15.4%) were mild, 56 (45.6%) were moderate, and 48 (39%) were severe MIS-C. High CRP, ferritin, pro-BNP, troponin, IL-6, and D-dimer values were found in proportion to the severity of the disease (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, p < 0.001), respectively. Two (1.6%) patients died. The mean follow-up period was 7.8 months. Valve failure, left ventricular dysfunction/hypertrophy, coronary involvement, and pericardial effusion were the most common cardiac pathologies in the short- and long-term follow-up of the patients. In the long-term follow-up, the most common reasons for admission to the hospital were recurrent abdominal pain (14.2%), cardiac findings (14.2%), pulmonary symptoms (8%), fever (7.1%), neuropsychiatric findings (6.2%) and hypertension (3.5%). Neuropsychiatric abnormalities were observed significantly more common in severe MIS-C patients at follow-up (p = 0.016). In the follow-up, 6.2% of the patients required recurrent hospitalization. CONCLUSION MIS-C is a serious and life-threatening disease, according to short-term outcomes. In addition to the cardiac findings of patients with MIS-C, long-term outcomes such as neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms should be monitored. Key Points • In MIS-C patients, attention should be paid not only to cardiac findings, but also to symptoms related to other systems. • Patients should be followed up in terms of neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms that may occur during follow-up.
Collapse
Affiliation(s)
- Müge Sezer
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Çelikel
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Zahide Ekici Tekin
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatric Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tuba Kurt
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilüfer Tekgöz
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cüneyt Karagöl
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Coşkun
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Melike Mehveş Kaplan
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nimet Öner
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Merve Cansu Polat
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar Gül
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
9
|
Estrada-Luna D, Carreón-Torres E, González-Reyes S, Martínez-Salazar MF, Ortiz-Rodríguez MA, Ramírez-Moreno E, Arias-Rico J, Jiménez-Osorio AS. Nutraceuticals for Complementary Treatment of Multisystem Inflammatory Syndrome in Children: A Perspective from Their Use in COVID-19. Life (Basel) 2022; 12:life12101652. [PMID: 36295088 PMCID: PMC9605437 DOI: 10.3390/life12101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has been widely reported in some children diagnosed with SARS-CoV-2. Clinical signs of MIS-C are manifested at 2 to 4 weeks after SARS-CoV-2 infection, where elevated biomarkers of inflammation and cardiac dysfunction are the hallmark of this syndrome when infection or exposure to SARS-CoV-2 has been confirmed. However, after two years of acknowledgment, MIS-C treatment is still under research to reach safety and effectiveness in the acute phase in children. Therefore, in this review, we discuss the potential use of natural compounds with antioxidant and anti-inflammatory effects to reduce collateral damage caused by hyperinflammation in MIS-C pathology for new research in treatment and interventions.
Collapse
Affiliation(s)
- Diego Estrada-Luna
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Elizabeth Carreón-Torres
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Susana González-Reyes
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana 22390, Mexico
| | - María Fernanda Martínez-Salazar
- Facultad de Ciencias del Deporte, Universidad Autónoma del Estado de Morelos, Av. Universidad No. 1001 Col. Chamilpa, Cuernavaca 62209, Mexico
| | - María Araceli Ortiz-Rodríguez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Iztaccíhuatl 100 Col. Los Volcanes, Cuernavaca 62350, Mexico
| | - Esther Ramírez-Moreno
- Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - José Arias-Rico
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Angélica Saraí Jiménez-Osorio
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
- Correspondence: ; Tel.: +52-771-717-2000 (ext. 4323)
| |
Collapse
|
10
|
Buonsenso D. Partnerships in the Comprehensive Management of Multisystem Inflammatory Syndrome in Neonates (MIS-N): Translating 2 Years of Pediatric Practice to the Neonatal Wards. Am J Perinatol 2022. [PMID: 35240695 DOI: 10.1055/a-1787-8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, Roma, Italia.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
11
|
Zuccotti G, Calcaterra V, Mannarino S, D'Auria E, Bova SM, Fiori L, Verduci E, Milanese A, Marano G, Garbin M, Zirpoli S, Fabiano V, Carlucci P, Olivotto S, Gianolio L, De Santis R, Pelizzo G, Zoia E, Dilillo D, Biganzoli EM. Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience. Front Pediatr 2022; 10:1080654. [PMID: 36776681 PMCID: PMC9909209 DOI: 10.3389/fped.2022.1080654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. METHODS We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. RESULTS Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. CONCLUSIONS The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.
Collapse
Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Laura Fiori
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Health Sciences, University of Milano, Milano, Italy
| | - Alberto Milanese
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | | | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Sara Olivotto
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Laura Gianolio
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children's Hospital, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| |
Collapse
|
12
|
Nayak S, Panda PC, Biswal B, Agarwalla SK, Satapathy AK, Jena PK, Gulla KM, Rath D, Mahapatra A, Mishra P, Priyadarshini D, Mahapatro S, Nayak S, Das RR. Eastern India Collaboration on Multisystem Inflammatory Syndrome in Children (EICOMISC): A Multicenter Observational Study of 134 Cases. Front Pediatr 2022; 10:834039. [PMID: 35377583 PMCID: PMC8963178 DOI: 10.3389/fped.2022.834039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Few single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-center studies on the same is lacking including from Indian setting. METHODS This retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤ 15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was mortality. RESULTS A total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 50.7% and 39.6% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Fifteen (11.2%) children died. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were the factors significantly associated an increased mortality. CONCLUSIONS MIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with an increased mortality. No difference in outcome was noted with either steroid or IVIg or both. Coronary artery abnormalities resolved in nearly all cases.
Collapse
Affiliation(s)
- Snehamayee Nayak
- SCB Medical College, Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics (SVPPGIP), Cuttack, India
| | - Prakash Chandra Panda
- Department of Pediatrics, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Sambalpur, India
| | - Basudev Biswal
- Department of Pediatrics, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, India
| | - Sunil Kumar Agarwalla
- Department of Pediatrics, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Berhampur, India
| | - Amit Kumar Satapathy
- Department of Pediatrics and Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Pradeep Kumar Jena
- SCB Medical College, Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics (SVPPGIP), Cuttack, India
| | - Krishna Mohan Gulla
- Department of Pediatrics and Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Debasmita Rath
- Department of Pediatrics, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, India
| | - Anuspandana Mahapatra
- Department of Pediatrics, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, India
| | - Pravakar Mishra
- SCB Medical College, Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics (SVPPGIP), Cuttack, India
| | - Debashree Priyadarshini
- Department of Pediatrics, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, India
| | - Samarendra Mahapatro
- Department of Pediatrics and Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Saurav Nayak
- Department of Pediatrics and Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Rashmi Ranjan Das
- Department of Pediatrics and Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | | |
Collapse
|