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Benvenuto S, Avcin T, Taddio A. Multisystem inflammatory syndrome in children: A review. Acta Paediatr 2024. [PMID: 38714363 DOI: 10.1111/apa.17267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
AIM To comprehensively review the literature on multisystem inflammatory syndrome in children (MIS-C). METHODS Narrative review of relevant studies published between April 2020 and January 2024. RESULTS MIS-C is a SARS-CoV-2-related hyperinflammatory syndrome developing 2-6 weeks after COVID-19 in genetically susceptible individuals. Persisting fever, mucocutaneous manifestations, GI and cardiac involvement, together with lymphopenia and elevated inflammatory and cardiac markers are the main clinical features. It is believed to recognise some pathogenetic and clinical overlap with Kawasaki disease. New case definitions have been proposed after an assessment of the diagnostic performance of existing criteria; epidemiological criterion is however progressively losing its usefulness as the pandemic turns into an endemic and in the areas with the highest rates of COVID-19 vaccination. Current guidelines recommend both intravenous immunoglobulin and glucocorticoids in the first-line immunomodulatory treatment, mainly based on comparative retrospective cohorts; the actual role of biologics remains to be adequately established. Strict follow-up is mandatory, especially for those with severe cardiac involvement, as longitudinal studies evaluate the long-term evolution of cardiac damage. CONCLUSION In this paper, we review the epidemiological, pathogenetic, clinical and prognostic features of MIS-C, and outline the main questions which still remain unanswered after more than 3 years of research.
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Affiliation(s)
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrea Taddio
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Mauro A, Giani T. Editorial: Multisystem inflammatory syndrome in children. Front Pediatr 2024; 12:1370467. [PMID: 38567181 PMCID: PMC10985328 DOI: 10.3389/fped.2024.1370467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Angela Mauro
- Rheumatology Unit, Department of Pediatrics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Teresa Giani
- Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
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Balkarlı E, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Yılmaz Çelebi M, Apa H, Meşe T, Ağın H, Bayram SN, Devrim İ. The evaluation of the burden of multisystem inflammatory syndrome in children on health economics. Arch Rheumatol 2024; 39:10-19. [PMID: 38774689 PMCID: PMC11104748 DOI: 10.46497/archrheumatol.2023.10147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives This study aimed to evaluate the diagnostic tests and treatments applied in patients with multisystem inflammatory syndrome in children (MIS-C) and to determine the effect of the disease on health costs. Patients and methods This retrospective cohort study included 59 MIS-C patients (40 males, 19 females; mean age: 7.7±4.2 years; range, 4 months to 16.5 years) who were admitted and treated between April 1, 2020, and November 1, 2021. Demographic and clinical features with hospital costs and length of stay were retrospectively reviewed from the medical files and computerized system of the hospital. Direct medical care costs of items were calculated with the hospital perspective using a combination of microcosting technique (resource-based accounting method) and hospital list data. Cases were classified as mild, moderate, or severe, and the patients were divided into two groups: the mild group and the moderate-severe group. Classification was determined by the vasoactive inotropic score (VIS), degree of respiratory support, and evidence of organ damage. Results The mean age of the cases in the mild group was 6.5±3.7 years, and the mean age of the cases in the moderate-severe group was 9.2±4.3 years. Of 59 patients, 19 (32.2%) were followed up in the pediatric intensive care unit. The median duration of hospitalization in the hospital was 8 (interquartile range: 7-12) days. The total cost of the patients hospitalized with the diagnosis of MIS-C during the study period was 849,242.93$, and the mean cost per patient was 14,393.94±9,631.92$. In the distribution of the total cost of hospitalization according to expenses, the highest rate was pharmacy and blood products (51.99%) and IVIG costs (43.99%). While the mean total cost per person was 13,682.87±8,799.63$ in mild cases, it was 16,433.82±9,440.02$ in moderate-severe cases, and no statistically significant relationship was found between the two groups (p>0.05). There was no difference in the mean cost per patient between the cases with and without heart, lung, kidney, or neurologic involvement and advanced respiratory support (p>0.05). There was a strong positive correlation between the total costs and age (r=0.883, n=59, p<0.0001), with increased amount of costs with increased age. Conclusion In the study, no statistically significant correlation was found between the total cost of per person in the mild group and the moderate-severe group (p>0.05). This finding may be due to the wide use of IVIG in MIS-C treatment, in addition to low transfer rates to pediatric intensive care units due to high-flow nasal cannula usage.
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Affiliation(s)
- Ezgi Balkarlı
- Department of Child Health and Diseases, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Türkiye
| | - Elif Kıymet
- Department of Pediatric Infectious Diseases, Batman Training and Research Hospital, Batman, Türkiye
| | - Elif Böncüoğlu
- Department of Pediatric Infectious Diseases, Konya City Hospital, Konya, Türkiye
| | - Şahika Şahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Miray Yılmaz Çelebi
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Hurşit Apa
- Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Timur Meşe
- Department of Pediatric Cardiology, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Hasan Ağın
- Pediatric Intensive Care, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Süleyman Nuri Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
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Mastrolia MV, De Cillia C, Orlandi M, Abu-Rumeileh S, Maccora I, Maniscalco V, Marrani E, Pagnini I, Simonini G. Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2027. [PMID: 38004076 PMCID: PMC10673592 DOI: 10.3390/medicina59112027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This narrative review aims to report the main clinical manifestations, therapeutic strategies, outcomes, and complications of acute SARS-CoV-2 infection in childhood and to summarize the data relating the SARS-CoV-2 vaccination efficacy and safety in pediatric age. SARS-CoV-2 infection mostly occurs asymptomatically in the pediatric population, while multisystem inflammatory syndrome in children (MIS-C) represents the most severe coronavirus disease 2019 (COVID-19)-related illness, a life-threatening event with a high morbidity rate. After the development of SARS-CoV-2 vaccines and their subsequent approval in children, the rate of infection as well as the number of its related complications have shown a drastic decrease. Fully vaccinated children are protected from the risk of developing a severe disease and a similar protective role has been observed in the reduction of complications, in particular MIS-C. However, long-lasting immunity has not been demonstrated, booster doses have been required, and reinfection has been observed. With regards to vaccine safety, adverse events were generally mild to moderate in all age groups: local adverse events were the most commonly reported. Nevertheless, a potential association between SARS-CoV-2 vaccine and the subsequent development of inflammatory manifestations has been suggested. Myocarditis has rarely been observed following vaccination; it appeared to be more frequent among adolescent males with a mild clinical course leading to a complete recovery. SARS-CoV-2 vaccine-related MIS-C cases have been described, although a univocal definition and an exact time interval with respect to vaccination has not been reported, thus not establishing a direct causal link. Current evidence about COVID-19 vaccination in children and adolescents suggest that benefits outweigh potential risks. Long-term data collection of the post-authorization safety surveillance programs will better define the real incidence of SARS-CoV-2 vaccine-related complications in the pediatric population.
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Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Camilla De Cillia
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Michela Orlandi
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
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Ebrahimi M, Aghapour SA, Rashidbaghan A, Mazandarani M. Stevens-Johnson syndrome and COVID-19: a case report with suspected multisystem inflammatory syndrome in children (MIS-C). Ann Med Surg (Lond) 2023; 85:5641-5644. [PMID: 37915708 PMCID: PMC10617869 DOI: 10.1097/ms9.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/09/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Symptoms similar to diseases such as Stevens-Johnson syndrome (SJS) and multisystemic inflammatory syndrome in children (MIS-C) were reported in pediatric coronavirus infections. Case presentation Here, we present a 4-year-old girl with coronavirus disease 2019 (COVID-19), an earlier diagnosis of SJS, and a final diagnosis of MIS-C. Clinical discussion Unlike the negative PCR test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the positive serological test confirmed COVID-19. Conclusion The monitoring of this case indicated that higher coronavirus infection can delay immune reaction and cause symptoms similar to SJS.
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Affiliation(s)
| | - Seyed Ali Aghapour
- Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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Fastiggi M, Meneghel A, Gutierrez de Rubalcava Doblas J, Vittadello F, Tirelli F, Zulian F, Martini G. Prognostic role of euthyroid sick syndrome in MIS-C: results from a single-center observational study. Front Pediatr 2023; 11:1217151. [PMID: 37635797 PMCID: PMC10448823 DOI: 10.3389/fped.2023.1217151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Euthyroid sick syndrome (ESS) is characterized by low serum levels of free triiodothyronine (fT3) with normal or low levels of thyroid stimulating hormone (TSH) and free thyroxine (fT4) and is reported in different acute clinical situations, such as sepsis, diabetic ketoacidosis and after cardiac surgery. Our aim was to evaluate the predicting role of ESS for disease severity in patients with Multisystem Inflammatory Syndrome in children (MIS-C). Methods A single-centre observational study on consecutive patients with MIS-C. Before treatment clinical, and laboratory data were collected and, in a subset of patients, thyroid function tests were repeated 4 weeks later. Variables distribution was analyzed by Mann-Whitney U-test and correlations between different parameters were calculated by Spearman's Rho coefficient. Results Forty-two patients were included and 36 (85.7%) presented ESS. fT3 values were significantly lower in patients requiring intensive care, a strong direct correlation was shown between fT3 and Hb, platelet count and ejection fraction values. A significant inverse correlation was retrieved between fT3 levels and C-reactive protein, brain natriuretic peptide, IL-2 soluble receptor and S-100 protein. Subjects with severe myocardial depression (EF < 45%) had lower fT3 values than subjects with higher EF. The thyroid function tests spontaneously normalized in all subjects who repeated measurement 4 weeks after admission. Conclusion ESS is a frequent and transient condition in acute phase of MIS-C. A severe reduction of fT3 must be considered as important prognostic factor for severe disease course, with subsequent relevant clinical impact in the management of these patients.
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Affiliation(s)
- Michele Fastiggi
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Alessandra Meneghel
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | | | - Fabio Vittadello
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Francesca Tirelli
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Francesco Zulian
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Giorgia Martini
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
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La Torre F, Taddio A, Conti C, Cattalini M. Multi-Inflammatory Syndrome in Children (MIS-C) in 2023: Is It Time to Forget about It? CHILDREN (BASEL, SWITZERLAND) 2023; 10:980. [PMID: 37371212 PMCID: PMC10297102 DOI: 10.3390/children10060980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is defined as a clinically serious condition requiring hospitalization involving fever, multi-system organ dysfunction, and an increase in inflammatory biomarkers. The syndrome was originally described as a post-infectious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which usually causes COVID-19. During the COVID-19 pandemic, not only did the virus undergo mutations but vaccines against SARS-CoV-2 were also developed. Both these conditions led to a decrease in the incidence of MIS-C. This narrative review summarizes the recent updates for MIS-C, particularly regarding the change in incidence, the link between the SARS-CoV-2 vaccine and MIS-C, and new updates of MIS-C treatments.
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Affiliation(s)
- Francesco La Torre
- Pediatric Rheumatology Center, Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70121 Bari, Italy
| | - Andrea Taddio
- Institute of Child and Maternal Health–IRCCS “Burlo Garofolo”, University of Trieste, 34127 Trieste, Italy
| | - Chiara Conti
- Pediatrics Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25121 Brescia, Italy
| | - Marco Cattalini
- Pediatrics Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25121 Brescia, Italy
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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.
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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
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