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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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Baykan A, Kum YE, Yılmazer MM, Varan C, Yakut K, Sert A, Öztunç F, Öncül M, Uç D, Başpınar O, Pamukçu Ö, Murat M, Tanıdır İC, Alkan G, Murt NU, Akın A, Karakurt C, Şahin DA, Doğan A, Duman D, Öztürk E, Coşkun Yİ, Türe M, Temel MT, Elkıran Ö. One-Year Follow-Up Results of MIS-C Patients with Coronary Artery Involvement: A Multi-center Study. Pediatr Cardiol 2024; 45:282-291. [PMID: 38159144 DOI: 10.1007/s00246-023-03364-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: 10/07/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
Multisystem inflammatory syndrome (MIS-C) in children is a rare complication of SARS-CoV-2 infection. Knowing the course of the affected or unaffected coronary arteries in the patients under follow-up is important in terms of defining the long-term prognosis of the disease and determining the follow-up plan. This is a multicenter and retrospective study. The data were obtained from nine different centers. Between May 2020 and August 2022, 68 of 790 patients had coronary artery involvement. One-year echocardiographic data of 67 of 789 MIS-C patients with coronary artery involvement were analyzed. Existing pathologies of the coronary arteries were grouped as increased echogenicity, dilatation and aneurysm according to Z scores, and their changes over a 1-year period were determined. The data of all three groups are defined as frequency. SPSS Statistics version 22 was used to evaluate the data. In our study, aneurysm was observed in 16.4%, dilatation in 68.7% and increased echogenicity in 13.4% of the patients. All of the patients with involvement in the form of increased echogenicity recovered without sequelae by the end of the first month. No progression to aneurysm was observed in any of the patients with dilatation. No new-onset involvement was observed in patients with previously healthy coronary arteries during the convalescent period. In addition, from the sixth month follow-up period, there was no worsening in the amount of dilatation in any of the patients. At least 94% of the patients who completed the 12th month control period returned to normal.
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Affiliation(s)
- Ali Baykan
- Department of Pediatric Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Yunus Emre Kum
- Department of Pediatric Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Murat Muhtar Yılmazer
- Department of Pediatric Cardiology, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Celal Varan
- Department of Pediatric Cardiology, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Kahraman Yakut
- Department of Pediatric Cardiology, Istanbul Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ahmet Sert
- Department of Pediatric Cardiology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Funda Öztunç
- Department of Pediatric Cardiology, Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Mehmet Öncül
- Department of Pediatric Cardiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Duygu Uç
- Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Osman Başpınar
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özge Pamukçu
- Department of Pediatric Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Murat
- Department of Pediatric Cardiology, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - İbrahim Cansaran Tanıdır
- Department of Pediatric Cardiology, Istanbul Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Gülsüm Alkan
- Department of Pediatric Infectious Disease, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Nujin Uluğ Murt
- Department of Pediatric Cardiology, Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Alper Akın
- Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Cemşit Karakurt
- Department of Pediatric Cardiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Derya Aydın Şahin
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Alper Doğan
- Department of Pediatric Cardiology, Batman Training and Research Hospital, Batman, Turkey
| | - Derya Duman
- Department of Pediatric Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Erkut Öztürk
- Department of Pediatric Cardiology, Istanbul Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Yusuf İskender Coşkun
- Department of Pediatric Cardiology, Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Mehmet Türe
- Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Münevver Tuğba Temel
- Department of Pediatric Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özlem Elkıran
- Department of Pediatric Cardiology, Faculty of Medicine, İnönü University, Malatya, Turkey
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Pandit M, Frishman WH. Multisystem Inflammatory Syndrome in Children during the COVID-19 Pandemic: A Review of Clinical Manifestations, Cardiac Complications and Medical Management. Cardiol Rev 2024:00045415-990000000-00140. [PMID: 38169229 DOI: 10.1097/crd.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The SARS-CoV-2 pandemic has led to widespread research on associated clinical syndromes. While pediatric patients were initially deemed as a low-risk population for severe COVID-related disease, an increasing number of case reports have revealed a rare but potentially life-threatening syndrome, multisystem inflammatory syndrome in children (MIS-C). MIS-C is hypothesized to be due to hyperactivation of the immune system via a cytokine storm which leads to end-organ damage via endothelial dysfunction and changes in vascular permeability. Laboratory studies have displayed increased inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, D-dimer, tumor necrosis factor-alpha, and various interleukins. Studies have reported a wide range of clinical manifestations, including but not limited to fever, hypotension, shock, rash, coagulopathy, and gastrointestinal distress. Cardiac imaging and screening tests have revealed several complications, such as left ventricular failure, arrhythmias, and pericardial effusions. Medical management of MIS-C and cardiac sequelae have included supportive care, intravenous immunoglobulins, and corticosteroids, as well as immunomodulators, monoclonal antibodies, aspirin, and therapeutic anticoagulation, which have prevented serious outcomes in the majority of pediatric patients. Future multicenter and large-scale research is required for precise risk-stratification of MIS-C as well as long-term monitoring of sequelae. In this review, we aim to (1) outline the laboratory findings and clinical manifestations of MIS-C, and (2) describe cardiac complications and medical management of MIS-C.
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Affiliation(s)
- Maya Pandit
- From the New York Medical College, Valhalla, NY
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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Durak C, Guney Sahin E, Can YY, Varol F. Retrospective evaluation of therapeutic plasma exchange treatment in a pediatric intensive care unit: Single-center experience. Artif Organs 2023; 47:1464-1471. [PMID: 37150936 DOI: 10.1111/aor.14559] [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: 01/18/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The aim of this study is to characterize the clinical indications, outcomes, and complications of therapeutic plasma exchange (TPE) in pediatric intensive care unit. METHODS A retrospective study was conducted on critically ill patients who received TPE. A dataset of 672 treatments administered to 102 patients was analyzed. RESULTS The most common indication for TPE was COVID-19-related clinical conditions, followed by sepsis (24.5%), neurological diseases (9.8%) and renal diseases (6.9%). None of our patients died due to TPE-related complications, and the most common complication during and after the TPE was hypotension (21.7%). CONCLUSION Although TPE is riskier to provide to critically ill children, our experience indicates that it can be performed relatively safely in critically ill children with appropriate treatment indications. In particular, indications, onset time, number of sessions and other procedures should be standardized for the pediatric age group.
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Affiliation(s)
- Cansu Durak
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Istanbul, Turkey
| | - Ebru Guney Sahin
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Istanbul, Turkey
| | - Yasar Yusuf Can
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Istanbul, Turkey
| | - Fatih Varol
- Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Istanbul, Turkey
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5
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Silva Luz M, Lemos FFB, Rocha Pinheiro SL, Marques HS, de Oliveira Silva LG, Calmon MS, da Costa Evangelista K, Freire de Melo F. Pediatric multisystem inflammatory syndrome associated with COVID-19: Insights in pathogenesis and clinical management. World J Virol 2023; 12:193-203. [PMID: 37396702 PMCID: PMC10311577 DOI: 10.5501/wjv.v12.i3.193] [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: 12/29/2022] [Revised: 04/28/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been a major challenge to be faced in recent years. While adults suffered the highest morbidity and mortality rates of coronavirus disease 2019, children were thought to be exclusively asymptomatic or to present with mild conditions. However, around April 2020, there was an outbreak of a new clinical syndrome related to SARS-CoV-2 in children - multisystemic inflammatory syndrome in children (MIS-C) - which comprises a severe and uncon-trolled hyperinflammatory response with multiorgan involvement. The Centers for Disease Control and Prevention considers a suspected case of MIS-C an individual aged < 21 years presenting with fever, high inflammatory markers levels, and evidence of clinically severe illness, with multisystem (> 2) organ involvement, no alternative plausible diagnoses, and positive for recent SARS-CoV-2 infection. Despite its severity, there are no definitive disease management guidelines for this condition. Conversely, the complex pathogenesis of MIS-C is still not completely understood, although it seems to rely upon immune dysregulation. Hence, in this study, we aim to bring together current evidence regarding the pathogenic mechanisms of MIS-C, clinical picture and management, in order to provide insights for clinical practice and implications for future research directions.
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Affiliation(s)
- Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabian Fellipe Bueno Lemos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Samuel Luca Rocha Pinheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Mariana Santos Calmon
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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Martínez-García JJ, López-Acosta JR, Arce-Cabrera D, León-Sicairos N, Hernández-Parra AC, Cuen-Diaz HM, Zatarain-Lopez R, Canizalez-Roman A. Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease. Front Pediatr 2023; 11:1167828. [PMID: 37138560 PMCID: PMC10149839 DOI: 10.3389/fped.2023.1167828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C), is a severe complication of coronavirus disease 2019 (COVID-19), characterized by persistent fever, systemic inflammatory response, and organ failure. MIS-C with a history of COVID-19 may share clinical features with other well-defined syndromes such as macrophage activation syndrome, Kawasaki disease, hemophagocytic syndrome and toxic shock syndrome. Case 1 An 11-year-old male with a history of hypothyroidism and precocious puberty with positive antibody test for COVID-19 was admitted for fever, poor general condition, severe respiratory distress, refractory shock, and multiple organ failure. His laboratory examination showed elevated inflammatory parameters, and bone marrow aspirate showed hemophagocytosis. Case 2 A 13-year-old male with a history of attention deficit hyperactivity disorder and cognitive delay presented clinical manifestations of Kawasaki disease, fever, conjunctival congestion, exanthema, and hyperemia in oral mucosa, tongue, and genitals, with refractory shock and multiple organ failure. Reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies for COVID-19 were negative, inflammation parameters were elevated, and bone marrow aspirate showed hemophagocytosis. Patients required intensive care with invasive mechanical ventilation, vasopressor support, intravenous gamma globulin, systemic corticosteroids, low molecular weight heparin, antibiotics, and monoclonal antibodies and, patient 2 required renal replacement therapy. Conclusions Multisystemic inflammatory syndrome in children can have atypical manifestations, and identifying them early is very important for the timely treatment and prognosis of patients.
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Affiliation(s)
- Jesús Javier Martínez-García
- Pediatric Intensive Care Unit, Pediatric Hospital of Sinaloa, Culiacan, Mexico
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Mexico
| | | | | | - Nidia León-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Mexico
- Research Department, Pediatric Hospital of Sinaloa, Culiacan, Mexico
| | | | | | | | - Adrian Canizalez-Roman
- School of Medicine, Autonomous University of Sinaloa, Culiacan, Mexico
- Research Department, The Women’s Hospital, Secretariat of Health, Culiacan, Mexico
- Correspondence: Adrian Canizalez Roman
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Gadiwala S, Mistry A, Patel S, Chaithanya A, Pathak S, Satnarine T, Bekina-Sreenivasan D, Bakarr AA, Das BB, Chakinala RC, Patel S, Areti S. MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management. LE INFEZIONI IN MEDICINA 2022; 30:344-352. [PMID: 36148163 PMCID: PMC9448305 DOI: 10.53854/liim-3003-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 06/25/2022] [Indexed: 06/16/2023]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawasaki-like disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a total of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C presented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunctival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase in IL-17A, IL-6, and arterial damage, a distinct difference from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were successful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potentially fatal pediatric complication, after COVID-19 infection. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.
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Affiliation(s)
- Salika Gadiwala
- Department of Public Health, Drexel University/Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ayushi Mistry
- Department of Pediatrics, Dr. N. D. Desai Medical College and Research Center, Gujarat, India
| | - Sejal Patel
- Department of Pediatrics, Government Medical College, Surat, India
| | | | | | | | | | | | - Bibhuti Bhusan Das
- Department of Forensic Psychiatry, Central New York Psychiatric Center, OMH, NY, USA
| | - Raja Chandra Chakinala
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Saurabhkumar Patel
- Department of Pediatrics, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Sathya Areti
- Department of Internal-Medicine-Pediatrics, Case Western University Hospitals/Rainbow Babies, Cleveland, OH, USA
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8
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Varol F, Ergul N, Sahin EG, Can YY, Ergul U, Guven S, Cam H. Can plasma exchange therapy be an option for the treatment of SARS-CoV-2 Related Splenial Lesion Syndrome: Two cases from the pediatric intensive care unit. Transfus Apher Sci 2022; 61:103491. [PMID: 35710765 PMCID: PMC9187863 DOI: 10.1016/j.transci.2022.103491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
Background Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum. RESLES is one of the most common causes of Mild encephalitis/encephalopathy reversible splenial lesion (MERS) and a rare clinical syndrome for the pediatric population. In a limited number of pediatric case reports, association with SARS-COV-2 in was reported. We aimed to increase the awareness of neurological involvement and treatment options of RESLES in children diagnosed with MIS-C. Case presentation We report two cases with a diagnosis of multisystem inflammatory syndrome-children who developed RESLES during the disease course. Fever, blurred vision, ataxia and encephalopathy were the main central nervous system symptoms. In our first case, we observed a rapid recovery in clinical symptoms and complete resolution of the splenial lesion in with intravenous immunoglobulin (IVIG) and methylprednisolone treatment. However, our second case did not respond to IVIG and methylprednisolone treatment. We performed therapeutic plasma exchange therapy and observed a successful recovery both in brain magnetic resonance imaging and echocardiographic findings. Conclusion Although IVIG and methylprednisolone are the first choice treatment methods in MIS-C cases progressing with RESLES, therapeutic plasma exchange may be an option for the treatment of unresponsive cases.
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Affiliation(s)
- Fatih Varol
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Intensive Care, Turkey.
| | - Nese Ergul
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Pediatrics, Turkey.
| | - Ebru Guney Sahin
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Intensive Care, Turkey.
| | - Yasar Yusuf Can
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Intensive Care, Turkey.
| | - Umut Ergul
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Radiology, Turkey.
| | - Sirin Guven
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Pediatrics, Turkey.
| | - Halit Cam
- Health Science University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Intensive Care, Turkey.
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9
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Welzel T, Schöbi N, André MC, Bailey DGN, Blanchard-Rohner G, Buettcher M, Grazioli S, Koehler H, Perez MH, Trück J, Vanoni F, Zimmermann P, Atkinson A, Sanchez C, Whittaker E, Faust SN, Bielicki JA, Schlapbach LJ. Multicenter Randomized Trial of Methylprednisolone vs. Intravenous Immunoglobulins to Treat the Pediatric Inflammatory Multisystem Syndrome-Temporally Associated With SARS-CoV-2 (PIMS-TS): Protocol of the Swissped RECOVERY Trial. Front Pediatr 2022; 10:905046. [PMID: 35669398 PMCID: PMC9163685 DOI: 10.3389/fped.2022.905046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction In 2020, a new disease entitled Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C), emerged, with thousands of children affected globally. There is no available evidence based on randomized controlled trials (RCT) to date on the two most commonly used immunomodulatory treatments, intravenous immunoglobulins (IVIG) and corticosteroids. Therefore, the Swissped RECOVERY trial was conducted to assess whether intravenous (IV) methylprednisolone shortens hospital length of stay compared with IVIG. Methods and Analysis Swissped RECOVERY is an ongoing investigator-initiated, open-label, multicenter two-arm RCT in children and adolescents <18 years hospitalized with a diagnosis of PIMS-TS. The trial is recruiting at 10 sites across Switzerland. Patients diagnosed with PIMS-TS are randomized 1:1 to methylprednisolone IV (10 mg/kg/day for 3 days) or IVIG (2 g/kg as a single dose). The primary outcome is hospital length of stay censored at day 28, death, or discharge (whichever is first). The target total sample size is ~80 patients 1:1 randomized to each study arm. Ancillary and exploratory studies on inflammation, vaccination acceptance and coverage, long-term outcomes, and healthcare costs are pre-planned. Significance Currently, robust trial evidence for the treatment of PIMS-TS is lacking, with a controversy surrounding the use of corticosteroids vs. IVIG. This trial will provide evidence for the effectiveness and safety of these two treatments. Ethics and Dissemination The study protocol, which was designed based on the U.K. RECOVERY trial, the patient information and consent forms, and other study-specific study documents were approved by the local ethics committees (Project ID: 2021-00362). Registration Details The study is registered on the Swiss National Clinical Trials Portal (SNCTP000004720) and Clinicaltrials.gov (NCT04826588).
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Affiliation(s)
- Tatjana Welzel
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Division of Paediatric Rheumatology, University Children‘s Hospital Basel, University of Basel, Basel, Switzerland
| | - Nina Schöbi
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maya C. André
- Division of Respiratory and Critical Care Medicine, University Children‘s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Paediatric Hematology and Oncology, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Douggl G. N. Bailey
- Paediatric and Neonatal Intensive Care Unit, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Geraldine Blanchard-Rohner
- Paediatric Immunology and Vaccinology Unit, Division of General Paediatrics, Department of Child, Woman and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Michael Buettcher
- Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Paediatric Intensive Care, Department of Child, Woman and, Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Henrik Koehler
- Department of Paediatrics, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Marie-Helene Perez
- Paediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland
| | - Johannes Trück
- Division of Immunology and Children‘s Research Center, University Children's Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Federica Vanoni
- Clinic of Paediatrics, Paediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 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
| | - Andrew Atkinson
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Carlos Sanchez
- Paediatric Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Elizabeth Whittaker
- Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - 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, United Kingdom
| | - Luregn J. Schlapbach
- Department of Intensive Care and Neonatology, Children‘s Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Paediatric Intensive Care Unit, Queensland Children‘s Hospital and Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
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10
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TUFAN A, MATUCCI CERINIC M. Immune dysfunction in COVID-19 and judicious use of antirheumatic drugs for the treatment of hyperinflammation. Turk J Med Sci 2021; 51:3391-3404. [PMID: 34844296 PMCID: PMC8771052 DOI: 10.3906/sag-2110-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022] Open
Abstract
In the Wuhan province of China, almost two years ago, in December 2019, the novel Coronavirus 2019 has caused a severe involvement of the lower respiratory tract leading to an acute life-threatening respiratory syndrome, coronavirus disease-19 (COVID-19). Subsequently, coronavirus 2 (SARS-CoV-2) rapidly spread to the entire world causing a pandemic and affected every single person on earth either directly or indirectly with destroying all facets of social life and economy. Since the announcement of COVID-19 as a global pandemic, we have witnessed tremendous scientific work on all aspects of COVID-19 across the globe, which has never been witnessed before. The most remarkable achievement would be the introduction of vaccines, which provide protection from the severe infection and is the only premise for the control of disease. However, despite the tremendous work, the number of treatments either antiviral or immunomodulatory for infected patients are considerably limited, yet disease is causing substantial morbidity and mortality. COVID-19 follows heterogenous disease course among infected individuals, and dysregulated immune system is primarily responsible for the worse outcomes. Immune deficiency, being on corticosteroids for inflammatory diseases, delayed interferon response and advanced age adversely influence prognosis with impairing viral clearance. On the other hand, exuberant immune response with features of cytokine storm is the leading cause of death, which can be alleviated by use of either general immunosuppression with corticosteroids or selective neutralization of potent pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Herein, we summarized the potential effective immunomodulatory treatments emphasizing in which patient population it is the most suitable, which dose should be administered, and which is the most appropriate timepoint to administer the drug during the course of the disease.
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Affiliation(s)
- Abdurrahman TUFAN
- Division of Rheumatology, Department of Internal Medicine, Gazi University, AnkaraTurkey
| | - Marco MATUCCI CERINIC
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence , FlorenceItaly
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, MilanItaly
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Gupta V, Jindal G. State of the Globe: Multisystem Inflammatory Syndrome in Children - Did the COVID-19 Pandemic Actually Handle Kids with Kids-Glove? J Glob Infect Dis 2021; 13:157-158. [PMID: 35017870 PMCID: PMC8697815 DOI: 10.4103/jgid.jgid_307_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Vipul Gupta
- Department of Pediatrics, GMCH, Chandigarh, India
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