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Shioji N, Sumie M, Englesakis M, Gilfoyle E, Maynes JT, Aoyama K. Multisystem inflammatory syndrome in children: an Umbrella review. J Anesth 2024; 38:309-320. [PMID: 38530453 DOI: 10.1007/s00540-024-03323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
We conducted an Umbrella review of eligible studies to evaluate what patient features have been investigated in the multisystem inflammatory syndrome in children (MIS-C) population, in order to guide future investigations. We comprehensively searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from December 1, 2019 to the May 6, 2022. The time period was limited to cover the coronavirus disease-2019 (COVID-19) pandemic period. The protocol was registered in the PROSPERO registry (CRD42022340228). Eligible studies included (1) a study population of pediatric patients ≤21 years of age diagnosed with MIS-C; (2) an original Systematic review or Mata-analysis; (3) published 2020 afterward; and (4) was published in English. A total of 41 studies met inclusion criteria and underwent qualitative analysis. 28 studies reported outcome data of MIS-C. 22 studies selected clinical features of MIS-C, and 6 studies chose demographic data as a main topic. The mortality rate for children with MIS-C was 1.9% (interquartile range (IQR) 0.48), the ICU admission rate was 72.6% (IQR 8.3), and the extracorporeal membrane oxygenation rate was 4.7% (IQR 2.0). A meta-analysis of eligible studies found that cerebral natriuretic peptide in children with MIS-C was higher than that in children with COVID-19, and that the use of intravenous immunoglobulin (IVIG) in combination with glucocorticoids to treat MIS-C compared to IVIG alone was associated with lower treatment failure. In the future, for patients with MIS-C, studies focused on safety of surgery requiring general anesthesia, risk factors, treatment, and long-term outcomes are warranted.
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Affiliation(s)
- Naohiro Shioji
- Department of Anesthesiology and Intensive Care Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Sumie
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Department of Anesthesiology, St. Mary's Hospital, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Elaine Gilfoyle
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Molecular Medicine, SickKids Research Institute, Toronto, ON, Canada
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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Nasiri K, Tehrani S, Mohammadikhah M, Banakar M, Alaeddini M, Etemad‐Moghadam S, Fernandes GVO, Heboyan A, Imannezhad S, Abbasi F. Oral manifestations of COVID-19 and its management in pediatric patients: A systematic review and practical guideline. Clin Exp Dent Res 2023; 9:922-934. [PMID: 37602892 PMCID: PMC10582234 DOI: 10.1002/cre2.776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes coronavirus disease 2019 (COVID-19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID-19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID-19 in children and to recommend appropriate methods of diagnosis and treatment. METHODS A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID-19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated. RESULTS A total of 24 studies involving 2112 pediatric patients with COVID-19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi-system inflammatory syndrome in children (MIS-C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications. CONCLUSION Oral symptoms of COVID-19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS-C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation.
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Affiliation(s)
- Kamyar Nasiri
- Department of DentistryIslamic Azad UniversityTehranIran
| | - Sahar Tehrani
- Department of Pediatric Dentistry, School of DentistryAhvaz Jundishapour University of Medical SciencesAhvazIran
| | - Meysam Mohammadikhah
- Department of Oral and Maxillofacial SurgerySchool of Dentistry, Alborz University of Medical SciencesKarajIran
| | - Morteza Banakar
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
- Department of Pediatric Dentistry, Faculty of DentistryShahed UniversityTehranIran
| | - Mojgan Alaeddini
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
| | - Shahroo Etemad‐Moghadam
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
| | - Gustavo V. O. Fernandes
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
- Centre for Interdisciplinary Research in Health (CIIS)Universidade Católica PortuguesaViseuPortugal
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of StomatologyYerevan State Medical University after Mkhitar HeratsiArmenia
| | - Shima Imannezhad
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Farid Abbasi
- Department of Oral Medicine, Faculty of DentistryShahed UniversityTehranIran
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Sarasati A, Agustina D, Surboyo MDC. The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not? Infect Drug Resist 2023; 16:4357-4385. [PMID: 37424667 PMCID: PMC10329433 DOI: 10.2147/idr.s411615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Many previously reported publications mentioned that oral lesion in COVID-19 patients was varied. The term oral manifestations refer to pathognomonic features that are found consistently with a specific cause and effect. In this context, the oral manifestation of COVID-19 was inconclusive. This systematic review aimed to analyse previously reported publications related to oral lesions in COVID-19 patients to define as oral manifestations or not. The PRISMA guidelines were implemented in this review. Methods All umbrella reviews, systematic reviews, systematic reviews and meta-analyses, comprehensive reviews, and original and non-original studies were included. Twenty-one of systematic review, 32 original studies and 68 non-original studies reported the oral lesion in COVID-19 patients. Results Most of the publications mentioned that ulcers, macular, pseudomembranes and crusts were frequent oral lesions. The reported oral lesions in COVID-19 patients did not show any pathognomonic features and might be unrelated directly to COVID-19 infections, however, more likely due to gender, age, underlying diseases, and medication. Conclusion The oral lesions found in previous studies do not have pathognomonic features and are inconsistent. Therefore, the reported oral lesion, in present time, cannot be defined as an oral manifestation.
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Affiliation(s)
- Andari Sarasati
- Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Dewi Agustina
- Department of Oral Medicine, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Di Spirito F, D'Ambrosio F, Di Palo MP, Giordano F, Coppola N, Contaldo M. COVID-19 and Related Vaccinations in Children: Pathogenic Aspects of Oral Lesions. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050809. [PMID: 37238357 DOI: 10.3390/children10050809] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Various clinical manifestations of SARS-CoV-2 infections and adverse reactions to COVID-19 vaccination have been described in children. The present narrative review aimed to collect and synthesize reported findings on oral lesions detected in SARS-CoV-2-positive subjects following COVID-19 EMA-authorized and WHO Emergency Use Listing-approved vaccine administration in the pediatric population to detail their clinical features and highlight possible pathogenic aspects of those lesions based on current evidence. Few and incomplete reports were retrieved from the literature, probably because most lesions belonged to a broad spectrum of systemic diseases and syndromes and were nonspecific or inaccurately described. The most common oral lesions in pediatric SARS-CoV-2-positive patients were erosive-ulcerative lesions and macules/petechiae, primarily erythematous. In the context of COVID-19 vaccination, oral adverse reactions were rare and typically presented as erosive-ulcerative lesions, with EM-like or unspecified patterns. Future studies should investigate oral lesions in SARS-CoV-2-positive subjects and after COVID-19 vaccination in the pediatric population, taking into account viral variants and newly developed vaccines. Deeper insight into oral lesions detectable in pediatric SARS-CoV-2-positive subjects and after COVID-19 vaccination may increase clinicians' ability to improve multidisciplinary pediatric oral and general care.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco D'Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Nicoletta Coppola
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
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Multisystem Inflammatory Syndrome Associated With COVID-19 in Children (MIS-C): A Systematic Review of Studies From India. Indian Pediatr 2022. [PMID: 35869878 PMCID: PMC9379896 DOI: 10.1007/s13312-022-2559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Di Spirito F, Iandolo A, Amato A, Caggiano M, Raimondo A, Lembo S, Martina S. Prevalence, Features and Degree of Association of Oral Lesions in COVID-19: A Systematic Review of Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127486. [PMID: 35742735 PMCID: PMC9224460 DOI: 10.3390/ijerph19127486] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
Regardless of rapidly emerging findings on oral lesions described in adult SARS-CoV-2-positive subjects, the evidence level remains quite low and rather contrasting; therefore, the present systematic review of systematic reviews primarily aims to point out the overall prevalence of diagnosed cases. Secondary aims are to estimate the degree of association between oral lesions and SARS-CoV-2 infection and to grade, based on the reported frequency, the primary oral lesions, with related clinical presentations and microscopic features, in relation to COVID-19 forms. A study protocol compliant with the PRISMA statement was developed. Twelve studies were included, reporting highly heterogeneous and incomplete findings, thus precluding a meta-analysis. Further studies should be conducted to assess the overall prevalence of cases diagnosed with oral lesions among adult SARS-CoV-2-positive subjects, especially considering novel viral variants, and to determine their degree of association with SARS-CoV-2 infection and COVID-19 forms. Moreover, the reported findings noticed the need to evaluate the putative role both of SARS-CoV-2 in oral lesions genesis and of periodontitis and periodontal microbiome in COVID-19 worsening and re-activations. Deeper insights into oral lesions in adult SARS-CoV-2-positive subjects could enhance the comprehension of illness pathogenesis, natural history and clinical presentation, thus improving the preparedness of health professionals in the inter-disciplinary management of COVID-19.
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Safety and tolerability of cinnamaldehyde in orabase for oral candidiasis treatment: phase I clinical trial. Clin Oral Investig 2022; 26:4825-4833. [PMID: 35305150 DOI: 10.1007/s00784-022-04450-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/12/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To advance studies on the effect of a new pharmaceutical formulation for the treatment of oral fungal infections, we evaluated the safety and tolerability of orabase ointment containing cinnamaldehyde for use on the oral mucosa. MATERIAL AND METHODS A clinical trial (phase I) was carried out on 35 individuals with healthy oral mucosa divided into three groups: ointments at 200 µg/mL, n = 12; 300 µg/mL, n = 11; and 400 µg/mL, n = 12. Product safety was assessed using three parameters: (a) clinical evolution as recorded by trained examiners; (b) evolution of the inflammatory process as registered by an exfoliative cytology exam and analyzed by trained pathologists; (c) mucosal swab to count Candida spp. colony-forming units (CFU). These parameters were analyzed both beforehand and at 15 days of treatment. RESULTS The three ointment concentrations evaluated did not trigger inflammatory processes. The mycological analyses revealed a reduction of at least 99% in the number of Candida spp. CFU. In the exfoliative cytology analyses, the cells were found to be healthy. Participants reported a pleasant taste, yet 17% reported a slight burning sensation when applying the product. CONCLUSIONS The ointment is safe and tolerable for use on healthy oral mucosa. TRIAL REGISTRATION Registration number: RBR-7zwzs3. CLINICAL RELEVANCE The ointment proved to be safe and tolerable for use on oral mucosa, encouraging studies to evaluate its clinical efficacy in patients with oral candidiasis, and contributing to a new therapeutic proposal for the treatment of fungal infections caused by Candida spp.
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