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Caorsi R, Consolaro A, Speziani C, Sozeri B, Ulu K, Faugier-Fuentes E, Menchaca-Aguayo H, Ozen S, Sener S, Akhter Rahman S, Imnul Islam M, Haerynck F, Simonini G, Mastri MV, Avcin T, Sršen S, de Albuquerque Pedrosa Fernandes T, Stanevicha V, Vojinovic J, Sobh A, Fingerhutova S, Minxova L, Gagro A, Rodrigues Fonseca A, Pandya D, Varbanova B, Sánchez-Manubens J, Ganeva M, Montin D, Boyarchuk O, Minghini A, Bracaglia C, Brogan P, Candotti F, Cattalini M, Meyts I, Minoia F, Taddio A, Wouters C, De Benedetti F, Bovis F, Ravelli A, Ruperto N, Gattorno M, Bilginer Y, Laila K, Islam MM, Meertens B, Hoste L, Dehoorne J, Schelstraete P, Vandekerckhove K, Willems J, Matthijs I, Filocamo E Gisella Beatrice Beretta G, Magalhaes CS, Chubata O, Ricci F, Vukovic A, Temelkova K, Avramovic MZ, Emersic N, Bizjak M, Vesel T, Rodrigues MF, Gasparello de Almeida R, Lukjanovica K, Elnagdy MH, Soliman A, Terifajova E, Brejchova I, Magner M, Myrup C, Vougiouka O, Jelusic M, La Torre F, Rigante D, Maggio MC, Verdoni L, Rubio-Perez N, Cornejo GV, Villarreal Trevino AV, Brito I, Oliveira-Ramos F, Alexeeva E, Chasnyk V, Arkachaisri T, Boyko Y, Vyzhga Y, Samsonenko S. The HyperPed-COVID international registry: Impact of age of onset, disease presentation and geographical distribution on the final outcome of MIS-C. J Autoimmun 2024; 147:103265. [PMID: 38838452 DOI: 10.1016/j.jaut.2024.103265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The aim of the study was to establish an international multicenter registry to collect data on patients with Multisystem Inflammatory Syndrome in Children (MIS-C), in order to highlight a relationship between clinical presentation, age of onset and geographical distribution on the clinical outcome. STUDY DESIGN Multicenter retrospective study involving different international societies for rare immunological disorders.1009 patients diagnosed with MIS-C between March and September 2022, from 48 centers and 22 countries were collected. Five age groups (<1, 1-4, 5-11, 12-16, >16 years) and four geographic macro-areas, Western Europe, Central-Eastern Europe, Latin America, Asian-African resource-limited countries (LRC), were identified. RESULTS Time to referral was significantly higher in LRC. Intensive anti-inflammatory treatment, including biologics, respiratory support and mechanic ventilation were more frequently used in older children and in European countries. The mortality rate was higher in very young children (<1 year), in older patients (>16 years of age) and in LRC. Multivariate analysis identified the residence in LRC, presence of severe cardiac involvement, renal hypertension, lymphopenia and non-use of heparin prophylaxis, as the factors most strongly associated with unfavorable outcomes. CONCLUSIONS The stratification of patients by age and geographic macro-area provided insights into the clinical presentation, treatment and outcome of MIS-C. The mortality and sequelae rates exhibited a correlation with the age and geographical areas. Patients admitted and treated in LRC displayed more severe outcomes, possibly due to delays in hospital admission and limited access to biologic drugs and to intensive care facilities.
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Affiliation(s)
- Roberta Caorsi
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Alessandro Consolaro
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy; Università Degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Genoa, Italy
| | - Camilla Speziani
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Betul Sozeri
- Health Sciences University, Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Kadir Ulu
- Health Sciences University, Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Enrique Faugier-Fuentes
- Hospital Infantil de México Federico Gómez, Medicina Interna y Reumatologia, Mexico City, Mexico
| | - Hector Menchaca-Aguayo
- Hospital Infantil de México Federico Gómez, Medicina Interna y Reumatologia, Mexico City, Mexico
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Seher Sener
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | | | - Mohammad Imnul Islam
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Paediatrics, Dhaka, Bangladesh
| | | | - Gabriele Simonini
- IRCCS Meyer Children's Hospital, Rheumatology Unit, ERN-ReCONNECT Center, Florence, Italy
| | - Mariel Viviana Mastri
- Hospital Interzonal de Agudos Especializado en Pediatría, Sor María Ludovica. Sala de Reumatologia La Plata, Argentina
| | - Tadej Avcin
- University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia
| | - Saša Sršen
- University Hospital Centre Split, Department of Pediatrics, Split, Croatia
| | | | - Valda Stanevicha
- Riga Stradins University, Children University Hospital, Riga, Latvia
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, University Clinical Center Nis, Clinic of Pediatrics, Department of Pediatric Rheumatology, Nis, Serbia
| | - Ali Sobh
- Mansoura University Children's Hospital, Faculty of Medicine Mansoura University, Mansura, Egypt
| | - Sarka Fingerhutova
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Minxova
- University Hospital Hradec Kralove, Department of Pediatrics, Hradec Kralove, Czech Republic
| | - Alenka Gagro
- Children's Hospital Zagreb, Department of Pulmonology, Allergology, Clinical Immunology and Rheumatology, The University of Zagreb School of Medicine, Zagreb, Croatia
| | - Adriana Rodrigues Fonseca
- Universidade Federal Do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Rio de Janeiro, Brazil
| | | | - Boriana Varbanova
- Varna Medical University, Department of Pediatrics First Pediatric Clinic, Varna, Bulgaria
| | - Judith Sánchez-Manubens
- Hospital Parc Taulí de Sabadell, Reumatologia Pediàtrica - Servei de Medicina Pediàtrica, Barcelona, Spain
| | - Margarita Ganeva
- University Children Hospital, Department of Paediatric Rheumatology, Sofia, Bulgaria
| | - Davide Montin
- Regina Margherita Children Hospital, Immunology and Rheumatology Unit, Turin, Italy
| | - Okana Boyarchuk
- I.Horbachevsky Ternopil National Medical University, Department of Children's Diseases and Pediatric Surgery, Ternopil, Ukraine
| | - Andrea Minghini
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy
| | - Claudia Bracaglia
- IRCCS Ospedale Pediatrico Bambino Gesù, Division of Rheumatology, Rome, Italy
| | - Paul Brogan
- UCL GOS Institute of Child Health, London, UK
| | - Fabio Candotti
- Division of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Francesca Minoia
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Pediatria e Immunoreumatologia2 Milan, Italy
| | - Andrea Taddio
- Institute of Child and Maternal Health - IRCCS "Burlo Garofolo" and University of Trieste, Trieste, Italy
| | - Carine Wouters
- UZ Leuven - Universitair Ziekenhuis, Leuven, Belgium; KU Leuven - University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, Leuven, Belgium
| | | | - Francesca Bovis
- University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - Angelo Ravelli
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOC Servizio di Sperimentazioni Cliniche Pediatriche, PRINTO, Genoa, Italy
| | - Marco Gattorno
- IRCCS Istituto Giannina Gaslini, UOC Reumatologia e Malattie Autoinfiammatorie, Genoa, Italy.
| | - Yelda Bilginer
- Hacettepe University Children's Hospital, Ankara, Turkey
| | - Kamrul Laila
- Bangabandhu Sheikh Mujib Medical Universit, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | - Oksana Chubata
- Ternopil Regional Children's Hospital, Ternopil, Ukraine
| | - Francesca Ricci
- Clinica Pediatrica Dell'Università di Brescia, Spedali Civili, Brescia, Italy
| | | | | | - Mojca Zajc Avramovic
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Emersic
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Masa Bizjak
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Vesel
- Tajnsek University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | - Eva Terifajova
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Martin Magner
- Thomayer University Hospital, Prague, Czech Republic
| | | | | | - Marija Jelusic
- University Hospital Centre Zagreb, University School of Medicine, Zagreb, Croatia
| | - Francesco La Torre
- Ospedale Pediatrico Giovanni XXIII - Azienda Ospedaliero-Universitaria Consorziale-Policlinico, Bari, Italy
| | | | | | | | - Nadina Rubio-Perez
- Hospital Universitario Dr. J. E. Gonzalez, Universidad, Autónoma de Nuevo León, Monterrey, NL, Mexico
| | | | | | | | | | - Ekaterina Alexeeva
- State Institution Scientific Center of Children Health of Rams Moscow, Moscow, Russian Federation
| | - Vyacheslav Chasnyk
- Saint-Petersburg State Pediatric Medical Academy, Saint-Petersburg, Russian Federation
| | | | - Yaryna Boyko
- Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Yulia Vyzhga
- National Pirogov Memorial Medical University, Vinnytsia, Ukraine
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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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A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease. Sci Rep 2023; 13:1173. [PMID: 36670127 PMCID: PMC9857913 DOI: 10.1038/s41598-022-26832-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023] Open
Abstract
The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4-11] vs. 3 [IQR 1-4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae-mainly cardiovascular-were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.
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Vainstein E, Baleani S, Urrutia L, Affranchino N, Ackerman J, Cazalas M, Goldsman A, Sardella A, Tolin AL, Goldaracena P, Fabi M, Cosentino M, Magliola R, Roggiero G, Manso P, Triguy J, Ballester C, Cervetto V, Vaccarello M, De Carli DN, De Carli ME, Ciotti AL, Sicurello MI, Rios Leiva C, Villalba C, Hortas M, Peña S, González G, Zold CL, Murer MG, Vázquez H, Morós C, Di Santo M, Villa A, Lazota P, Foti M, Napoli N, Katsikas MM, Tonello L, Peña J, Etcheverry M, Iglesias D, Alcalde AL, Bruera MJ, Bruzzo V, Giordano P, Acero FP, Pelandi GN, Pastaro D, Bleiz J, Rodríguez MF, Laghezza L, Molina MB, Patynok N, Chatelain, Aguilar MJ, Gamboa J, Cervan M, Ruggeri A, Marinelli I, Checcacci E, Meregalli C, Damksy Barbosa J, Fernie L, Fernández MJ, Saenz Tejeira MM, Cereigido C, Nunell A, Villar D, Mansilla AD, Darduin MD. Multicentre observational study on multisystem inflammatory syndrome related to COVID-19 in Argentina. Pediatr Int 2023; 65:e15431. [PMID: 36464947 PMCID: PMC9878215 DOI: 10.1111/ped.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in low- and middle-income countries remains poorly understood. Our aim was to understand the characteristics and outcomes of PIMS-TS in Argentina. METHODS This observational, prospective, and retrospective multicenter study enrolled patients younger than 18 years-old manifesting PIMS-TS, Kawasaki disease (KD) or Kawasaki shock syndrome (KSS) between March 2020 and May 2021. Patients were followed-up until hospital discharge or death (one case). The primary outcome was pediatric intensive care unit (PICU) admission. Multiple logistic regression was used to identify variables predicting PICU admission. RESULTS Eighty-one percent, 82%, and 14% of the 176 enrolled patients fulfilled the suspect case criteria for PIMS-TS, KD, and KSS, respectively. Temporal association with SARS-CoV-2 was confirmed in 85% of the patients and 38% were admitted to the PICU. The more common clinical manifestations were fever, abdominal pain, rash, and conjunctival injection. Lymphopenia was more common among PICU-admitted patients (87% vs. 51%, p < 0.0001), who also showed a lower platelet count and higher plasmatic levels of inflammatory and cardiac markers. Mitral valve insufficiency, left ventricular wall motion alterations, pericardial effusion, and coronary artery alterations were observed in 30%, 30%, 19.8%, and 18.6% of the patients, respectively. Days to initiation of treatment, rash, lymphopenia, and low platelet count were significant independent contributions to PICU admission. CONCLUSION Rates of severe outcomes of PIMS-TS in the present study agreed with those observed in high-income countries. Together with other published studies, this work helps clinicians to better understand this novel clinical entity.
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Affiliation(s)
- Eduardo Vainstein
- Clínica Pediátrica, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Silvia Baleani
- Clínica Pediátrica, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Luis Urrutia
- Clínica Pediátrica, Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - Nicolás Affranchino
- Clínica Pediátrica, Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - Judith Ackerman
- Unidad de Cardiología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Mariana Cazalas
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez y Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Alejandro Goldsman
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez y Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Angela Sardella
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ana Laura Tolin
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Pablo Goldaracena
- Clínica Médica, Hospital Sor María Ludovica de La Plata, Provincia de Buenos Aires, Argentina
| | - Mariana Fabi
- Servicio de Reumatología, Hospital Sor María Ludovica de La Plata, Provincia de Buenos Aires, Argentina
| | | | - Ricardo Magliola
- Clínica Pediátrica, Unidad Terapia Intensiva, Hospital Británico, Buenos Aires, Argentina
| | - Gustavo Roggiero
- Servicio de Cardiología, Hospital El Cruce Néstor Carlos Kirchner y Clínica del Niño de Quilmes, Provincia de Buenos Aires, Argentina
| | - Paula Manso
- Servicio de Cardiología, Hospital El Cruce Néstor Carlos Kirchner, Provincia de Buenos Aires, Argentina
| | - Jésica Triguy
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Celeste Ballester
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Vanesa Cervetto
- Reumatología, Hospital General de Niños Pedro de Elizalde y Hospital Británico, Buenos Aires, Argentina
| | - María Vaccarello
- Clínica Pediátrica, Sanatorio la Trinidad, Quilmes, Provincia de Buenos Aires, Argentina
| | | | - Maria Estela De Carli
- Clínica Pediátrica, Clínica del Niño de Quilmes, Provincia de Buenos Aires, Argentina
| | - Ana Laura Ciotti
- Servicio de Cardiología, Hospital A. Posadas, Provincia de Buenos Aires, Argentina
| | - María Irene Sicurello
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Cecilia Rios Leiva
- Servicio de Cardiología, Hospital Eva Perón de San Martín, Provincia de Buenos Aires, Argentina
| | - Claudia Villalba
- Servicio de Cardiología, Hospital Británico y Hospital Nacional de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - María Hortas
- Servicio de Reumatología, Sanatorio la Trinidad, Quilmes, Provincia de Buenos Aires, Argentina
| | - Sonia Peña
- Servicio de Inmunología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Gabriela González
- Servicio de Cardiología, Hospital H. Notti, Provincia de Mendoza, Argentina
| | - Camila Lidia Zold
- Universidad de Buenos Aires, CONICET, Instituto de Fisiología y Biofísica (IFIBIO) Bernardo Houssay, Buenos Aires, Argentina
| | - Mario Gustavo Murer
- Universidad de Buenos Aires, CONICET, Instituto de Fisiología y Biofísica (IFIBIO) Bernardo Houssay, Buenos Aires, Argentina
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Sadeghi P, Gorji M, Assari R, Tahghighi F, Raeeskarami SR, Ziaee V. Methylprednisolone pulses as an initial treatment in hyperinflammatory syndrome after COVID-19 in children: evaluation of laboratory data, serial echocardiography and outcome: a case series. Intensive Care Med Exp 2022; 10:56. [PMID: 36585531 PMCID: PMC9803403 DOI: 10.1186/s40635-022-00484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/17/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hyper-inflammatory syndrome in children and young adult occur 2-6 weeks after COVID-19 infection or closed contact with COVID-19 persons. In this study, the laboratory data and echocardiography and abdominal ultrasonography assessments were evaluated before and after Methylprednisolone pulse as an initial treatment of hyper-inflammatory syndrome. Therefore, the aim of this study is to assessment the clinical manifestations and laboratory data and outcome after methylprednisolone pulse as an initial treatment. METHOD In this retrospective study, the demographic status, clinical features, laboratory data, echocardiography, abdominal ultrasound, treatment and outcome of 31 pediatric patients under 16 years old, with inflammatory process after COVID-19 were evaluated. The clinical assessments, laboratory data, sonography and echocardiography were evaluated before and after methylprednisolone pulse. The patients were divided in two age group < and ≥ 7 years old and the clinical manifestations were compared with each other. The Mann-Whitney U test was used to assess the difference in quantitative variables between two groups. To compare pre- and post- treatment values, Wilcoxol test was used. To assess the correlation between qualitative variables chi-square test was used. The level of significant was considered 0.05. These patients with fever and hyper-inflammation features admitted to the referral pediatric rheumatology ward in Children Medical Center of Tehran University of medical sciences, from April 2020 to May 2021 were assessed. RESULT The mean age ± SD were (5.94 ± 3) and 51.6% (16) patients were male and 48.4% (15) patients were female. The most documented of previous COVID infection were antibody positive in about 27 (87%) patients. Moreover, 1 (3.8%) was PCR positive, 2 (7.7%) were positive in both PCR and serology and 3(11.5%) had closed contact with COVID-19 patients. About 9(29%) of patients were admitted in Intensive Care Unit (ICU). There were significant correlation between days of delay in starting treatment and ICU admission (P-value = 0.02). The mortality rate was negative in patients and no re-hospitalization was documented. There were significant differences (P-value < 0.05) between lymphocytes, platelet, Erythrocyte Sedimentation rate, C-reactive protein, Aspartate transaminase, Alanine transaminase and ferritin before and after treatment. Skin rashes and cardiac involvement totally as carditis (myocarditis, vulvulitis and pericarditis) (33.3%) and coronary involvements (53.3%) were the most prominent initial presentation in patients. There were near significant correlation (P-value = 0.066) between ferritin level and carditis before treatment. Cervical lymphadenopathy was seen significantly more in ≥ 7 years old (P-value = 0.01). CONCLUSION Multisystem inflammatory system in children as a hyperinflammatory syndrome could be treated with first step methylprednisolone pulse with decreasing inflammation in laboratory data and cardiac involvements and good outcome. Furthermore, the ferritin level may be one of the predictor of severe hyper-inflammatory syndrome leading to aggressive and urgent treatment with methylprednisolone pulse.
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Affiliation(s)
- Payman Sadeghi
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
| | - Mojtaba Gorji
- grid.411705.60000 0001 0166 0922Department of Pediatric Cardiology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, Tehran, Iran
| | - Raheleh Assari
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
| | - Fatemeh Tahghighi
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
| | - Seyed Reza Raeeskarami
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
| | - Vahid Ziaee
- grid.411705.60000 0001 0166 0922Department of Pediatric Rheumatology, Pediatric Center of Excellence, Children’s Medical Center of Tehran University of Medical Science, No 63, Gharib Ave., Keshavarz Blv., Tehran, Iran
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Karki S, Agrawal S, Rayamajhi A, Parajuli A, Yadav SK, Basnet S. Refractory Cardiogenic Shock Secondary to Acute Myocarditis in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19: A Case Report. JNMA J Nepal Med Assoc 2022; 60:965-968. [PMID: 36705185 PMCID: PMC9795101 DOI: 10.31729/jnma.6376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Children with Coronavirus disease 2019 infection usually have mild symptoms but rarely may present with a life-threatening condition called a multisystem inflammatory syndrome. We report a case of COVID-19-related multisystem inflammatory syndrome in an 8-year-old boy who presented with cardiogenic shock due to acute myocarditis with no features of Kawasaki disease. Cardiogenic shock was refractory to fluids and inotropes. Later, this case was successfully managed with hydrocortisone and intravenous immunoglobulin. Therefore, this case report highlights keeping a lookout for such atypical presentations and early referral to a higher center for timely intervention and aggressive therapy specifically directed against the underlying inflammatory process to ameliorate the outcomes. Keywords cardiogenic shock; COVID-19; kawasaki disease; myocarditis; Nepal.
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Affiliation(s)
- Susmin Karki
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal,Correspondence: Mr Susmin Karki, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. , Phone: +977-9842141166
| | - Saurav Agrawal
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Aadesh Rayamajhi
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Asmita Parajuli
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Sushil Kumar Yadav
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Srijana Basnet
- Department of Paediatrics, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Caorsi R, Civino A, Ravelli A. Complications of severe acute respiratory syndrome coronavirus 2 infection in children. Curr Opin Rheumatol 2022; 34:267-273. [PMID: 35797144 DOI: 10.1097/bor.0000000000000892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Although during the initial stages of COVID-19 pandemic, the pediatric population seemed to be less affected, a number of SARS-CoV-2-related manifestations emerged over time, the principal of which is the multisystem inflammatory syndrome in children (MIS-C). Here we provide an update on the main pediatric disorders associated with SARS-CoV-2 infection. RECENT FINDINGS MIS-C is novel postinfectious manifestation with clinical features similar to Kawasaki disease and characterized by intense systemic inflammation affecting multiple organs. Many children required intensive care therapy because of circulatory shock, usually of myocardial origin. Appropriate treatment with immunomodulatory therapies led to favorable outcomes in most patients, with recovery of overall health and cardiac dysfunction. In addition to MIS-C, a variety of other complications of COVID-19 in children have been described, including thrombotic events, neurologic manifestations, and chilblain-like lesions. There is still uncertainty about the true prevalence of long COVID in children and its distinction from pandemic-related complaints. SUMMARY The experience gained so far with MIS-C and the other SARS-CoV-2-related complications in children and adolescents will facilitate accurate diagnosis and appropriate treatment. Further studies are needed to elucidate the pathophysiology of MIS-C and to determine the real impact of long-COVID in the pediatric age group.
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Affiliation(s)
- Roberta Caorsi
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa
| | - Adele Civino
- UOSD Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
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8
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Rouva G, Vergadi E, Hatzidaki E, Germanakis I. Mild coronary artery dilatation developed in some children with mild COVID-19 but completely regressed within 3 months. Acta Paediatr 2022; 111:1764-1770. [PMID: 35748529 PMCID: PMC9350397 DOI: 10.1111/apa.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 12/02/2022]
Abstract
Aim We studied the incidence and time course of any coronary artery changes in children up to 2 years of age who were hospitalised with mild COVID‐19. Methods This was a single‐centre prospective study of 29 children (19 males) with a median age of 3 months and interquartile range (IQR) of 1.6–4.3 months. They were admitted to a Greek University hospital for mild COVID‐19 from 1 March to 30 December 2021. Three echocardiographic evaluations were performed at a median (IQR) of 19 (16–24) days, 82 (75–89) days and 172 (163–197) after the first symptoms. The prevalence of coronary artery dilation, regression, and changes was documented. Results Coronary artery dilation was present in 3 (10.3%) cases at the first evaluation, with complete regression at the second. Regression was observed in 18/24 (75%) cases with follow‐up data and 9 (31%) demonstrated significant z‐score changes of >2. Coronary artery changes in any segment at any time were documented in 18/29 (62%) of the patients. Conclusion Cases of transient and very mild coronary artery dilatation following mild COVID‐19 completely regressed within 3 months. Large‐scale studies are needed to document the extent and time course of coronary artery dilation following paediatric COVID‐19.
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Affiliation(s)
- Glykeria Rouva
- Department of Pediatrics, University Hospital Heraklion, School of Medicine, University of Crete, Greece
| | - Eleni Vergadi
- Department of Pediatrics, University Hospital Heraklion, School of Medicine, University of Crete, Greece
| | - Eleftheria Hatzidaki
- Department of Neonatology, University Hospital Heraklion, School of Medicine, University of Crete, Greece
| | - Ioannis Germanakis
- Department of Pediatrics, University Hospital Heraklion, School of Medicine, University of Crete, Greece
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9
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Santaniello M, Matucci-Cerinic C, Natoli V, Trincianti C, Ridella F, Ravelli A. Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): Distinct from Kawasaki disease or part of the same spectrum? Pediatr Allergy Immunol 2022; 33 Suppl 27:102-104. [PMID: 35080303 PMCID: PMC9306717 DOI: 10.1111/pai.13645] [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: 06/11/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
One of the most challenging and intriguing phenomena observed during the COVID-19 pandemic has been the multisystem inflammatory syndrome in children (MIS-C). Patients with this condition present with some clinical features similar to those of Kawasaki disease (KD) and display signs and symptoms that are uncommon or rarely occur in this disorder, such as gastrointestinal complaints and myocarditis, often leading to myocardial failure and shock. In addition, patients' age is older than that of children with classic KD. Management is based on administering intravenous immunoglobulin, glucocorticoids, and anakinra in the most severe instances. It is still debated whether MIS-C and KD are different illnesses or represent a disease continuum.
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Affiliation(s)
- Maria Santaniello
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Caterina Matucci-Cerinic
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Valentina Natoli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Chiara Trincianti
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Francesca Ridella
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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10
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Zhou C, Zhao Y, Wang X, Huang Y, Tang X, Tang L. Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease. Pediatr Pulmonol 2021; 56:3688-3698. [PMID: 34583417 DOI: 10.1002/ppul.25687] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/26/2021] [Accepted: 09/18/2021] [Indexed: 12/19/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers, and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels. In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and erythrocyte sedimentation rate (ESR). In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of N-terminal pro-brain natriuretic peptide, troponin and aspartate aminotransferase were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and alanine aminotransferase and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.
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Affiliation(s)
- Chunling Zhou
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Yan Zhao
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Xia Wang
- Department of Pediatrics, Chongqing Youyoubaobei Women and Children's Hospital, Chongqing, China
| | - Ying Huang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuewen Tang
- Department of Cardiology, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Lei Tang
- Department of Pediatrics, People's Hospital of Chongqing Banan District, Chongqing, China
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11
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Roe K. Explanations for 10 of the most puzzling aspects of multisystem inflammatory syndrome and other Kawasaki-like diseases. J Clin Pharm Ther 2021; 47:539-543. [PMID: 34729795 DOI: 10.1111/jcpt.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE An extensively documented multisystem inflammatory syndrome (MIS) has been observed in a small but significant percentage of COVID-19 patients, in some adults but primarily in paediatric patients, and for these patients it is sometimes called MIS-C. COMMENT Kawasaki disease has also been observed over the last several decades in patients that tested positive for a variety of very virulent pathogens. Several differences and similarities between MIS-C and Kawasaki disease pathology have been observed. Several puzzling aspects of MIS-C, Kawasaki disease and other Kawasaki-like diseases have been discussed, but not yet explained. WHAT IS NEW AND CONCLUSION An explanatory hypothesis has been presented. Using the hypothesis that a transient or permanent inability to quickly phagocytize antigen-antibody immune complexes created by a novel virulent pathogen infection induces a Type III hypersensitivity immune response and the resulting proteinase exposure and expression of new autoantigens are the fundamental steps for MIS and other Kawasaki-like diseases, it is possible to provide straightforward explanations for at least 10 of the most puzzling aspects of these diseases. The validity of the hypothesis itself is also supported by its ability to provide consistent and straightforward explanations for a large number of these disease aspects. Furthermore, these straightforward explanations and the explanatory hypothesis on which they are based also suggest several potential new treatments, which could possibly be more effective than various treatments in current use.
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12
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Saez-de-Ocariz M, Gámez-González LB, Rivas-Larrauri F, Castaño-Jaramillo LM, Toledo-Salinas C, Garrido-García LM, Ulloa-Gutierrez R, Santamaría-Piedra M, Orozco-Covarrubias MDLL, Scheffler-Mendoza S, Yamazaki-Nakashimada MA. Kawasaki disease mimickers. Pediatr Int 2021; 63:880-888. [PMID: 33249696 DOI: 10.1111/ped.14561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/14/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects patients younger than 5 years. In the absence of an available, affordable diagnostic test, detailed clinical history and physical examination are still fundamental to make a diagnosis. METHODS We present five representative cases with KD-like presentations: systemic onset juvenile idiopathic arthritis, mycoplasma-induced rash and mucositis, staphylococcal scalded skin syndrome, BCGosis, and the recently described multisystemic inflammatory syndrome in children (MIS-C) associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus. RESULTS Rash, fever, and laboratory markers of inflammation can be present in several childhood diseases that may mimic KD. CONCLUSION The term 'Kawasaki syndrome' instead of 'Kawasaki disease' may be more appropriate. Physicians should consider an alternative diagnosis that may mimic KD, particularly considering MIS-C during the present pandemic, as an aggressive diagnostic and therapeutic approach is needed.
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Affiliation(s)
| | | | | | | | - Carla Toledo-Salinas
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáez Herrera", San José, Costa Rica
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13
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Bukulmez H. Current Understanding of Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 and Its Distinction from Kawasaki Disease. Curr Rheumatol Rep 2021; 23:58. [PMID: 34216296 PMCID: PMC8254432 DOI: 10.1007/s11926-021-01028-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this article, I have reviewed current reports that explore differences and similarities between multisystem inflammatory syndrome in children (MIS-C) and other known multisystem inflammatory diseases seen in children, particularly Kawasaki disease. RECENT FINDINGS Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a human coronavirus causing the COVID-19 disease which emerged in China in December 2019 and spread rapidly to the entire country and quickly to other countries. Currently, there is a pandemic of SARS-CoV-2 infection that results in 20% of patients admitted to hospital with illness, with 3% developing intractable acute respiratory distress syndrome (ARDS) with high mortality. However, pediatric COVID-19 is still reported to be a mild disease, affecting only 8% of children. Pathogenesis in children is comparable to adults. There are suggested impaired activation of IFN-alpha and IFN regulator 3, decreased cell response causing impaired viral defense, yet the clinical course is mild, and almost all children recover from the infection without major complications. Interestingly, there is a subset of patients that develop a late but marked immunogenic response to COVID-19 and develop MIS-C. Clinical features of MIS-C resemble certain pediatric rheumatologic diseases, such as Kawasaki disease (mucocutaneous lymph node syndrome) which affects small-medium vessels. Other features of MIS-C resemble those of macrophage activation syndrome (MAS). However, recent research suggests distinct clinical and laboratory differences between MIS-C, Kawasaki disease, and MAS. Since the start of the SARS-CoV-2 pandemic, MIS-C has become the candidate for the most common cause of acquired heart disease in children.
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Affiliation(s)
- Hulya Bukulmez
- Department of Pediatrics, Division of Pediatric Rheumatology, Metro Health Medical Center, Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
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14
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Abstract
Immune-related manifestations are increasingly recognized conditions in patients with COVID-19, with around 3,000 cases reported worldwide comprising more than 70 different systemic and organ-specific disorders. Although the inflammation caused by SARS-CoV-2 infection is predominantly centred on the respiratory system, some patients can develop an abnormal inflammatory reaction involving extrapulmonary tissues. The signs and symptoms associated with this excessive immune response are very diverse and can resemble some autoimmune or inflammatory diseases, with the clinical phenotype that is seemingly influenced by epidemiological factors such as age, sex or ethnicity. The severity of the manifestations is also very varied, ranging from benign and self-limiting features to life-threatening systemic syndromes. Little is known about the pathogenesis of these manifestations, and some tend to emerge within the first 2 weeks of SARS-CoV-2 infection, whereas others tend to appear in a late post-infectious stage or even in asymptomatic patients. As the body of evidence comprises predominantly case series and uncontrolled studies, diagnostic and therapeutic decision-making is unsurprisingly often based on the scarcely reported experience and expert opinion. Additional studies are required to learn about the mechanisms involved in the development of these manifestations and apply that knowledge to achieve early diagnosis and the most suitable therapy.
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15
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Matucci-Cerinic C, Caorsi R, Consolaro A, Rosina S, Civino A, Ravelli A. Multisystem Inflammatory Syndrome in Children: Unique Disease or Part of the Kawasaki Disease Spectrum? Front Pediatr 2021; 9:680813. [PMID: 34178896 PMCID: PMC8220809 DOI: 10.3389/fped.2021.680813] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
One of the most intriguing and mysterious phenomena observed during the COVID-19 pandemic has been represented by the occurrence of the multisystem inflammatory syndrome in children and adolescents (MIS-C). Patients with this condition have some overlapping signs and symptoms with those of Kawasaki disease (KD), but also display clinical features that are uncommon or less frequent in this illness, such as diarrhea, abdominal pain and myocardial involvement. The sickest patients may develop multiorgan failure and shock, usually due to myocarditis. Management is based on the administration of intravenous immunoglobulin, glucocorticoids and, in the most severe instances, anakinra. It is still debated whether MIS-C and KD represent different illnesses or are part of the same disease spectrum. The aim of the present review is to analyze critically the evidence in favor of the latter hypothesis and to provide the authors' personal interpretation of the relationship between the two conditions.
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Affiliation(s)
- Caterina Matucci-Cerinic
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Roberta Caorsi
- Unità Operativa Complessa (UOC) Clinica Pediatrica e Reumatologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Consolaro
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Unità Operativa Complessa (UOC) Clinica Pediatrica e Reumatologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Silvia Rosina
- Unità Operativa Complessa (UOC) Clinica Pediatrica e Reumatologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Adele Civino
- Unità di Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Unità Operativa Complessa (UOC) Clinica Pediatrica e Reumatologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russia
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16
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Rowley AH, Shulman ST, Arditi M. Immune pathogenesis of COVID-19-related multisystem inflammatory syndrome in children. J Clin Invest 2020; 130:5619-5621. [PMID: 32870815 DOI: 10.1172/jci143840] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Anne H Rowley
- Department of Pediatrics and.,Department of Microbiology/Immunology, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - Moshe Arditi
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, and.,Department of Biomedical Sciences, Infectious and Immunologic Diseases Research Center (IIDRC), Cedars-Sinai Medical Center, Los Angeles, California, USA
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17
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Li SC, Tsai KW, Huang LH, Weng KP, Chien KJ, Lin Y, Tu CY, Lin PH. Serum proteins may facilitate the identification of Kawasaki disease and promote in vitro neutrophil infiltration. Sci Rep 2020; 10:15645. [PMID: 32973234 PMCID: PMC7518260 DOI: 10.1038/s41598-020-72695-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022] Open
Abstract
Kawasaki disease (KD) usually affects the children younger than 5 years of age and subsequently causes coronary artery lesions (CALs) without timely identification and treatment. Developing a robust and fast prediction method may facilitate the timely diagnosis of KD, significantly reducing the risk of CALs in KD patients. The levels of inflammatory serum proteins dramatically vary during the onsets of many immune diseases, including in KD. However, our understanding of their pathogenic roles in KD is behind satisfaction. The purpose of this study was to evaluate candidate diagnostic serum proteins and the potential mechanism in KD using iTRAQ gel-free proteomics. We enrolled subjects and conducted iTRAQ gel-free proteomics to globally screen serum proteins followed by specific validation with ELISA. Further in vitro leukocyte trans-endothelial model was also applied to investigate the pathogenesis roles of inflammatory serum proteins. We identified six KD protein biomarkers, including Protein S100-A8 (S100A8), Protein S100-A9 (S100A9), Protein S100-A12 (S100A12), Peroxiredoxin-2 (PRDX2), Neutrophil defensin 1 (DEFA1) and Alpha-1-acid glycoprotein 1 (ORM1). They enabled us to develop a high-performance KD prediction model with an auROC value of 0.94, facilitating the timely identification of KD. Further assays concluded that recombinant S100A12 protein treatment activated neutrophil surface adhesion molecules responsible for adhesion to endothelial cells. Therefore, S100A12 promoted both freshly clinically isolated neutrophils and neutrophil-like cells to infiltrate through the endothelial layer in vitro. Finally, the antibody against S100A12 may attenuate the infiltration promoted by S100A12. Our result demonstrated that evaluating S100A8, S100A9, S100A12, PRDX2, DEFA1 and ORM1 levels may be a good diagnostic tool of KD. Further in vitro study implied that S100A12 could be a potential therapeutic target for KD.
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Affiliation(s)
- Sung-Chou Li
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Wang Tsai
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Lien-Hung Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ken-Pen Weng
- Congenital Structural Heart Disease Center, Department of Pediatrics, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, Taiwan. .,Department of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Kuang-Jen Chien
- Congenital Structural Heart Disease Center, Department of Pediatrics, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, Taiwan
| | - Yuyu Lin
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ying Tu
- Congenital Structural Heart Disease Center, Department of Pediatrics, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, Taiwan
| | - Pei-Hsien Lin
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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