1
|
Sadeghi P, Karimi H, Lavafian A, Rashedi R, Samieefar N, Shafiekhani S, Rezaei N. Machine learning and artificial intelligence within pediatric autoimmune diseases: applications, challenges, future perspective. Expert Rev Clin Immunol 2024. [PMID: 38771915 DOI: 10.1080/1744666x.2024.2359019] [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: 11/19/2023] [Accepted: 05/20/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Autoimmune disorders affect 4.5% to 9.4% of children, significantly reducing their quality of life. The diagnosis and prognosis of autoimmune diseases are uncertain because of the variety of onset and development. Machine learning can identify clinically relevant patterns from vast amounts of data. Hence, its introduction has been beneficial in the diagnosis and management of patients. AREAS COVERED This narrative review was conducted through searching various electronic databases, including PubMed, Scopus, and Web of Science This study thoroughly explores the current knowledge and identifies the remaining gaps in the applications of machine learning specifically in the context of pediatric autoimmune and related diseases. EXPERT OPINION Machine learning algorithms have the potential to completely change how pediatric autoimmune disorders are identified, treated, and managed. Machine learning can assist physicians in making more precise and fast judgments, identifying new biomarkers and therapeutic targets, and personalizing treatment strategies for each patient by utilizing massive datasets and powerful analytics.
Collapse
Affiliation(s)
- Parniyan Sadeghi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Atiye Lavafian
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Semnan University of Medical Science, Semnan, Iran
| | - Ronak Rashedi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
| | - Noosha Samieefar
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
| | - Sajad Shafiekhani
- Department of Biomedical Engineering, Buein Zahra Technical University, Qazvin, Iran
| | - Nima Rezaei
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Zhang H, Zhang Y. [Predictive indicators and risk model construction for coronary artery lesions in Kawasaki disease children over 5 years old]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:461-468. [PMID: 38802905 DOI: 10.7499/j.issn.1008-8830.2309103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To study predictive indicators for coronary artery lesions (CAL) and construct a risk prediction model for CAL in Kawasaki disease (KD) children over 5 years old. METHODS A retrospective analysis of KD children over 5 years old at Wuhan Children's Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to January 2023 was conducted. Among them, 47 cases were complicated with CAL, and 178 cases were not. Multivariate logistic regression analysis was used to explore predictive indicators for CAL in KD children over 5 years old and construct a risk prediction model. The receiver operating characteristic curve was used to evaluate the effectiveness of the prediction model. Finally, the Framingham risk scoring method was used to quantify the predictive indicators, calculate the contribution of each indicator to the prediction of CAL in KD children over 5 years old, and construct a risk prediction scoring model. RESULTS The multivariate logistic regression analysis showed that the duration of fever before the initial intravenous immunoglobulin (IVIG) treatment (OR=1.374, 95%CI: 1.117-1.689), levels of hypersensitive C-reactive protein (hs-CRP; OR=1.008, 95%CI: 1.001-1.015), and serum ferritin levels (OR=1.002, 95%CI: 1.001-1.003) were predictive indicators for CAL in KD children over 5 years old. The optimal cutoff values for predicting CAL were: duration of fever before initial IVIG treatment of 6.5 days (AUC=0.654, 95%CI: 0.565-0.744), hs-CRP of 110.50 mg/L (AUC=0.686, 95%CI: 0.597-0.774), and ferritin of 313.62 mg/L (AUC=0.724, 95%CI: 0.642-0.805). According to the Framingham risk scoring method, the low, medium, and high-risk states of CAL occurrence were defined as probabilities of <10%, 10%-20%, and >20%, respectively, with corresponding scores of 0-4 points, 5-6 points, and ≥7 points. CONCLUSIONS In KD children over 5 years old, those with a longer duration of fever before initial IVIG treatment, higher levels of hs-CRP, or elevated serum ferritin levels are more likely to develop CAL.
Collapse
Affiliation(s)
- Huayong Zhang
- Department of Cardiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology/Wuhan Maternal and Child Healthcare Hospital, Wuhan 430016
| | - Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology/Wuhan Maternal and Child Healthcare Hospital, Wuhan 430016
| |
Collapse
|
3
|
Tulling AJ, Holierhoek MG, Jansen-Hoogendijk AM, Hoste L, Haerynck F, Tavernier SJ, Oostenbrink R, Buysse CMP, Bannier MAGE, Bekhof J, Breukels M, Hammer SC, Jacobs MAM, Kamps AWA, van der Linden JW, Lebon A, Oudshoorn JH, Tramper-Stranders GA, Vastert SJ, Wieringa JW, Terheggen-Lagro SWJ, Wildenbeest JG, von Asmuth EGJ, van den Akker EB, van Gijn ME, Lugthart G, Buddingh EP. Serum proteomics reveals hemophagocytic lymphohistiocytosis-like phenotype in a subset of patients with multisystem inflammatory syndrome in children. Clin Immunol 2024; 264:110252. [PMID: 38744408 DOI: 10.1016/j.clim.2024.110252] [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: 04/26/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Children with Multisystem Inflammatory Syndrome in Children (MIS-C) can present with thrombocytopenia, which is a key feature of hemophagocytic lymphohistiocytosis (HLH). We hypothesized that thrombocytopenic MIS-C patients have more features of HLH. Clinical characteristics and routine laboratory parameters were collected from 228 MIS-C patients, of whom 85 (37%) were thrombocytopenic. Thrombocytopenic patients had increased ferritin levels; reduced leukocyte subsets; and elevated levels of ASAT and ALAT. Soluble IL-2RA was higher in thrombocytopenic children than in non-thrombocytopenic children. T-cell activation, TNF-alpha and IFN-gamma signaling markers were inversely correlated with thrombocyte levels, consistent with a more pronounced cytokine storm syndrome. Thrombocytopenia was not associated with severity of MIS-C and no pathogenic variants were identified in HLH-related genes. This suggests that thrombocytopenia in MIS-C is not a feature of a more severe disease phenotype, but the consequence of a distinct hyperinflammatory immunopathological process in a subset of children.
Collapse
Affiliation(s)
- Adam J Tulling
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Marloes G Holierhoek
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Levi Hoste
- Primary Immunodeficiency Research Lab (PIRL), Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Center for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Filomeen Haerynck
- Primary Immunodeficiency Research Lab (PIRL), Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Center for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Simon J Tavernier
- Primary Immunodeficiency Research Lab (PIRL), Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Center for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Rianne Oostenbrink
- Department of General Pediatrics, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands
| | - Corinne M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Michiel A G E Bannier
- Department of Pediatrics, MosaKids Children's Hospital, University Medical Center Maastricht, Maastricht, the Netherlands
| | - Jolita Bekhof
- Department of Pediatrics, Isala Hospital, Zwolle, the Netherlands
| | - Mijke Breukels
- Department of Pediatrics, Elkerliek Hospital, Helmond, the Netherlands
| | - Sanne C Hammer
- Department of Pediatrics, Amphia Hospital, Breda, the Netherlands
| | - Monique A M Jacobs
- Department of Pediatrics, Slingeland Hospital, Doetinchem, the Netherlands
| | - Arvid W A Kamps
- Department of Pediatrics, Martini Hospital, Groningen, the Netherlands
| | | | - Ankie Lebon
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | - Sebastiaan J Vastert
- Department of Pediatric Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jantien W Wieringa
- Department of Pediatrics, Haaglanden Medical Center, the Hague, the Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology and Allergy, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erik G J von Asmuth
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik B van den Akker
- Leiden Computational Biology Center, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; The Delft Bioinformatics Lab, Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, the Netherlands
| | - Marielle E van Gijn
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gertjan Lugthart
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Emilie P Buddingh
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
4
|
Tong T, Jin YH, Wang M, Gong FQ. Treatment of multisystem inflammatory syndrome in children. World J Pediatr 2024; 20:325-339. [PMID: 38509432 DOI: 10.1007/s12519-024-00798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), a relatively uncommon but severe pediatric complication, is associated with coronavirus disease 2019 (COVID-19). A variety of treatment approaches, including intravenous immunoglobulins (IVIGs), glucocorticoids (GCs) and biologic agents, such as anakinra and infliximab, have been described for the management of COVID-19-related MIS-C. Anticoagulant therapy is also important. However, a well-developed treatment system has not been established, and many issues remain controversial. Several recently published articles related to the treatment of MIS-C have been released. Hence, in this review, we identified relevant articles published recently and summarized the treatment of MIS-C more comprehensively and systematically. DATA SOURCES We reviewed the literature on the treatment of MIS-C through 20 September 2023. The PubMed/Medline, Web of Science, EMBASE, and Cochrane Library databases were searched with the combination of the terms "multisystem inflammatory syndrome", "MIS-C", "PIMS-TS", "therapy", "treatment", "drug", "IVIG", "GCs", "intravenous immunoglobulin", "corticosteroids", "biological agent", and "aspirin". RESULTS The severity of MIS-C varies, and different treatment schemes should be used according to the specific condition. Ongoing research and data collection are vital to better understand the pathophysiology and optimal management of MIS-C. CONCLUSIONS MIS-C is a disease involving multiple systems and has great heterogeneity. With the accumulation of additional experience, we have garnered fresh insights into its treatment strategies. However, there remains a critical need for greater standardization in treatment protocols, alongside the pressing necessity for more robust and meticulously conducted studies to deepen our understanding of these protocols. Supplementary file1 (MP4 208044 kb).
Collapse
Affiliation(s)
- Tong Tong
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China
| | - Yi-Hua Jin
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China
| | - Min Wang
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China
| | - Fang-Qi Gong
- Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310052, China.
| |
Collapse
|
5
|
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
| |
Collapse
|
6
|
Wang W, Zhu L, Li X, Liu Z, Lv H, Qian G. Emerging evidence of microbial infection in causing systematic immune vasculitis in Kawasaki disease. Front Microbiol 2023; 14:1313838. [PMID: 38188572 PMCID: PMC10771848 DOI: 10.3389/fmicb.2023.1313838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Kawasaki disease (KD) is a systematic vasculitis that is often complicated by coronary artery lesions and is a leading cause of acquired heart disease in developed countries. Previous studies have suggested that genetic susceptibility, together with an inducing infectious agent, could be involved in KD pathogenesis; however, the precise causative agent of this disease remains unknown. Moreover, there are still debates concerning whether KD is an infectious disease or an autoimmune disease, although many studies have begun to show that various pathogens functioning as critical inducers could activate different kinds of immune cells, consequently leading to the dysfunction of endothelial cells and systematic vasculitis. Here in this review, we attempt to summarize all the available evidence concerning pathogen infections associated with KD pathogenesis. We also discuss the related mechanisms, present a future perspective, and identify the open questions that remain to be investigated, thereby providing a comprehensive description of pathogen infections and their correlations with the host immune system in leading to KD.
Collapse
Affiliation(s)
- Wang Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Liyan Zhu
- Department of Experimental Center, Medical College of Soochow University, Suzhou, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiheng Liu
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
7
|
Phi DL, Dao TL, To MM, Nguyen TB, Nguyen DC, Gautret P, Hoang VT. Clinical and Laboratory Characteristics of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children. J Korean Med Sci 2023; 38:e410. [PMID: 38111281 PMCID: PMC10727921 DOI: 10.3346/jkms.2023.38.e410] [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: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 12/20/2023] Open
Abstract
Geographical and racial factors constitute important distinctions between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C), but no study has been conducted in Vietnam. Forty-one children with KD from January 2018 to July 2020 and 42 with KD/MIS-C from August 2020 to December 2022 were included in this study. Of the patients, 52.3% were aged between 12 and 35 months. Only two were aged over 5 years, and both were belong to the KD/MIS-C group. A 59.5% of the patients were male. Apart from fever, all symptoms tended to be more frequent in patients with KD/MIS-C. The prevalence of diffuse skin rash, hand and foot edema or erythema and gastrointestinal signs was significantly higher in patients hospitalized with KD/MIS-C. There was no significant difference in laboratory findings between the two groups. Coronary artery dilation was more frequently observed in patients with KD/MIS-C compared to those with KD (40.5% vs. 14.6%, P = 0.009).
Collapse
Affiliation(s)
- Duc Long Phi
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi Loi Dao
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Minh Manh To
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Duy Cuong Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.
| |
Collapse
|
8
|
Mileva N, Vasilev GH, Ganev B, Chervenkov L, Batselova H, Tzotcheva I, Tomov L, Velikova T, Lazova S. Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2175. [PMID: 38138278 PMCID: PMC10744581 DOI: 10.3390/medicina59122175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.
Collapse
Affiliation(s)
- Niya Mileva
- Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria;
| | - Georgi H. Vasilev
- Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, “Plovdivsko pole” Str. No. 6, 1756 Sofia, Bulgaria;
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
| | - Borislav Ganev
- Pediatric Department, University Hospital N. I. Pirogov, 21 General Eduard I. Totleben blvd, 1606 Sofia, Bulgaria;
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, University Hospital “St George”, blvd. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
| | - Iren Tzotcheva
- Pediatric Clinic, UMHATEM “N. I. Pirogov”, Blvd. “General Eduard I. Totleben” 21, Pette Kyosheta, 1606 Sofia, Bulgaria;
| | - Latchezar Tomov
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
- Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
| | - Snezhina Lazova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria; (L.T.); (T.V.)
- Pediatric Clinic, UMHATEM “N. I. Pirogov”, Blvd. “General Eduard I. Totleben” 21, Pette Kyosheta, 1606 Sofia, Bulgaria;
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria
| |
Collapse
|
9
|
Pavan Kumar N, Abbas KM, Renji RM, Venkataraman A, Nancy A, Varadarjan P, Selladurai E, Sangaralingam T, Selvam R, Thimmaiah A, Natarajan S, Ramasamy G, Hissar S, Ranganathan UD, Nutman TB, Babu S. Multisystem inflammatory syndrome in children characterized by enhanced antigen-specific T-cell expression of cytokines and its reversal following recovery. Front Pediatr 2023; 11:1235342. [PMID: 38116577 PMCID: PMC10728284 DOI: 10.3389/fped.2023.1235342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Background Multisystem inflammatory syndrome (MIS) in children is considered to be a post-infectious complication of COVID-19. T-cell responses in children with this condition have not been well-studied. Methods We aimed to study the immune responses in children with MIS in comparison to children with acute COVID-19 and children with other infections. Whole blood was stimulated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-specific antigens and flow cytometry was performed to examine CD4+ and CD8+ T-cell responses. Results Children with MIS had higher frequencies of CD4+ and CD8+ T cells expressing cytokines at baseline and upon SARS-CoV-2 antigen-specific stimulation in comparison to children with COVID-19 and/or other infections. Children with COVID-19 also exhibited higher frequencies of CD4+ and CD8+ T cells expressing cytokines at baseline and upon SARS-CoV-2 antigen-specific stimulation in comparison to children with other infections. At 6-9 months following treatment and recovery, this enhanced response against SARS-CoV-2 antigens was down modulated in children with MIS. Conclusion Our study, therefore, provides evidence of enhanced activation of CD4+ and CD8+ T-cell responses in children with MIS and reversal following recovery.
Collapse
Affiliation(s)
- Nathella Pavan Kumar
- Department of Immunology, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Kadar M. Abbas
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
| | - Rachel M. Renji
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
| | - Aishwarya Venkataraman
- Department of Clinical Research, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Arul Nancy
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
| | - Poovazhagi Varadarjan
- Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India
| | - Elilarasi Selladurai
- Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India
| | | | - Ramya Selvam
- General Pediatrics, Dr. Mehta’s Children’s Hospital, Chennai, India
| | | | | | - Ganesh Ramasamy
- General Pediatrics, Rainbow Children’s Hospital, Chennai, India
| | - Syed Hissar
- Department of Clinical Research, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Uma Devi Ranganathan
- Department of Immunology, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Subash Babu
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
10
|
Jiang J, Fan Z, Mao Y. A case of multisystem inflammatory syndrome in children: A case report. Medicine (Baltimore) 2023; 102:e36329. [PMID: 38050295 PMCID: PMC10695486 DOI: 10.1097/md.0000000000036329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Multisystemic inflammatory syndrome is a syndrome of multisystem involvement caused by a novel coronavirus infection that can lead to cardiogenic shock and death in children. PATIENT CONCERNS A 4-year-old girl was diagnosed with multiple organ and multiple system involvement after Kawasaki disease. DIAGNOSIS Novel coronavirus infection-associated multisystem inflammatory syndrome in children was considered. INTERVENTIONS The patients received aspirin, methylprednisolone and gammaglobulin to treat multisystem inflammatory syndrome. OUTCOMES After treatment, the child recovered and was discharged from the hospital. LESSONS Multisystem inflammatory syndrome is often mistaken for Kawasaki disease, fortunately, their treatments are similar, the purpose of this case is to remind clinicians of the need for early management of children with multisystem failure following novel coronavirus infection, increase the detection rate, and save the life of the child.
Collapse
Affiliation(s)
- Junsheng Jiang
- Department of Pediatrics, Linping Branch of the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zheng Fan
- Department of Pediatrics, Linping Branch of the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yueyan Mao
- Department of Pediatrics, Linping Branch of the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| |
Collapse
|
11
|
Shah AB, Abrams JY, Godfred-Cato S, Kunkel A, Hammett TA, Perez MA, Hsiao HM, Baida N, Rostad CA, Ballan W, Ede K, Laham FR, Kao CM, Oster ME, Belay ED. Treatments and Severe Outcomes for Patients Diagnosed With MIS-C at Four Children's Hospitals in the United States, March 16, 2020-March 10, 2021. Pediatr Infect Dis J 2023; 42:990-998. [PMID: 37862698 DOI: 10.1097/inf.0000000000004065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Clinical management of multisystem inflammatory syndrome in children (MIS-C) has varied over time and by medical institution. METHODS Data on patients with MIS-C were collected from 4 children's hospitals between March 16, 2020 and March 10, 2021. Relationships between MIS-C treatments and patient demographics, clinical characteristics, and outcomes were described. Propensity score matching was utilized to assess the relative risk of outcomes dependent on early treatment with intravenous immunoglobulin (IVIG) or low-dose steroids, controlling for potential confounding variables. RESULTS Of 233 patients diagnosed with MIS-C, the most commonly administered treatments were steroids (88.4%), aspirin (81.1%), IVIG (77.7%) and anticoagulants (71.2%). Compared with those patients without respiratory features, patients with respiratory features were less likely to receive IVIG and steroids on the same day (combination treatment) (44.1%). Controlling for confounding variables, patients receiving IVIG within 1 day of hospitalization were less likely to have hospital length of stay ≥8 days (RR = 0.53, 95% CI: 0.31-0.88). Patients receiving low-dose steroids within 1 day of hospitalization were less likely to develop ventricular dysfunction (RR = 0.45, 95% CI: 0.26-0.77), have increasingly elevated troponin levels (RR = 0.55, 95% CI: 0.40-0.75) or have hospital length of stay ≥8 days (RR = 0.46, 95% CI: 0.29-0.74). CONCLUSION Treatments for MIS-C differed by hospital, patient characteristics and illness severity. When IVIG and low-dose steroids were administered in combination or low-dose steroids were administered alone within 1 day of hospitalization, the risk of subsequent severe outcomes was decreased.
Collapse
Affiliation(s)
- Ami B Shah
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Falls Church, Virginia
| | - Joseph Y Abrams
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shana Godfred-Cato
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amber Kunkel
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa A Hammett
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria A Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nadine Baida
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Kaleo Ede
- Phoenix Children's Hospital, Phoenix, Arizona
| | - Federico R Laham
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew E Oster
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ermias D Belay
- From the CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
12
|
Kumar NP, Venkataraman A, Nancy A, Selvaraj N, Moideen K, Ahamed SF, Renji RM, Sasidaran K, Kumar S, Periyakuppan M, Sangaralingam T, Varadarajan P, Chelladurai E, Babu S. Immune Profiles in Multisystem Inflammatory Syndrome in Children with Cardiovascular Abnormalities. Viruses 2023; 15:2162. [PMID: 38005840 PMCID: PMC10674423 DOI: 10.3390/v15112162] [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: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), a sequela of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV2), has been progressively reported worldwide, with cardiac involvement being a frequent presentation. Although the clinical and immunological characteristics of MIS-C with and without cardiac involvement have been described, the immunological differences between cardiac and non-cardiac MIS-C are not well understood. METHODS The levels of type 1, type 2, type 17, other proinflammatory cytokines and CC chemokines and CXC chemokines were measured using the Magpix multiplex cytokine assay system in MIS-C children with MIS-C cardiac (MIS-C (C) (n = 88)) and MIS-C non-cardiac (MIS-C (NC) (n = 64)) abnormalities. RESULTS MIS-C children with cardiac manifestations presented with significantly increased levels of cytokines such as IFN-γ, IL-2, TNFα, IL-5, IL-1α, IL-1β, IL-6, IL-10 and IL-12p70 and chemokines such as CCL2, CCL3, CCL11 and CXCL10 in comparison to MIS-C children without cardiac manifestations. Clustering analysis revealed that cytokines and chemokines could clearly distinguish MIS-C children with and without cardiac manifestations. In addition, these responses significantly diminished and normalized 9 months after treatment. CONCLUSIONS This is one of the first studies characterizing and differentiating systemic inflammation in MIS-C with and without cardiac involvement from a low- and middle-income country (LMIC). Our study contributes to the existing body of evidence and advances our knowledge of the immunopathogenesis of MIS-C in children.
Collapse
Affiliation(s)
- Nathella Pavan Kumar
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
| | - Aishwarya Venkataraman
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
| | - Arul Nancy
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Nandhini Selvaraj
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Kadar Moideen
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Shaik Fayaz Ahamed
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Rachel Marriam Renji
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Kandasamy Sasidaran
- Dr. Mehta’s Children’s Hospital, Chennai 600031, India; (K.S.); (M.P.); (T.S.)
| | - Sandip Kumar
- Dr. Mehta’s Children’s Hospital, Chennai 600031, India; (K.S.); (M.P.); (T.S.)
| | | | | | - Poovazhagi Varadarajan
- Institute of Child Health and Hospital for Children, Chennai 600008, India; (P.V.); (E.C.)
| | - Elilarasi Chelladurai
- Institute of Child Health and Hospital for Children, Chennai 600008, India; (P.V.); (E.C.)
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
13
|
Tang SW, Helmeste DM, Leonard BE. COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain. Acta Neuropsychiatr 2023; 35:248-269. [PMID: 36861428 DOI: 10.1017/neu.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.
Collapse
Affiliation(s)
- Siu Wa Tang
- Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
- Institute of Brain Medicine, Hong Kong, China
| | - Daiga Maret Helmeste
- Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
- Institute of Brain Medicine, Hong Kong, China
| | - Brian E Leonard
- Institute of Brain Medicine, Hong Kong, China
- Department of Pharmacology, National University of Ireland, Galway, Ireland
| |
Collapse
|
14
|
Cao N, Ouyang H, Zhang X, Xu Y, Li J, Chen Y. Integration of scRNA-Seq and bulk RNA-Seq uncover perturbed immune cell types and pathways of Kawasaki disease. Front Immunol 2023; 14:1259353. [PMID: 37841239 PMCID: PMC10568768 DOI: 10.3389/fimmu.2023.1259353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Kawasaki disease (KD) is an acute febrile illness primarily affecting children and characterized by systemic inflammation and vasculitis that can lead to coronary artery complications. The aim of this study was to gain a comprehensive understanding of immune dysregulation in KD. Methods To this end, we employed integration of single-cell RNA sequencing (scRNA-Seq) and bulk RNA sequencing (bulk RNA-Seq) data. Furthermore, we conducted flow cytometry analysis for a cohort of 82 KD patients. Results Our analysis revealed significant heterogeneity within immune cell populations in KD patients, with distinct clusters of T cells, B cells, and natural killer (NK) cells. Importantly, CD4+ naïve T cells in KD patients were found to predominantly differentiate into Treg cells and Th2 cells, potentially playing a role in the excessive inflammation and vascular damage characteristic of the disease. Dysregulated signaling pathways were also identified, including the mTOR signaling pathway, cardiomyopathy pathway, COVID-19 signaling pathway, and pathways involved in bacterial or viral infection. Discussion These findings provide insights into the immunopathogenesis of KD, emphasizing the importance of immune cell dysregulation and dysregulated signaling pathways. Integration of scRNA-Seq and bulk RNA-Seq data offers a comprehensive view of the molecular and cellular alterations in KD and highlights potential therapeutic targets for further investigation. Validation and functional studies are warranted to elucidate the roles of the identified immune cell types and pathways in KD pathogenesis and to develop targeted interventions to improve patient outcomes.
Collapse
Affiliation(s)
- Naixin Cao
- Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming Children’s Hospital, Kunming, China
- Department of Immunology, Center of Immunomolecular Engineering, Innovation and Practice Base for Graduate Students Education, Zunyi Medical University, Zunyi, China
| | - Huayi Ouyang
- Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming Children’s Hospital, Kunming, China
- Department of Immunology, Center of Immunomolecular Engineering, Innovation and Practice Base for Graduate Students Education, Zunyi Medical University, Zunyi, China
| | - Xing Zhang
- Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming Children’s Hospital, Kunming, China
| | - Yuanyuan Xu
- Department of Immunology, Center of Immunomolecular Engineering, Innovation and Practice Base for Graduate Students Education, Zunyi Medical University, Zunyi, China
| | - Jun Li
- Department of Immunology, Center of Immunomolecular Engineering, Innovation and Practice Base for Graduate Students Education, Zunyi Medical University, Zunyi, China
| | - Yanfei Chen
- Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming Children’s Hospital, Kunming, China
| |
Collapse
|
15
|
Lee J, Kim BJ, Cho KS, Rhim JW, Lee SY, Jeong DC. Similarities and Differences between Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki Disease Shock Syndrome. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1527. [PMID: 37761488 PMCID: PMC10527784 DOI: 10.3390/children10091527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
This study aimed to investigate the characteristics of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome (KDSS) and to compare the similarities and differences between the two diseases. The incidence of KDSS and MIS-C was also estimated. Medical records of patients diagnosed with MIS-C or KDSS at four hospitals from January 2013 to December 2022 were retrospectively reviewed. Thirty-one patients were enrolled in the study in either an MIS-C group (n = 22) or a KDSS group (n = 9). The incidence of KDSS in KD was 0.8% (9/1095) and the incidence of MIS-C versus KD was 10.2% (22/216). Compared with the MIS-C group, the KDSS group had longer hospital stays and more severe systemic inflammation (e.g., anemia, elevated C-reactive protein, hypoalbuminemia, and pyuria) and organ dysfunction (e.g., number of involved organs, shock, vasoactive infusion, and intensive care unit admission). All patients in the MIS-C group, but none in the KDSS group, including two patients during the COVID-19 pandemic, had laboratory evidence of SARS-CoV-2 infection. MIS-C and KDSS shared demographic, clinical, and laboratory characteristics; organ dysfunction; treatment; and outcomes. Overall severity was more severe in patients with KDSS than in those with MIS-C. The most important difference between MIS-C and KDSS was whether SARS-CoV-2 was identified as an infectious trigger.
Collapse
Affiliation(s)
- Jin Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (B.J.K.); (K.-S.C.); (J.W.R.); (D.C.J.)
- Department of Pediatrics, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon 21431, Republic of Korea
| | - Beom Joon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (B.J.K.); (K.-S.C.); (J.W.R.); (D.C.J.)
- Department of Pediatrics, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Kyoung-Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (B.J.K.); (K.-S.C.); (J.W.R.); (D.C.J.)
- Department of Pediatrics, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon 14647, Republic of Korea
| | - Jung Woo Rhim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (B.J.K.); (K.-S.C.); (J.W.R.); (D.C.J.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Republic of Korea
| | - Soo-Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (B.J.K.); (K.-S.C.); (J.W.R.); (D.C.J.)
- Department of Pediatrics, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon 14647, Republic of Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (B.J.K.); (K.-S.C.); (J.W.R.); (D.C.J.)
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Pediatrics, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| |
Collapse
|
16
|
Rassi CE, Zareef R, Honeini R, Latouf C, Bitar F, Arabi M. Multisystem inflammatory syndrome in children: another COVID-19 sequel. Cardiol Young 2023; 33:1418-1428. [PMID: 37409933 DOI: 10.1017/s1047951123001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
With the rapid expansion of the COVID-19 pandemic, the disease burden and its consequences on the paediatric population has been progressively recognised. Although COVID-19 infection in children presents as asymptomatic to mild illness, instances of hyperinflammation and multi-organ involvement following the viral infection have been described. This condition, known as the multisystem inflammatory syndrome in children (MIS-C), has gained a wide global attention. Despite the global efforts to uncover the disease characteristics and management, a clear pathogenesis and a unified treatment regimen have not been reached yet. This paper tackles the epidemiology of the MIS-C, discusses its suggested pathogenesis, drives through its varying clinical presentations, and evaluates the different treatment regimens employed in managing MIS-C.
Collapse
Affiliation(s)
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawan Honeini
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Latouf
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
17
|
García-Domínguez M, Anaya-Enríquez N, Luque-Vega L, Canizales-Muñoz S, Flores R, Tostado-Morales E, Torres CG, Melchor V, Quibrera J, Velázqueaz-Ríos C, León-Ramírez ÁR, Carreón-Guerrero JM, Llausás-Magaña E. [Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico]. REVISTA ALERGIA MÉXICO 2023; 70:80-88. [PMID: 37566771 DOI: 10.29262/ram.v70i3.1237] [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: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C). METHODS We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospi-talized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria be-tween May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups. RESULTS Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and lab-oratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symp-toms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C. CONCLUSIONS Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, signifi-cant differences such as severity of clinical presentation with multi-organ involvement and worst inflammato-ry response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C thanpatients with KD. Similar results have been observed in other studies where both disorders were compared.
Collapse
Affiliation(s)
| | | | - Lynnete Luque-Vega
- Departamento de Pediatría, Hospital Pediátrico de Sinaloa, Culiacán, México
| | | | - Rosalino Flores
- Departamento de Epidemiología, Hospital Pediátrico de Sinaloa, Culiacán, México
| | | | - Cynthia G Torres
- Departamento de Terapia intensiva, Hospital Pediátrico de Sinaloa, Culiacán, México
| | - Vianey Melchor
- Departamento de Terapia intensiva, Hospital Pediátrico de Sinaloa, Culiacán, México
| | - José Quibrera
- Departamento de Cardiología, Hospital Pediátrico de Sinaloa, Culiacán, México
| | | | | | | | | |
Collapse
|
18
|
Barroso-Santos J, Robledo-Martínez AI, Espinosa-Padilla SE, Hurtado Del Ángel RG, Arteaga-García F, Langarica-Bulos M, Madrid-Gómez-Tagle JA, Sánchez-Reyes BA, Hernández-Cadena SE, Suárez-Soto JI, Delgado-Amézquita C, Godínez-Hernández B, Otamendi-Canales O, Jiménez-Osorio AS. Multisystemic Inflammatory Syndrome Temporally Associated with COVID-19 in a Regional Pediatric Hospital from México. Pediatr Rep 2023; 15:341-348. [PMID: 37368363 DOI: 10.3390/pediatric15020030] [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: 03/04/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/28/2023] Open
Abstract
Multisystemic inflammatory syndrome (MIS-C) is an inflammatory condition temporally associated with COVID-19 in children; nevertheless, the clinical and immunologic spectrum of MIS-C is heterogeneous, and its long-term effects are unknown. During the period of August 2020 to December 2021, a total of 52 MIS-C cases were confirmed in pediatric patients from the Hospital del Niño DIF Hidalgo, diagnosed using criteria from the World Health Organization. All patients had serologic IgG confirmation of SARS-CoV2, the mean age of the patients was 7 years, and 94% of the patients did not have a previous underlying disease. In addition to the presentation of lymphopenia, neutropenia, and thrombocytopenia, elevations in D-dimer and ferritin levels were observed in all patients. There was clinical improvement with intravenous gamma globulin and corticosteroid treatment.
Collapse
Affiliation(s)
- Joel Barroso-Santos
- Hospitalization Service, Hospital del Niño DIF Hidalgo, Pachuca 42080, Hidalgo, Mexico
| | | | | | | | - Felipe Arteaga-García
- Hospitalization Service, Hospital del Niño DIF Hidalgo, Pachuca 42080, Hidalgo, Mexico
| | | | | | | | | | | | | | | | | | - Angélica Saraí Jiménez-Osorio
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, San Agustín Tlaxiaca 42060, Hidalgo, Mexico
- Research Service, Hospital del Niño DIF Hidalgo, Pachuca 42080, Hidalgo, Mexico
| |
Collapse
|
19
|
La Torre F, Elicio MP, Monno VA, Chironna M, Moramarco F, Campanozzi A, Civino A, Cecinati V, Vairo U, Giordano M, Milella L, Loconsole D, Cardinale F. Incidence and Prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C) in Southern Italy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050766. [PMID: 37238314 DOI: 10.3390/children10050766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/26/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a pediatric hyperinflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection whose epidemiology is not very well known at present. The objective of the study was to better understand the incidence of MIS-C in the Apulia region in southern Italy. Our primary goal was to estimate the incidence of newly identified cases of MIS-C in children aged 0-18 years, during a period of six months, encompassing the second pandemic wave. We also analyzed the characteristics of our cohort in terms of clinical features, treatment, and outcomes. The cumulative incidence of MIS-C was 3.27 per 100,000 residents between 0 and 18 years of age. In our cohort, gastrointestinal, mucocutaneous, and cardiac involvement were the most common clinical features. With our step-up approach to therapy, no patients required intensive care unit (ICU) admission and no cardiac sequelae after 6 months of onset were found in echocardiograms. Conclusion: Our epidemiological study of MIS-C in southern Italy showed unexpectedly overlapping figures with other US studies.
Collapse
Affiliation(s)
- Francesco La Torre
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| | - Maria Pia Elicio
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| | - Viviana Anna Monno
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, 70123 Bari, Italy
| | - Fulvio Moramarco
- Department of Pediatrics, Antonio Perrino Hospital, 72100 Brindisi, Italy
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, Pediatric Section, University of Foggia, 71122 Foggia, Italy
| | - Adele Civino
- Division of Pediatric Rheumatology and Immunology, Vito Fazzi Hospital, 73100 Lecce, Italy
| | - Valerio Cecinati
- Department of Pediatrics, SS Annunziata Hospital, 74100 Taranto, Italy
| | - Ugo Vairo
- Division of Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Mario Giordano
- Division of Pediatric Nephrology and Dialysis, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Leonardo Milella
- Division of Intensive Care, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Daniela Loconsole
- Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, 70123 Bari, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, 70126 Bari, Italy
| |
Collapse
|
20
|
Lee PI, Hsueh PR. Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:236-245. [PMID: 36720670 PMCID: PMC9841678 DOI: 10.1016/j.jmii.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/07/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 2-6 weeks. The median age of patients with MIS-C is 6-11 years. Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. Respiratory tract, neurological system, musculoskeletal system, and kidney are less frequently affected. Mucocutaneous manifestations and coronary artery abnormalities characteristic for Kawasaki disease (KD) may be observed in a significant proportion of MIS-C patients that may make the differential diagnosis be difficult for some patients, especially in the post-pandemic era. The mortality rate is 1-3%. Management and prognosis of MIS-C are similar to that of KD. MIS-C and KD may share a common pathogenic process. Based on the observation of MIS-C-like illness in uninfected neonates, i.e. multisystem inflammatory syndrome in neonates, both MIS-C and KD may be a consequence of dysregulated, over-exaggerated humoral immune responses triggered by a specific infectious agent.
Collapse
Affiliation(s)
- Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; Ph.D Program for Aging, School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
21
|
Sobh A, Mosa DM, Khaled N, Korkor MS, Noureldin MA, Eita AM, Elnagdy MH, El-Bayoumi MA. How multisystem inflammatory syndrome in children discriminated from Kawasaki disease: a differentiating score based on an inception cohort study. Clin Rheumatol 2023; 42:1151-1161. [PMID: 36409406 PMCID: PMC9684855 DOI: 10.1007/s10067-022-06444-0] [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: 09/06/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND About 25-50% of multisystem inflammatory syndrome in children (MIS-C) patients meet the criteria for diagnosis of Kawasaki disease (KD). The differentiation of both conditions is so challenging on clinical practice as the management of both is time dependant and precise diagnosis is fundamental. METHOD Data were collected from children < 18 years old hospitalized with MIS-C or KD. Patient demographics, clinical, and laboratory data were compared, and a discrimination score was created to assist in clinical differentiation. RESULTS 72 patients with MIS-C and 18 with KD were included in the study. Patients with MIS-C had a higher prevalence of abdominal pain (p = 0.02), vomiting (p = 0.03), and cervical lymphadenopathy (p = 0.02) compared with KD cases. MIS-C patients had higher liver enzymes (aspartate aminotransferase (AST) (p = 0.04), alanine aminotransferase (ALT) (p = 0.03), serum creatinine (p = 0.03), and lower platelet count nadir (p = 0.02) than KD. Four variables were detected in the regression analysis model, and the independent predictors were utilized to generate a scoring model that distinguished MIS-C from KD with an area under the curve of 0.70. CONCLUSION This study constructed a prediction model for differentiation of MIS-C from KD based on clinical and laboratory profiles. This model will be valuable to guide clinicians in the treatment decisions. Key Points • Children with MIS-C are more likely to have gastrointestinal symptoms, cervical lymphadenopathy, and respiratory involvement than KD patients. • Elevated liver enzymes and lower platelet count are more pronounced laboratory findings in MIS-C than KD. • This study constructed a prediction model for differentiation of MIS-C from KD based on clinical and laboratory profiles. This model will be valuable to guide clinicians in the treatment decisions.
Collapse
Affiliation(s)
- Ali Sobh
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Doaa Mosad Mosa
- Rheumatology & Rehabilitation Department, Mansoura University Hospitals, Mansoura University Faculty of medicine , 60 Elgomhoria St, Mansoura, 35516, Egypt.
| | - Nada Khaled
- Department of Clinical Pathology (Hematology Unit), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mai S Korkor
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | | | - Ahmad M Eita
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Marwa H Elnagdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed A El-Bayoumi
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University Faculty of Medicine, Mansoura, Egypt
| |
Collapse
|
22
|
Money NM, Wallace SS. A "Kawasaki Disease Test": When Will We Get There? Hosp Pediatr 2023; 13:e54-e56. [PMID: 36775806 DOI: 10.1542/hpeds.2022-007079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- Nathan M Money
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
| | - Sowdhamini S Wallace
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
23
|
Root-Bernstein R, Churchill E, Oliverio S. T Cell Receptor Sequences Amplified during Severe COVID-19 and Multisystem Inflammatory Syndrome in Children Mimic SARS-CoV-2, Its Bacterial Co-Infections and Host Autoantigens. Int J Mol Sci 2023; 24:ijms24021335. [PMID: 36674851 PMCID: PMC9861234 DOI: 10.3390/ijms24021335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Published hypervariable region V-beta T cell receptor (TCR) sequences were collected from people with severe COVID-19 characterized by having various autoimmune complications, including blood coagulopathies and cardiac autoimmunity, as well as from patients diagnosed with the Kawasaki disease (KD)-like multisystem inflammatory syndrome in children (MIS-C). These were compared with comparable published v-beta TCR sequences from people diagnosed with KD and from healthy individuals. Since TCR V-beta sequences are supposed to be complementary to antigens that induce clonal expansion, it was surprising that only a quarter of the TCR sequences derived from severe COVID-19 and MIS-C patients mimicked SARS-CoV-2 proteins. Thirty percent of the KD-derived TCR mimicked coronaviruses other than SARS-CoV-2. In contrast, only three percent of the TCR sequences from healthy individuals and those diagnosed with autoimmune myocarditis displayed similarities to any coronavirus. In each disease, significant increases were found in the amount of TCRs from healthy individuals mimicking specific bacterial co-infections (especially Enterococcus faecium, Staphylococcal and Streptococcal antigens) and host autoantigens targeted by autoimmune diseases (especially myosin, collagen, phospholipid-associated proteins, and blood coagulation proteins). Theoretical explanations for these surprising observations and implications to unravel the causes of autoimmune diseases are explored.
Collapse
Affiliation(s)
- Robert Root-Bernstein
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
| | - Elizabeth Churchill
- School of Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Shelby Oliverio
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|
24
|
Pektaş A, Bükülmez A, Çeleğen M, Eker İ. Rash and Gastrointestinal Dysfunction May Indicate Cardiac Involvement in Children with Multisystem Inflammatory System Associated with Coronavirus Disease 2019. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractThis study aims to investigate the management of children diagnosed with “multisystem inflammatory syndrome” (MIS-C) potentially associated with coronavirus disease 2019 (COVID-19) at a tertiary health center. This is a retrospective review of 34 children who were diagnosed with MIS-C at the pediatrics department of the study center from August 2021 to December 2021. Data related to age, sex, body mass index, vital findings, laboratory data, clinical symptoms, ultrasonography, and echocardiography findings were acquired from hospital records. Cardiac markers were compared with respect to clinical symptoms and imaging. Fever (91.2%), rash (50%), and abdominal pain (44.1%) were the most observed symptoms. Echocardiography visualized mild mitral regurgitation in 12 patients (35.3%), pericardial effusion in 9 patients (26.5%), and mild coronary dilatation in 9 patients (26.5%). All patients received corticosteroids, whereas acetylsalicylic acid was prescribed in 29 patients (85.3%) and intravenous immunoglobulins were administered in 21 patients (61.8%). Serum probrain natriuretic peptide concentrations were significantly higher in MIS-C patients with rash than those without rash (9,592.2 ± 7,764.5 vs. 1,501.2 ± 1,385.4 pg/mL, p = 0.021). Serum troponin T concentrations were significantly higher in MIS-C patients with ileitis than those without ileitis (0.026 ± 0.024 vs. 0.008 ± 0.003 µg/L, p = 0.013). Serum troponin T concentrations were also significantly higher in MIS-C patients with pericardial effusion than those without pericardial effusion (0.022 ± 0.020 vs. 0.008 ± 0.007 µg/L, p = 0.036). The presence of rash and sonographic visualization of ileitis might act as signs for cardiac involvement in children exposed to COVID-19. To assess the cardiac involvement in MIS-C patients, cardiac enzymes should be measured and echocardiography examination should be performed.
Collapse
Affiliation(s)
- Ayhan Pektaş
- Division of Pediatric Cardiology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Ayşegül Bükülmez
- Division of Pediatric Gastroenterology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mehmet Çeleğen
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - İbrahim Eker
- Division of Pediatric Hematology, Department of Pediatrics, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| |
Collapse
|
25
|
Al-ma’aiteh A, Al-Momani H, Elhaj I, Alkhatatba M. Limping as Presenting Symptom of Multisystem Inflammatory Syndrome in Children (MIS-C): a Case Report of Large Vessel Vasculitis in MIS-C. Med Arch 2023; 77:310-313. [PMID: 37876567 PMCID: PMC10591239 DOI: 10.5455/medarh.2023.77.310-313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background Multisystem Inflammatory Syndrome of children (MIS) is a pathological condition that occurs in response to a SARS-CoV-2 infection, the syndrome has been described as a "Kawasaki disease"-like illness and the spectrum of associated abnormalities, including vascular complications, remain to be fully defined. Objective The aim of this article was to present a case of MISC presented with limping and associated with large vessel vasculitis. Case presentation In this article we present a case of 10-year-old male presented to emergency department complaining of limping of one-week duration and left hip pain, associated with high grade prolonged fever, abdominal pain and weight loss. The patient was ill looking, couldn't bear weight and was admitted to pediatric intensive care unit. Laboratory workup have rule out infectious and malignant causes as well as known rheumatological causes. Inflammatory markers were elevated. Ultrasound, Doppler ultrasound, CT scan of the affected hip showed evidence of vasculitis extending from the left femoral artery reaching the left common iliac artery with intramural thrombus. According to WHO criteria the patient diagnoses was MIS-C. treatment was started immediately with IVIG and steroids in addition to anticoagulants, dramatic improvement was noticed within 24 hours. Patient was discharged after 10 days of hospitalization. Conclusion MIS-C is a new emerging medical diagnosis after the pandemic of COVID-19. it is described a Kawasaki-like syndrome that affect small to medium vessels. This case reports a large vessel vasculitis associated with MIS-C, it helps the understand the extend of this new syndrome and the variety of complaints that may result from large vessels involvement.
Collapse
Affiliation(s)
- Ala’a Al-ma’aiteh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Momani
- Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Ibrahim Elhaj
- Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mohammad Alkhatatba
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
26
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Fridman MD, Tsoukas P, Jeewa A, Yeung RS, Gamulka BD, McCrindle BW. Differentiation of COVID-19-Associated Multisystem Inflammatory Syndrome From Kawasaki Disease With the Use of Cardiac Biomarkers. Can J Cardiol 2022:S0828-282X(22)01049-2. [PMID: 36462758 PMCID: PMC9711900 DOI: 10.1016/j.cjca.2022.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 shares clinical similarities to Kawasaki disease (KD). We sought to determine whether cardiac biomarker levels differentiate MIS-C from KD and their association with cardiac involvement. METHODS Subjects included 38 MIS-C patients with confirmed prior COVID-19 and 32 prepandemic and 38 contemporaneous KD patients with no evidence of COVID-19. Patient, clinical, echocardiographic, electrocardiographic, and laboratory data timed within 72 hours of cardiac biomarker assessment were abstracted. Groups were compared, and regression analyses were used to determine associations between biomarker levels, diagnosis and cardiac involvement, adjusting for clinical factors. RESULTS MIS-C patients had fewer KD clinical features, with more frequent shock, intensive care unit admission, inotrope requirement, and ventricular dysfunction, with no difference regarding coronary artery involvement. Multivariable regression analysis showed that both higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (TnI) were associated with MIS-C vs KD, after adjusting for significant covariates. Receiver operating characteristic curves for diagnosis showed that any detectable TnI greater than 10 ng/L was predictive of MIS-C vs KD with 91% sensitivity and 76% specificity. NT-proBNP > 2000 ng/L predicted MIS-C vs KD with 82% sensitivity and 82% specificity. Higher TnI but not NT-proBNP was associated with lower LV ejection fraction. Neither biomarker was associated with coronary artery involvement. CONCLUSIONS Positive TnI and higher NT-proBNP may differentiate MIS-C from KD, which may become more relevant as evidence of prior COVID-19 becomes more challenging to determine. Cardiac biomarkers may have limited associations with cardiac involvement in this setting.
Collapse
Affiliation(s)
- Michael D. Fridman
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Tsoukas
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rae S.M. Yeung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Beth D. Gamulka
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada,Corresponding author: Dr Brian W. McCrindle, Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Tel.: +1-416-813-7654 ext 207609
| |
Collapse
|
28
|
Estrada-Luna D, Carreón-Torres E, González-Reyes S, Martínez-Salazar MF, Ortiz-Rodríguez MA, Ramírez-Moreno E, Arias-Rico J, Jiménez-Osorio AS. Nutraceuticals for Complementary Treatment of Multisystem Inflammatory Syndrome in Children: A Perspective from Their Use in COVID-19. Life (Basel) 2022; 12:life12101652. [PMID: 36295088 PMCID: PMC9605437 DOI: 10.3390/life12101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has been widely reported in some children diagnosed with SARS-CoV-2. Clinical signs of MIS-C are manifested at 2 to 4 weeks after SARS-CoV-2 infection, where elevated biomarkers of inflammation and cardiac dysfunction are the hallmark of this syndrome when infection or exposure to SARS-CoV-2 has been confirmed. However, after two years of acknowledgment, MIS-C treatment is still under research to reach safety and effectiveness in the acute phase in children. Therefore, in this review, we discuss the potential use of natural compounds with antioxidant and anti-inflammatory effects to reduce collateral damage caused by hyperinflammation in MIS-C pathology for new research in treatment and interventions.
Collapse
Affiliation(s)
- Diego Estrada-Luna
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Elizabeth Carreón-Torres
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Susana González-Reyes
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana 22390, Mexico
| | - María Fernanda Martínez-Salazar
- Facultad de Ciencias del Deporte, Universidad Autónoma del Estado de Morelos, Av. Universidad No. 1001 Col. Chamilpa, Cuernavaca 62209, Mexico
| | - María Araceli Ortiz-Rodríguez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Iztaccíhuatl 100 Col. Los Volcanes, Cuernavaca 62350, Mexico
| | - Esther Ramírez-Moreno
- Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - José Arias-Rico
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Angélica Saraí Jiménez-Osorio
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
- Correspondence: ; Tel.: +52-771-717-2000 (ext. 4323)
| |
Collapse
|
29
|
Giant Partially Thrombosed Coronary Aneurysm in Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 in Children. Case Rep Med 2022; 2022:3785103. [PMID: 36212082 PMCID: PMC9534692 DOI: 10.1155/2022/3785103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious condition which usually develops 4 to 6 weeks after SARS-CoV-2 infection in a genetically predisposed individual. Clinical features are heterogeneous and include fever, respiratory compromise, mucocutaneous involvement with conjunctival abnormalities and erythematous exanthem, abdominal pain, and diarrhea. Neurologic and cardiovascular symptoms can also develop, including coronary artery dilatation. Some cases involve 2 or more organs and require critical admission. Echocardiography is the mainstay of cardiac evaluation in the acute setting as well as on outpatient follow-up. We present the case of a 4-month-old female with no past medical or surgical history who presented with a prolonged febrile syndrome associated with severe respiratory illness, gastrointestinal symptoms, and mucocutaneous abnormalities. Diagnosis of MIS-C was established based on clinical findings, persistently elevated markers of systemic inflammation and positive SARS-CoV-2 molecular test and evidence of prior SARS-CoV-2 infection with SARS-CoV-2 IgG positive. Echocardiogram evidenced myopericarditis and coronary aneurysms and patient was deemed candidate for immunomodulatory therapy with intravenous immunoglobulin (IVIg), resulting in favorable clinical and paraclinical outcomes. Few cases of giant coronary aneurysms have been reported in children. There are no existing literature reports about coronary thrombosis or thrombus formation resulting from vascular aneurysmal dilations in this population. As such, the prognosis and natural history of coronary artery aneurysms in the setting of MIS-C remain largely unknown.
Collapse
|
30
|
Rostami-Maskopaee F, Ladomenou F, Razavi-Amoli SK, Navaeifar MR, Hajialibeig A, Shahbaznejad L, Hosseinzadeh F, Haghighi Aski B, Manafi Anari A, Mohammadi M, Rahmati MB, Shorafa E, Abootalebi S, Rezai MS. Clinical characteristics and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection in Iran: A multicenter study. PLoS One 2022; 17:e0274104. [PMID: 36137147 PMCID: PMC9498965 DOI: 10.1371/journal.pone.0274104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives This study aimed to assess the clinical characteristics, treatment and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 in five different geographical regions of Iran. Methods In this multicenter observational study, patients <21 years were included between March 2020 and October 2021. By Disease Control and Prevention (CDC) checklist, demographic characteristics, comorbidities, clinical signs and symptoms, laboratory and radiology findings, and treatment were collected. Statistical analysis was using Chi-square and t-test in STATA14. Results In total 225 patients with median age of 55 (26–96) months were included that 59.56% boys. 57.33% were admitted to the PICU with a median of 7 days (4–10). 95.56% of patients were discharged with recovery and the rest died. All of the patients in our study were included based on the MIS-C criteria. However, some patients had Kawasaki symptoms, so we compared the clinical and epidemiological characteristics of the two groups. Conjunctival injection, cervical lymphadenopathy>1.5 cm diameter, and strawberry tongue in Kawasaki-like MIS-C patients were higher than of MIS-C patients, and this difference was significant(p<0.001). The most common comorbidity was obesity (24.86%). Most patients tested for COVID-19 and about 60% of the patients had a positive test by serology or reverse transcription-polymerase chain reaction (RT-PCR). Gastrointestinal (88.89%) and hematologic signs (84.44%) were most common. Most drugs used in patients were IVIG and steroids. 88.07% and 61.29% of the patients had at least one problem in echocardiography and lung CT, respectively. Conclusions The best outcome was seen in patients who were treated with both IVIG and steroids on the first days of admission. Myocarditis was common in two groups of patients. According to most patients had echocardiography abnormal, screening of heart function is recommended for patients.
Collapse
Affiliation(s)
- Fereshteh Rostami-Maskopaee
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Mohammad Reza Navaeifar
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Azin Hajialibeig
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Shahbaznejad
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Hosseinzadeh
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Behzad Haghighi Aski
- Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Manafi Anari
- Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Mohammadi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Bagher Rahmati
- Department of Pediatrics, School of Medicine, Bandar Abbas University of Medical Sciences, Bandar Abbas, Iran
| | - Eslam Shorafa
- Division of Intensive Care Unit, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedenarjes Abootalebi
- Division of Intensive Care Unit, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- * E-mail:
| |
Collapse
|
31
|
Ko MS, Sullivan RP, Riskallah J, Weatherall CJ. Two cases of multisystem inflammatory syndrome in adults: experience at a single centre in Sydney. Intern Med J 2022; 52:1423-1428. [PMID: 35973957 DOI: 10.1111/imj.15875] [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: 02/27/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
We report two cases of middle-aged men who presented with clinical features that satisfied the diagnostic criteria for multisystem inflammatory syndrome in adults (MIS-A). Both patients were treated for toxic shock syndrome and MIS-A and have recovered. The purpose of this article is to communicate our experience and challenges of assessing and treating this condition and to raise awareness of the condition.
Collapse
Affiliation(s)
- Myung S Ko
- Department of Infectious Diseases, Immunology, and Sexual Health, St George Hospital, Sydney, Australia.,Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
| | - Richard P Sullivan
- Department of Infectious Diseases, Immunology, and Sexual Health, St George Hospital, Sydney, Australia.,St George and Sutherland Campus, School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - John Riskallah
- Department of Cardiology, St George Hospital, Sydney, Australia
| | - Christopher J Weatherall
- Department of Infectious Diseases, Immunology, and Sexual Health, St George Hospital, Sydney, Australia.,St George and Sutherland Campus, School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia
| |
Collapse
|
32
|
Stafie CS, Solomon SM, Sufaru IG, Manaila M, Stafie II, Melinte G, Simionescu B, Leustean L. Pathogenic Connections in Post-COVID Conditions: What Do We Know in the Large Unknown? A Narrative Review. Viruses 2022; 14:1686. [PMID: 36016309 PMCID: PMC9413998 DOI: 10.3390/v14081686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
The coronavirus 2019 (COVID-19) disease has long-term effects, known as post-COVID conditions (PCC) or long-COVID. Post-COVID-19 syndrome is defined by signs and symptoms that occur during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection which persist for more than 12 weeks and cannot be supported by an alternative diagnosis. The cardiovascular damage caused by COVID-19 in the severe forms of the disease is induced by severe systemic inflammation, considered to be one of the causes of myocardial lesions, with increased levels of circulating cytokines and toxic response mediators. We have focused on conditions that can induce long-COVID-19, or multisystem inflammatory syndrome in adults or children (MIS-C/MIS-A), with an emphasis on endocrinological and metabolic disorders. Although described less frequently in children than in adults, long-COVID syndrome should not be confused with MIS-C, which is an acute condition characterized by multisystem involvement and paraclinical evidence of inflammation in a pediatric patient who tested positive for SARS-CoV-2. At the same time, we mention that the MIS-A symptoms remit within a few weeks, while the duration of long-COVID is measured in months. Long-COVID syndrome, along with its complications, MIS-A and MIS-C, represents an important challenge in the medical community. Underlying comorbidities can expose both COVID-19 adult and pediatric patients to a higher risk of negative outcomes not only during, but in the aftermath of the SARS-CoV-2 infection as well.
Collapse
Affiliation(s)
- Celina Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity—Family Medicine Discipline, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Sorina Mihaela Solomon
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700111 Iasi, Romania
| | - Irina-Georgeta Sufaru
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700111 Iasi, Romania
| | - Maria Manaila
- Endocrinology Residency Program, Sf. Spiridon Clinical Emergency Hospital, Independentei, 1, 700111 Iasi, Romania; (M.M.); (I.I.S.); (G.M.)
| | - Ingrid Ioana Stafie
- Endocrinology Residency Program, Sf. Spiridon Clinical Emergency Hospital, Independentei, 1, 700111 Iasi, Romania; (M.M.); (I.I.S.); (G.M.)
| | - Gabriela Melinte
- Endocrinology Residency Program, Sf. Spiridon Clinical Emergency Hospital, Independentei, 1, 700111 Iasi, Romania; (M.M.); (I.I.S.); (G.M.)
| | - Bianca Simionescu
- Pediatric Clinic No. 2, Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes, 400347 Cluj-Napoca, Romania;
| | - Letitia Leustean
- Department of Endocrinology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| |
Collapse
|
33
|
Pfeifer J, Fries P, Thurner L, Abdul-Khaliq H. Cardiac affection associated to severe Multisystem Inflammatory Syndrome in Children (MIS-C) in a 6-year-old girl with a single coronary artery. Clin Res Cardiol 2022; 111:1184-1187. [PMID: 35904641 PMCID: PMC9336140 DOI: 10.1007/s00392-022-02060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Germany.
| | - Peter Fries
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Lorenz Thurner
- José Carreras Center for Immuno and Gene Therapy and Department of Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Germany
| |
Collapse
|
34
|
Multisystem Inflammatory Syndrome in Adults Presenting as Retropharyngeal Phlegmon. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. More than 5 million children have been infected in the United States. Risk factors for more severe disease progression include obesity, pulmonary disease, gastrointestinal disorders, and neurologic comorbidities. Children with COVID-19 are admitted to the pediatric intensive care unit because of severe acute COVID-19 illness or COVID-19-associated multisystem inflammatory syndrome in children. The delta surge of 2021 was responsible for an increased disease burden in children and points to the key role of vaccinating children against this sometimes-deadly disease.
Collapse
Affiliation(s)
- Meena Kalyanaraman
- Pediatric Critical Care Medicine, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, C-5, 201 Lyons Avenue, Newark, NJ 07112, USA.
| | - Michael R. Anderson
- Children’s National Hospital, George Washington University School of Medicine and Health Sciences
| |
Collapse
|
36
|
Dhaliwal M, Tyagi R, Malhotra P, Barman P, Loganathan SK, Sharma J, Sharma K, Mondal S, Rawat A, Singh S. Mechanisms of Immune Dysregulation in COVID-19 Are Different From SARS and MERS: A Perspective in Context of Kawasaki Disease and MIS-C. Front Pediatr 2022; 10:790273. [PMID: 35601440 PMCID: PMC9119432 DOI: 10.3389/fped.2022.790273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/04/2022] [Indexed: 12/15/2022] Open
Abstract
Coronaviruses have led to three major outbreaks to date-Severe Acute Respiratory Syndrome (SARS; 2002), Middle East Respiratory Syndrome (MERS; 2012) and the ongoing pandemic, Coronavirus Disease (COVID-19; 2019). Coronavirus infections are usually mild in children. However, a few children with MERS had presented with a severe phenotype in the acute phase resulting in progressive pneumonic changes with increasing oxygen dependency and acute respiratory distress requiring ventilatory support. A subset of children with a history of SARS-CoV-2 infection develops a multisystem hyper-inflammatory phenotype known as Multisystem Inflammatory Syndrome in Children (MIS-C). This syndrome occurs 4-6 weeks after infection with SARS-CoV-2 and has been reported more often from areas with high community transmission. Children with MIS-C present with high fever and often have involvement of cardiovascular, gastrointestinal and hematologic systems leading to multiorgan failure. This is accompanied by elevation of pro-inflammatory cytokines such as IL-6 and IL-10. MIS-C has several similarities with Kawasaki disease (KD) considering children with both conditions present with fever, rash, conjunctival injection, mucosal symptoms and swelling of hands and feet. For reasons that are still not clear, both KD and MIS-C were not reported during the SARS-CoV and MERS-CoV outbreaks. As SARS-CoV-2 differs from SARS-CoV by 19.5% and MERS by 50% in terms of sequence identity, differences in genomic and proteomic profiles may explain the varied disease immunopathology and host responses. Left untreated, MIS-C may lead to severe abdominal pain, ventricular dysfunction and shock. Immunological investigations reveal reduced numbers of follicular B cells, increased numbers of terminally differentiated CD4+T lymphocytes, and decreased IL-17A. There is still ambiguity about the clinical and immunologic risk factors that predispose some children to development of MIS-C while sparing others. Host-pathogen interactions in SARS, MERS and COVID-19 are likely to play a crucial role in the clinical phenotypes that manifest. This narrative review focuses on the immunological basis for development of MIS-C syndrome in the ongoing SARS-CoV-2 pandemic. To the best of our knowledge, these aspects have not been reviewed before.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Surjit Singh
- Allergy and Immunology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
37
|
Ailioaie LM, Ailioaie C, Litscher G. Implications of SARS-CoV-2 Infection in Systemic Juvenile Idiopathic Arthritis. Int J Mol Sci 2022; 23:ijms23084268. [PMID: 35457086 PMCID: PMC9029451 DOI: 10.3390/ijms23084268] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a serious multifactorial autoinflammatory disease with a significant mortality rate due to macrophage activation syndrome (MAS). Recent research has deepened the knowledge about the pathophysiological mechanisms of sJIA-MAS, facilitating new targeted treatments, and biological disease-modifying antirheumatic drugs (bDMARDs), which significantly changed the course of the disease and prognosis. This review highlights that children are less likely to suffer severe COVID-19 infection, but at approximately 2–4 weeks, some cases of multisystem inflammatory syndrome in children (MIS-C) have been reported, with a fulminant course. Previous established treatments for cytokine storm syndrome (CSS) have guided COVID-19 therapeutics. sJIA-MAS is different from severe cases of COVID-19, a unique immune process in which a huge release of cytokines will especially flood the lungs. In this context, MIS-C should be reinterpreted as a special MAS, and long-term protection against SARS-CoV-2 infection can only be provided by the vaccine, but we do not yet have sufficient data. COVID-19 does not appear to have a substantial impact on rheumatic and musculoskeletal diseases (RMDs) activity in children treated with bDMARDs, but the clinical features, severity and outcome in these patients under various drugs are not yet easy to predict. Multicenter randomized controlled trials are still needed to determine when and by what means immunoregulatory products should be administered to patients with sJIA-MAS with a negative corticosteroid response or contraindications, to optimize their health and safety in the COVID era.
Collapse
Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, Traditional Chinese Medicine (TCM) Research Center Graz, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-83907
| |
Collapse
|
38
|
Gowin E, Toczyłowski K, Sulik A, Wysocki J, Januszkiewicz-Lewandowska D. The Role of Glucocorticoids in the Treatment of Multisystem Inflammatory Syndrome (MIS-C)—Data from POLISH MIS-C Registry. CHILDREN 2022; 9:children9020178. [PMID: 35204900 PMCID: PMC8870526 DOI: 10.3390/children9020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022]
Abstract
Background: Multisystem inflammatory syndrome (MIS-C) is a condition related to COVID-19. It’s most significant feature is cardiac involvement. Methods: We have analyzed data from 42 hospitals in the Polish MIS-C Registry. To compare the effect of GCS on fever, we formed two groups: the first treated with IVIG and the second treated with IVIG+GCS. Results: There were 111 boys and 56 girls; the mean age was 8.57 years. All the patients were treated with IVIG: 76 patients with IVIG only, and 91 patients with IVIG+GCS. There were no statistically significant differences between the groups regarding age, gender, BMI, or inflammatory markers. Methylprednisolone was the most common drug (80%). Echocardiographic abnormalities on admission were more prevalent in the IVIG+GCS group. Mean time from IVIG infusion to subsidence of fever was 1.1 days, and 1.5 for those in the IVIG+GCS group. Conclusions: GCS are commonly used in the treatment of MIS-C patients in Poland. Various GCS regimens are used, from a single dose to a month-long therapy. Children with lower lymphocyte levels and cardiac abnormalities on an echocardiographic examination performed on admission were more likely to receive GCS+IVIG. The effect of GCS is difficult to access as patients were not randomly assigned to receive the treatment.
Collapse
Affiliation(s)
- Ewelina Gowin
- Health Promotion Department, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland;
- Correspondence: ; Tel.: +48-605-723-017
| | - Kacper Toczyłowski
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland; (K.T.); (A.S.)
| | - Artur Sulik
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland; (K.T.); (A.S.)
| | - Jacek Wysocki
- Health Promotion Department, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland;
| | - Danuta Januszkiewicz-Lewandowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland;
| |
Collapse
|
39
|
Mitchell EC, Romano A, Capone CA, Cooper R, Epstein S, Hayes DA, Parness IA, Schleien C, Misra N. Multisystem inflammatory syndrome in children: Salient echocardiogram findings in the acute phase and longitudinal follow-up. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
40
|
Abstract
INTRODUÇÃO: A potencial associação da COVID-19 com fenômenos inflamatórios e autoimunes abre um novo capítulo na prática clínica. Entre várias condições inflamatórias descritas no pós-COVID-19, destacam-se a doença de Kawasaki e uma nova afecção denominada síndrome inflamatória multissistêmica.OBJETIVOS: Revisar, de forma prática e concisa, conceito e critérios diagnósticos da síndrome inflamatória multisistêmica, as sobreposições com a doença de Kawasaki, assim como a imunopatogênese e o tratamento desta nova e intrigante enfermidade.MÉTODOS: Revisão da literatura disponível na base de dados Pubmed, com ênfase em revisões sistemáticas com metaanálises.RESULTADOS: A síndrome inflamatória multisistêmica se configura como uma condição hiperinflamatória multiorgânica pós-viral. A condição é primordialmente pediátrica, e os primeiros casos foram descritos na Inglaterra em maio de 2020. Os critérios diagnósticos são ainda imprecisos, e incluem algumas manifestações doença de Kawasaki-símiles. A síndrome inflamatória multisistêmica difere da doença de Kawasaki, entretanto, por geralmente acometer crianças acima cinco anos e de raças negras ou hispânicas; em termos clínicos, se distingue pela alta frequência de gastroenteropatia, miocardiopatia e choque. O diagnóstico diferencial inclui sepse bacteriana, síndrome de ativação macrofágica e formas sistêmicas de artrite reumatoide. Uma hiperexpressão de interferons e de outras citocinas inflamatórias caracteriza patogenicamente a síndrome inflamatória mulsistêmica. A enfermidade é, via de regra, responsiva a cuidados de terapia intensiva, corticóides, imunoglobulina intravenosa e imunobiológicos.CONCLUSÕES: A síndrome inflamatória multisistêmica é uma nova e complexa afecção hiperinflamatória associada à exposição prévia ao SARS-CoV-2. Apresenta instigantes interfaces com a doença de Kawasaki. Apesar da descrição recente, a literatura já é quantitativamente robusta, e algumas pendências de imunopatogênese, critérios diagnósticos e terapêutica deverão ser esclarecidas em breve.
Collapse
|
41
|
Suzuki T, Suenaga T, Sakai A, Sugiyama M, Mizokami M, Mizukami A, Takasago S, Hamada H, Kakimoto N, Takeuchi T, Ueda M, Komori Y, Tokuhara D, Suzuki H. Case Report: Ciclosporin A for Refractory Multisystem Inflammatory Syndrome in Children. Front Pediatr 2022; 10:890755. [PMID: 35712624 PMCID: PMC9194446 DOI: 10.3389/fped.2022.890755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 12/19/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a new syndrome involving the development of severe dysfunction in multiple organs after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Because the pathophysiology of MIS-C remains unclear, a treatment strategy has not yet been established. We experienced a 12-year-old boy who developed MIS-C at 56 days after SARS-CoV-2 infection and for whom ciclosporin A (CsA) was effective as a third-line treatment. He had a high fever on day 1, and developed a rash on the trunk, swelling in the cervical region, and palmar erythema on day 2. On days 3, he developed conjunctivitis and lip redness, and fulfilled the criteria for classical Kawasaki disease (KD). Although intravenous immunoglobulin infusion (IVIG) was started on day 4, fever persisted and respiratory distress and severe abdominal pain developed. On day 5, because he fulfilled the criteria for MIS-C, methylprednisolone pulse was started for 3 days as a second-line treatment. However, he did not exhibit defervescence and the symptoms continued. Therefore, we selected CsA as a third-line treatment. CsA was so effective that he became defervescent and his symptoms disappeared. In order to clarify the relationship with treatment and the change of clinical conditions, we examined the kinetics of 71 serum cytokines to determine their relationships with his clinical course during the three successive treatments. We found that CsA suppressed macrophage-activating cytokines such as, IL-12(p40), and IL-18 with improvement of his clinical symptoms. CsA may be a useful option for additional treatment of patients with MIS-C refractory to IVIG + methylprednisolone pulse.
Collapse
Affiliation(s)
- Takayuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Aiko Sakai
- Genome Medical Sciences Project, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masaya Sugiyama
- Genome Medical Sciences Project, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ayumi Mizukami
- Department of Pediatrics, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Takasago
- Department of Pediatrics, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Takashi Takeuchi
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Mina Ueda
- Department of Pediatrics, Wakayama Rousai Hospital, Wakayama, Japan
| | - Yuki Komori
- Department of Pediatrics, Wakayama Rousai Hospital, Wakayama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan.,Department of Pediatrics, Tsukushi Medical and Welfare Center, Iwade, Japan
| |
Collapse
|
42
|
Liu K, Yu J, Song G. Global Myocardial Strain in Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Healthy Children: A Network Meta-Analysis. Front Pediatr 2022; 10:848306. [PMID: 35832589 PMCID: PMC9272823 DOI: 10.3389/fped.2022.848306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/30/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nearly 6,000 multisystem inflammatory syndrome in children (MIS-C) have been reported in the United States by November 2021. Left ventricular global myocardial strain has been proved to be one of the best evidence of the diagnostic and prognostic implications for cardiac dysfunction. The global myocardial strain change of MIS-C in the acute phase was still unclear. METHODS PubMed and other sources were searched. A network meta-analysis was conducted. MIS-C was divided into two groups according to left ventricular ejection fraction (LVEF): MIS-C with depressed ejection fraction (MIS-C dEF) and MIS-C with preserved ejection fraction (MIS-C pEF). Global longitudinal strain (GLS) and global circumferential strain (GCS) were compared among MIS-C, Kawasaki disease (KD), and healthy children. RESULTS In total, nine case-control studies were included, published between 2014 and 2021. These studies involved 107 patients with MIS-C, 188 patients with KD, and 356 healthy children. After Bayesian analysis, MIS-C dEF group was found to have a lower LVEF, higher GLS and GCS than the KD groups. Both MIS-C pEF and KD had similar GLS and GCS, which were higher than healthy controls. There was no difference of LVEF among MIS-C pEF, KD, and healthy controls. CONCLUSION MIS-C dEF was more severe than KD, both in LVEF and global myocardial strain. MIS-C pEF and KD were similar with mild impaired left ventricular myocardial strain compared with the healthy children. Global myocardial strain may be a monitoring index for MIS-C. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021264760].
Collapse
Affiliation(s)
- Kaiwei Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiahui Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
43
|
Wu EY, Campbell MJ. Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19. Curr Cardiol Rep 2021; 23:168. [PMID: 34599465 PMCID: PMC8486157 DOI: 10.1007/s11886-021-01602-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/19/2022]
Abstract
Purpose of Review To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Recent Findings Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred. Summary Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.
Collapse
Affiliation(s)
- Eveline Y Wu
- Division of Pediatric Rheumatology, The University of North Carolina at Chapel Hill, 030 MacNider Hall, CB #7231, Chapel Hill, NC, 27599, USA.,Division of Pediatric Allergy/Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Jay Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, 2301 Erwin Road, Children's Health Center 1st Floor, Room 1921, Durham, NC, 27710, USA. .,Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USA.
| |
Collapse
|
44
|
Frustaci A, Francone M, Verardo R, Capobianchi MR, Chimenti C. Virus-Negative Necrotizing Coronary Vasculitis with Aneurysm Formation in Human SARS-CoV-2 Infection. Infect Dis Rep 2021; 13:597-601. [PMID: 34202646 PMCID: PMC8293265 DOI: 10.3390/idr13030055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/01/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
We report a case of myopericarditis associated to SARS-CoV-2 infection with necrotizing coronary vasculitis of intramural vessels, giving rise to biventricular apical microaneurysms and to electrical instability. Negativity of myocardial polymerase chain reaction for the most common cardiotropic viruses and for SARS-CoV-2 suggested an immune-mediated myocardial and pericardial inflammatory disease. High dose (1 mg/Kg daily) prednisone and anti-viral (Remdesivir, IDA Business, Carrigtohill, County Cork, T45 DP77, Ireland) therapy led to resolution of cardiac inflammation and ventricular arrhythmias. Morpho-molecular characterization of endomyocardial tissue may improve the outcome in subjects with SARS-CoV-2-associated myopericarditis and coronary vasculitis.
Collapse
Affiliation(s)
- Andrea Frustaci
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, 00166 Rome, Italy
- Correspondence: ; Tel.: +39-06-5517-0520
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, 00166 Rome, Italy;
| | - Romina Verardo
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, 00149 Rome, Italy;
| | - Maria Rosaria Capobianchi
- Laboratory of Virology National Institute for Infectious Diseases “L. Spallanzani”, 00149 Rome, Italy; (M.R.C.); (C.C.)
| | - Cristina Chimenti
- Laboratory of Virology National Institute for Infectious Diseases “L. Spallanzani”, 00149 Rome, Italy; (M.R.C.); (C.C.)
| |
Collapse
|