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Hosseini P, Fallahi MS, Erabi G, Pakdin M, Zarezadeh SM, Faridzadeh A, Entezari S, Ansari A, Poudineh M, Deravi N. Multisystem Inflammatory Syndrome and Autoimmune Diseases Following COVID-19: Molecular Mechanisms and Therapeutic Opportunities. Front Mol Biosci 2022; 9:804109. [PMID: 35495619 PMCID: PMC9046575 DOI: 10.3389/fmolb.2022.804109] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), has led to huge concern worldwide. Some SARS-CoV-2 infected patients may experience post–COVID-19 complications such as multisystem inflammatory syndrome, defined by symptoms including fever and elevated inflammatory markers (such as elevation of C reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, procalcitonin test, D-dimer, ferritin, lactate dehydrogenase or IL-6, presence of neutrophilia, lymphopenia, decreased albumin, and multiple organ dysfunction). Post–COVID-19 complications may also manifest as autoimmune diseases such as Guillain-Barré syndrome and systemic lupus erythematosus. Signaling disorders, increased inflammatory cytokines secretion, corticosteroid use to treat COVID-19 patients, or impaired immune responses are suggested causes of autoimmune diseases in these patients. In this review, we discuss the molecular and pathophysiological mechanisms and therapeutic opportunities for multisystem inflammatory syndrome and autoimmune diseases following SARS-CoV-2 infection with the aim to provide a clear view for health care providers and researchers.
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Affiliation(s)
- Parastoo Hosseini
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Gisou Erabi
- Student Research Committee, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Majid Pakdin
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Arezoo Faridzadeh
- Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sarina Entezari
- Student Research Committee, School of Allied Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arina Ansari
- Student Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | | | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Niloofar Deravi,
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Kahn R, Berg S, Berntson L, Berthold E, Brodin P, Bäckström F, Compagno M, Fasth A, Lingman Framme J, Horne A, Hätting J, Król P, Kukka AJ, Mossberg M, Månsson B, Nordenhäll C, Idring Nordström S, Khammari Nyström F, Palmblad K, Rasti R, Rudolph A, Rydenman K, Sundberg E, Säve‐Söderbergh E, Altman M. Population-based study of multisystem inflammatory syndrome associated with COVID-19 found that 36% of children had persistent symptoms. Acta Paediatr 2022; 111:354-362. [PMID: 34806789 PMCID: PMC9011862 DOI: 10.1111/apa.16191] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022]
Abstract
Aim Our aim was to describe the outcomes of multisystem inflammatory syndrome in children (MIS‐C) associated with COVID‐19. Methods This national, population‐based, longitudinal, multicentre study used Swedish data that were prospectively collected between 1 December 2020 and 31 May 2021. All patients met the World Health Organization criteria for MIS‐C. The outcomes 2 and 8 weeks after diagnosis are presented, and follow‐up protocols are suggested. Results We identified 152 cases, and 133 (87%) participated. When followed up 2 weeks after MIS‐C was diagnosed, 43% of the 119 patients had abnormal results, including complete blood cell counts, platelet counts, albumin levels, electrocardiograms and echocardiograms. After 8 weeks, 36% of 89 had an abnormal patient history, but clinical findings were uncommon. Echocardiogram results were abnormal in 5% of 67, and the most common complaint was fatigue. Older children and those who received intensive care were more likely to report symptoms and have abnormal cardiac results. Conclusion More than a third (36%) of the patients had persistent symptoms 8 weeks after MIS‐C, and 5% had abnormal echocardiograms. Older age and higher levels of initial care appeared to be risk factors. Structured follow‐up visits are important after MIS‐C.
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Affiliation(s)
- Robin Kahn
- Department of Paediatrics Clinical Sciences Lund Lund University Lund Sweden
- Wallenberg Centre for Molecular Medicine Lund University Lund Sweden
| | - Stefan Berg
- Paediatric Rheumatology Queen Silvia Children’s Hospital Gothenburg Sweden
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Lillemor Berntson
- Department of Women´s and Children´s health Uppsala University Uppsala Sweden
| | - Elisabet Berthold
- Department of Rheumatology Institute of Clinical Sciences Lund Lund University Lund Sweden
| | - Petter Brodin
- Science for Life Laboratory Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
| | | | - Michele Compagno
- Department of Rheumatology Institute of Clinical Sciences Lund Lund University Lund Sweden
- Department of Rheumatology Institute of Clinical Sciences Malmö Lund University Lund Sweden
| | - Anders Fasth
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Jenny Lingman Framme
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Paediatrics Halland Hospital Halmstad Region Halland Sweden
| | - AnnaCarin Horne
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
| | | | - Petra Król
- Department of Paediatrics Clinical Sciences Lund Lund University Lund Sweden
| | - Antti J Kukka
- Department of Women´s and Children´s health Uppsala University Uppsala Sweden
- Department of Paediatrics Gävle Sweden
| | - Maria Mossberg
- Department of Paediatrics Clinical Sciences Lund Lund University Lund Sweden
| | - Bengt Månsson
- Department of Rheumatology Institute of Clinical Sciences Lund Lund University Lund Sweden
| | | | - Selma Idring Nordström
- Centre for Psychiatry Research Department of Clinical Neuroscience Region Stockholm Sweden
- Child and Adolescent Psychiatry Research Centre Karolinska Institutet & Stockholm Healthcare Services Stockholm Sweden
| | - Fatine Khammari Nyström
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
- Clinical Epidemiology Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Karin Palmblad
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
| | - Reza Rasti
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
- Paediatric Immuno‐psychiatry Unit CAP Research Centre Stockholm Health Care Services Region Stockholm Sweden
| | - André Rudolph
- Paediatric Heart Centre Stockholm‐Uppsala Karolinska University Hospital Stockholm Sweden
- Department of Medicine Karolinska Institutet Stockholm Sweden
| | - Karin Rydenman
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Paediatric ClinicNU Hospital Group Uddevalla Sweden
| | - Erik Sundberg
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
| | | | - Maria Altman
- Department of Paediatric Rheumatology Astrid Lindgren Children’s Hospital Karolinska Sweden
- Clinical Epidemiology Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
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Boeckelmann M, Glaser N, Dejas F, Östreicher I, Grüner J, Höche A, Akanbi S, Thiemig D, Rossi R. „Pediatric inflammatory multisystem syndrome“ – Erfahrungen aus einer Berliner Kinderklinik. Monatsschr Kinderheilkd 2022; 170:139-145. [PMID: 35079175 PMCID: PMC8773388 DOI: 10.1007/s00112-021-01394-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
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Kapadia TH, Abdulla MT, Hawkes RA, Tang V, Maniyar JA, Dixon RE, Maniyar AF, Kind KMS, Willis E, Riley P, Alwan YM, Stivaros SM. Appendiceal involvement in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a diagnostic challenge in the coronavirus disease (COVID) era. Pediatr Radiol 2022; 52:1038-1047. [PMID: 35394163 PMCID: PMC8990674 DOI: 10.1007/s00247-022-05346-2] [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: 07/13/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many studies on pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) have described abdominal findings as part of multisystem involvement, with limited descriptions of abdominal imaging findings specific to PIMS-TS. OBJECTIVE To perform a detailed evaluation of abdominal imaging findings in children with PIMS-TS. MATERIALS AND METHODS We performed a single-center retrospective study of children admitted to our institution between April 2020 and January 2021 who fulfilled Royal College of Paediatrics and Child Health criteria for PIMS-TS and who had cross-sectional abdominal imaging. We studied clinical data, abdominal imaging, laboratory markers, echocardiography findings, treatment and outcomes for these children. We also reviewed the literature on similar studies. RESULTS During the study period, 60 PIMS-TS cases were admitted, of whom 23 required abdominal imaging. Most (74%) were from a Black, Asian or minority ethnic background and they had an average age of 7 years (range 2-14 years). All children had fever and gastrointestinal symptoms on presentation with elevated C-reactive protein, D-dimer and fibrinogen. Most had lymphopenia, raised ferritin and hypoalbuminemia, with positive severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies in 65%. Free fluid (78%), right iliac fossa mesenteric inflammation (52%), and significantly enlarged mesenteric lymph nodes (52%) were the most common imaging findings. Appendiceal inflammation (30%) and abnormal distal ileum and cecum/ascending colon wall thickening (35%) were also common. All children responded well to medical management alone, with no mortality. CONCLUSION In addition to free fluid, prominent lymphadenopathy, and inflammatory changes in the right iliac fossa, we found abnormal long-segment ileal thickening and appendicitis to be frequent findings. Recognition of appendiceal involvement as a component of the PIMS-TS spectrum should help clinicians avoid unnecessary surgical intervention as part of a multidisciplinary team approach.
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Affiliation(s)
- Tejas H. Kapadia
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Mohammed T. Abdulla
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Rob A. Hawkes
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Vivian Tang
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Jenny A. Maniyar
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Rachel E. Dixon
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Amit F. Maniyar
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Kirsten M. S. Kind
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Emily Willis
- Paediatric Rheumatology Department, Royal Manchester Children’s Hospital, Manchester, Manchester, UK
| | - Phil Riley
- Paediatric Rheumatology Department, Royal Manchester Children’s Hospital, Manchester, Manchester, UK
| | - Yousef M. Alwan
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Stavros Michael Stivaros
- Academic Unit of Paediatric Radiology, Paediatric X-ray Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK. .,Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, University of Manchester, Manchester, UK.
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Xia X, Wang Y, Zheng J. COVID-19 and Alzheimer's disease: how one crisis worsens the other. Transl Neurodegener 2021; 10:15. [PMID: 33941272 PMCID: PMC8090526 DOI: 10.1186/s40035-021-00237-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Alzheimer’s disease (AD) has emerged as a key comorbidity of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The morbidity and mortality of COVID-19 are elevated in AD due to multiple pathological changes in AD patients such as the excessive expression of viral receptor angiotensin converting enzyme 2 and pro-inflammatory molecules, various AD complications including diabetes, lifestyle alterations in AD, and drug-drug interactions. Meanwhile, COVID-19 has also been reported to cause various neurologic symptoms including cognitive impairment that may ultimately result in AD, probably through the invasion of SARS-CoV-2 into the central nervous system, COVID-19-induced inflammation, long-term hospitalization and delirium, and post-COVID-19 syndrome. In addition, the COVID-19 crisis also worsens behavioral symptoms in uninfected AD patients and poses new challenges for AD prevention. In this review, we first introduce the symptoms and pathogenesis of COVID-19 and AD. Next, we provide a comprehensive discussion on the aggravating effects of AD on COVID-19 and the underlying mechanisms from molecular to social levels. We also highlight the influence of COVID-19 on cognitive function, and propose possible routes of viral invasion into the brain and potential mechanisms underlying the COVID-19-induced cognitive impairment. Last, we summarize the negative impacts of COVID-19 pandemic on uninfected AD patients and dementia prevention.
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Affiliation(s)
- Xiaohuan Xia
- Center for Translational Neurodegeneration and Regenerative Therapy, Tenth People's Hospital of Tongji University, Shanghai, 200072, China. .,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434, China.
| | - Yi Wang
- Center for Translational Neurodegeneration and Regenerative Therapy, Tenth People's Hospital of Tongji University, Shanghai, 200072, China.,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434, China
| | - Jialin Zheng
- Center for Translational Neurodegeneration and Regenerative Therapy, Tenth People's Hospital of Tongji University, Shanghai, 200072, China. .,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434, China. .,Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, 200092, China. .,Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, 68198-5930, USA.
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Successful Treatment of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 (PIMS-TS) with Split Doses of Immunoglobulin G and Estimation of PIMS-TS Incidence in a County District in Southern Germany. Healthcare (Basel) 2021; 9:healthcare9040481. [PMID: 33919536 PMCID: PMC8073661 DOI: 10.3390/healthcare9040481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/02/2021] [Accepted: 04/16/2021] [Indexed: 01/14/2023] Open
Abstract
Pediatric inflammatory multisystem syndrome temporally associated with SARS Cov2 (PIMS-TS) is a newly encountered disease in children sharing clinical features with Kawasaki disease, toxic shock syndrome, or macrophage-activating syndrome. Pathogenically, it is associated with immune-mediated post-infectious hyperinflammation leading to short-term myocardial injury with yet unknown long-term outcome. We herein present three cases of PIMS-TS treated in our institution with divided doses of immunoglobulins and high dose acetyl salicylic acid, according to existing Kawasaki disease guidelines. Due to greater weight in adolescents affected and concerns of rheological sequelae following possible hyperviscosity, doses of immunoglobulins were divided and given 24 h apart with good tolerability. All patients recovered rapidly with normalization of previously encountered cardiac manifestations. As diagnosis of PIMS-TS should be made promptly, timing of therapy is of paramount importance for a favorable outcome. To date, no randomized controlled trial data exist concerning treatment recommendations. 1.8% (95% CI: 1.7% to 2.0%) of all children and adolescents in the county district of Ostallgäu were tested positive for SARS CoV-2, incidence of PIMS-TS was 1.7% (95% CI: 0.9% to 3.1%) among SARS CoV-2 positive tested earlier. As the pandemic is still ongoing, rising numbers of PIMS-TS in children might be expected.
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Mastrolia MV, Marrani E, Calabri GB, L'Erario M, Maccora I, Favilli S, Duchini PP, Pagnini I, Simonini G. Fast recovery of cardiac function in PIMS-TS patients early using intravenous anti-IL-1 treatment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:131. [PMID: 33827651 PMCID: PMC8024939 DOI: 10.1186/s13054-021-03548-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini, 24, 50139, Firenze, Italy.
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini, 24, 50139, Firenze, Italy
| | | | - Manuela L'Erario
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini, 24, 50139, Firenze, Italy
| | - Silvia Favilli
- Cardiologic Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Pier Paolo Duchini
- Pediatric Intensive Care Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital, Viale Gaetano Pieraccini, 24, 50139, Firenze, Italy
| | - Gabriele Simonini
- Rheumatology Unit, NEUROFARBA Department, Meyer Children's University Hospital, University of Florence, Firenze, Italy
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