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Shih WL, Huang LM, Wu MH, Chang LY. Secular trend of Kawasaki disease and its correlation with viral activity in Taiwan: a nationwide population-based study. BMC Public Health 2024; 24:1591. [PMID: 38872194 DOI: 10.1186/s12889-024-19066-9] [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: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the most important acquired heart disease in children. This study investigated annual incidence, seasonality, secular trend and the correlation of KD incidence with viral activity in Taiwan. METHODS Through the national health insurance database, we identified KD during 2001-2020. The viral activity was obtained from nationwide surveillance database. We analyzed KD age-specific annual incidence, secular trends, seasonality and the correlation between KD incidence and common enteric or respiratory viral activity. RESULTS The KD incidence of subjects younger than 18 years significantly increased from 2001 to 2020 (11.78 and 22.40 per 100,000 person-years, respectively), and substantially decreased with age. Infants younger than 1 year presented the highest KD annual incidence at 105.82 to 164.34 per 100,000 person-years from 2001 to 2020. For all KD patients, the most frequently occurring season was summer followed by autumn. The KD incidence of infants younger than 1 year had significantly positive correlation with enteric (r = 0.14) and respiratory (r = 0.18) viral activity. CONCLUSIONS This study demonstrates the increasing trend of KD annual incidence and seasonality (more in summer and autumn) in Taiwan. The activity of common respiratory and enteric viruses was significantly correlated with KD incidence in infants.
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Affiliation(s)
- Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan
- Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan
| | - Li-Min Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan
- Department of Pediatrics,, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 8, Chung-Shan South Road, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics,, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 8, Chung-Shan South Road, Taipei, Taiwan
| | - Luan-Yin Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, Taiwan.
- Department of Pediatrics,, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 8, Chung-Shan South Road, Taipei, Taiwan.
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Liu J, Su D, Qin S, Ye B, Wang B, Pang Y. Evaluation of the Association Between Coronary Artery Aneurysms and Concomitant Infection in Patients With Kawasaki Disease. Clin Pediatr (Phila) 2024; 63:785-797. [PMID: 37642409 DOI: 10.1177/00099228231196526] [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: 08/31/2023]
Abstract
We analyzed the relationship between recovery from coronary artery aneurysms (CAAs) and concurrent infections in patients with Kawasaki disease (KD). The estimated median time of aneurysm persistence between patients with and without infections was compared using Kaplan-Meier survival analyses. Risk factors associated with persistent CAAs at 2 years were identified using multivariable analyses. Co-infection was confirmed in 20.5% (106/518) of patients diagnosed with KD. No significant differences regarding treatment or coronary artery outcome were identified between patients with and without infections. The estimated median time of aneurysm persistence was higher in the co-infected group (9 vs. 6 months). A maximum Z-score ≥ 4.00 at 1 month had 78% sensitivity and 83% specificity in predicting CAAs without recovery within 1 year of onset, whereas the predictability was higher within 2 years of onset, with a Z-score ≥ 4.88 (sensitivity, 92%; specificity, 91%). Concomitant infections did not affect the response to treatment or coronary artery outcomes in patients with KD.
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Affiliation(s)
- Jie Liu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Danyan Su
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Suyuan Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Ye
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baofeng Wang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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3
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Wang Y, Yang L, Xu G. New-Onset Acute Interstitial Nephritis Post-SARS-CoV-2 Infection and COVID-19 Vaccination: A Panoramic Review. J Epidemiol Glob Health 2023; 13:615-636. [PMID: 37870719 PMCID: PMC10686899 DOI: 10.1007/s44197-023-00159-4] [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: 06/30/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
The 2019 coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has posed a considerable challenge to global healthcare. Acute interstitial nephritis (AIN) post SARS-CoV-2 infection and vaccination has been reported, but its clinical features and pathogenesis remained unclear. We reviewed so far the largest 22 cases of AIN post SARS-CoV-2 infection and 36 cases of AIN following COVID-19 vaccination. The onset of AIN was mainly related to messenger RNA vaccines (52.8%). Apart from fever, proteinuria (45.5%) was the main manifestation of AIN post SARS-CoV-2 infection, left acute kidney injury (AKI, 63.9%) in patients post COVID-19 vaccination. The potential mechanism of vaccination induced AIN was conjugating vaccines with proteins to form a hapten, which activated dendritic cells and promoted a cascade immunological reaction leading to AIN.
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Affiliation(s)
- Yu Wang
- Department of Nephrology, Donghu District, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Ling Yang
- Department of Health Management Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Gaosi Xu
- Department of Nephrology, Donghu District, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China.
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Li YW, Wan Q, Cheng Y, Hu HB. Possible Involvement of Infection with Human Rhinoviruses in Children with Kawasaki Disease. Mediterr J Hematol Infect Dis 2023; 15:e2023049. [PMID: 37705520 PMCID: PMC10497314 DOI: 10.4084/mjhid.2023.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Ya-wei Li
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, China
| | - Qing Wan
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, China
| | - Ying Cheng
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, China
| | - Hong-bo Hu
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, China
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5
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Namba T, Higuchi Y, Shimizu J. Respiratory pathogen trends in patients with Kawasaki disease during the COVID-19 pandemic and respiratory syncytial virus epidemic in Japan. Pediatr Neonatol 2023; 64:505-511. [PMID: 36878812 PMCID: PMC9937719 DOI: 10.1016/j.pedneo.2023.01.001] [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: 01/17/2022] [Revised: 11/24/2022] [Accepted: 01/05/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Although the etiology of Kawasaki disease (KD) remains unknown, the most common view is that an infectious agent triggers the activation of the inflammatory cascade in predisposed children. The coronavirus disease 2019 (COVID-19) pandemic has led to the establishment of infection control measures, which reduced the overall incidence of respiratory infections; however, a resurgence of respiratory syncytial virus (RSV) infection occurred in the summer of 2021. This study aimed to examine the relationship between respiratory pathogens and KD during the COVID-19 pandemic and the RSV epidemic in Japan between 2020 and 2021. METHODS We retrospectively reviewed the medical charts of pediatric patients with KD or respiratory tract infection (RTI) admitted to National Hospital Organization Okayama Medical Center between December 1, 2020, and August 31, 2021. All patients with KD and RTI underwent multiplex polymerase chain reaction testing upon admission. We classified patients with KD into the three subgroups-pathogen-negative, single pathogen-positive, and multi-pathogen-positive-and compared their laboratory data and clinical features. RESULTS This study enrolled 48 patients with KD and 269 with RTI. Rhinovirus and enterovirus were the most prevalent pathogens in both patients with KD and RTI (13 [27.1%] and 132 patients [49.1%], respectively). The clinical characteristics of the pathogen-negative KD group and the pathogen-positive KD group at diagnosis were similar; however, the pathogen-negative group tended to receive additional treatment, such as multiple courses of intravenous immunoglobulin, intravenous methylprednisolone, infliximab, cyclosporine A, and plasmapheresis, more frequently. The number of patients with KD remained stable when RTI was not prevalent but increased following the surge in RTI with RSV. CONCLUSIONS An epidemic of respiratory infections led to an increase in the incidence of KD. Patients with respiratory pathogen-negative KD could have greater recalcitrance to intravenous immunoglobulin than those with respiratory pathogen-positive KD.
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Affiliation(s)
- Takahiro Namba
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yousuke Higuchi
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan.
| | - Junya Shimizu
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
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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.
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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
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Valtuille Z, Lefevre-Utile A, Ouldali N, Beyler C, Boizeau P, Dumaine C, Felix A, Assad Z, Faye A, Melki I, Kaguelidou F, Meinzer U. Calculating the fraction of Kawasaki disease potentially attributable to seasonal pathogens: a time series analysis. EClinicalMedicine 2023; 61:102078. [PMID: 37483549 PMCID: PMC10359724 DOI: 10.1016/j.eclinm.2023.102078] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Kawasaki disease is an acute, febrile, systemic vasculitis of children that primarily affects medium-sized blood vessels with a tropism for the coronary arteries. Although the etiological factors remain unknown, infections have been suggested as the trigger of Kawasaki disease. We sought to calculate the fraction of Kawasaki disease potentially attributable to seasonal infections. Methods This cohort study used a population-based time series analysis from the French hospitalisation database (Programme de Médicalisation des Systèmes d'Information), which includes all inpatients admitted to any public or private hospital in France. We included all children aged 0-17 years hospitalised for Kawasaki disease in France over 13 years. The monthly incidence of Kawasaki disease per 10,000 children over time was analysed by a quasi-Poisson regression model. The model accounted for seasonality by using harmonic terms (a pair of sines and cosines with 12-month periods). The circulation of eight common seasonal pathogens (adenovirus, influenza, metapneumovirus, Mycoplasma pneumoniae, norovirus, rhinovirus, rotavirus, respiratory syncytial virus, and Streptococcus pneumonia) over the same period was included in the model to analyse the fraction of Kawasaki disease potentially attributable to each pathogen. Infections were identified on the basis of polymerase chain reaction or rapid antigen testing in hospital laboratories. Findings Between Jan 1, 2007, and Dec 31, 2019, we included 10,337 children with Kawasaki disease and 442,762 children with the selected infectious diseases. In the Kawasaki disease cohort, the median age [IQR] was 2 [0-4] years, 6164 [59.6%] were boys. Adenovirus infection was potentially responsible for 24.4% [21.5-27.8] (p < 0.001) of Kawasaki diseases, Norovirus for 6.7% [1.3-11.2] (p = 0.002), and RSV 4.6% [1.2-7.8] (p = 0.022). Sensitivity analyses found similar results. Interpretation This cohort study of data from a comprehensive national hospitalisation database indicated that approximately 35% of Kawasaki diseases was potentially attributable to seasonal infections. Funding None.
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Affiliation(s)
- Zaba Valtuille
- Centre of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
| | - Alain Lefevre-Utile
- General Paediatrics and Paediatric Emergencies, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, F-93140 Paris, France
- U976 HIPI Unit, Saint-Louis Research Institute, Université de Paris Cité, Inserm, Paris, France
| | - Naim Ouldali
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Constance Beyler
- Department of Paediatric Cardiology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
| | - Priscilla Boizeau
- Centre of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Cécile Dumaine
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, INSERM U1149, Centre de Recherche sur l’inflammation, F-75018, Paris, France
| | - Arthur Felix
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Department of General Paediatrics, Competence Centre RAISE Antilles-Guyane, Martinique University Hospital, MFME. CHU de La Martinique, Fort-de France, France
| | - Zein Assad
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Albert Faye
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Isabelle Melki
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
| | - Florentia Kaguelidou
- Centre of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Ulrich Meinzer
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, INSERM U1149, Centre de Recherche sur l’inflammation, F-75018, Paris, France
- Institut Pasteur, Université de Paris Cité, Biology and Genetics of Bacterial Cell Wall Unit, Department of Microbiology, Paris, France
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Galeotti C, Bajolle F, Belot A, Biscardi S, Bosdure E, Bourrat E, Cimaz R, Darbon R, Dusser P, Fain O, Hentgen V, Lambert V, Lefevre-Utile A, Marsaud C, Meinzer U, Morin L, Piram M, Richer O, Stephan JL, Urbina D, Kone-Paut I. French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [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: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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Affiliation(s)
- C Galeotti
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - F Bajolle
- M3C-Necker-Enfants-Malades, hôpital Necker-Enfants-Malades, université de Paris Cité, Paris, France
| | - A Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - S Biscardi
- Service des urgences pédiatriques, centre hospitalier intercommunal de Créteil, Créteil, France
| | - E Bosdure
- Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 13385 Marseille cedex 5, France
| | - E Bourrat
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - R Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - R Darbon
- Association France vascularites, Blaisy-Bas, France
| | - P Dusser
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - O Fain
- Service de médecine interne, hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Hentgen
- Service de pédiatrie, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), centre hospitalier de Versailles, Le Chesnay, France
| | - V Lambert
- Service de radiologie pédiatrique, Institut mutualiste Montsouris, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - A Lefevre-Utile
- Service de pédiatrie générale et des urgences pédiatriques, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - C Marsaud
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - U Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Morin
- Service de réanimation pédiatrique et néonatale, DMU 3 santé de l'enfant et adolescent, hôpital Bicêtre, université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - M Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, Quebec, Canada
| | - O Richer
- Service des urgences pédiatriques, hôpital universitaire de Pellegrin, Bordeaux, France
| | - J-L Stephan
- Service de pédiatrie, CHU Saint-Étienne, Saint-Étienne, France
| | - D Urbina
- Service d'accueil des urgences pédiatriques, hôpital Nord, AP-HM, 13005 Marseille, France
| | - I Kone-Paut
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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9
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Neubauer HC, Lopez MA, Haq HA, Ouellette L, Ramirez AA, Wallace SS. Viral Coinfections in Kawasaki Disease: A Meta-analysis. Hosp Pediatr 2023; 13:e153-e169. [PMID: 37170763 DOI: 10.1542/hpeds.2023-007150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT Viral infections are suspected triggers in Kawasaki disease (KD); however, a specific viral trigger has not been identified. OBJECTIVES In children with KD, to identify (1) overall prevalence of viral infections; (2) prevalence of specific viruses; and (3) whether viral positivity was associated with coronary artery aneurysms (CAAs) or refractoriness to intravenous immunoglobin (IVIG). DATA SOURCES We searched Embase, Medline, and Cochrane databases and gray literature. STUDY SELECTION Eligible studies were conducted between 1999 and 2019, and included children diagnosed with KD who underwent viral testing. DATA EXTRACTION Two investigators independently reviewed full-text articles to confirm eligibility, extract data, appraise for bias, and assess evidence quality for outcomes using the Grading of Recommendations Assessment Development and Evaluation criteria. We defined viral positivity as number of children with a positive viral test divided by total tested. Secondary outcomes were CAA (z score ≥2.5) and IVIG refractoriness (fever ≥36 hours after IVIG). RESULTS Of 3189 unique articles identified, 54 full-text articles were reviewed, and 18 observational studies were included. Viral positivity weighted mean prevalence was 30% (95% confidence interval [CI], 14-51) and varied from 5% to 66%, with significant between-study heterogeneity. Individual virus positivity was highest for rhinovirus (19%), adenovirus (10%), and coronavirus (7%). Odds of CAA (odds ratio, 1.08; 95% CI, 0.75-1.56) or IVIG refractoriness (odds ratio, 0.88; 95% CI, 0.58-1.35) did not differ on the basis of viral status. LIMITATIONS Low or very low evidence quality. CONCLUSIONS Viral infection was common with KD but without a predominant virus. Viral positivity was not associated with CAAs or IVIG refractoriness.
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Affiliation(s)
- Hannah C Neubauer
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Michelle A Lopez
- Divisions of Pediatric Hospital Medicine
- Texas Children's Hospital, Houston, Texas
| | - Heather A Haq
- Divisions of Pediatric Hospital Medicine
- Texas Children's Hospital, Houston, Texas
| | | | - Andrea A Ramirez
- Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Sowdhamini S Wallace
- Divisions of Pediatric Hospital Medicine
- Texas Children's Hospital, Houston, Texas
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10
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Rand KH, Bhaduri-McIntosh S, Gurka MJ, Chi X, Harris A. Is Kawasaki Disease Caused by a Respiratory Virus? Pediatr Infect Dis J 2023; 42:468-472. [PMID: 37171979 DOI: 10.1097/inf.0000000000003889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Kawasaki disease is characterized by high fever, rash, cervical lymphadenopathy, conjunctival injection, oral mucous membrane changes and swelling of the extremities followed by skin sloughing. Despite >50 years of study, no bacterial, viral or other infectious agent has been consistently associated with the illness. The lockdown and social distancing for COVID-19 in March 2020 led to a marked decrease in respiratory virus circulation. This provided an "experiment of nature" to determine whether Kawasaki disease would decline in parallel. METHODS Discharge ICD-10 diagnosis codes were obtained from the Vizient Clinical Data Base for Kawasaki disease and respiratory viruses, and analyzed for the age group < 5 years. Weekly respiratory virus positivity data were also obtained from BioFire Diagnostics. RESULTS Common enveloped respiratory viruses declined precipitously from April 2020 through March 2021 to levels at or below historical seasonal minimum levels. Kawasaki Disease declined about 40% compared with 2018-2019, which is distinctly different from the pattern seen for the enveloped respiratory viruses. Strong seasonality was seen for Kawasaki disease as far back as 2010, and correlated most closely with respiratory syncytial virus, human metapneumovirus and less so with influenza virus suggesting there is a baseline level of Kawasaki disease activity that is heightened during yearly respiratory virus activity but that remains at a certain level even in the near total absence of respiratory viruses. CONCLUSIONS The striking decrease in enveloped respiratory viruses after lockdown and social distancing was not paralleled by a comparable decrease in Kawasaki disease incidence, suggesting a different epidemiology.
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Affiliation(s)
- Kenneth H Rand
- From the Departments of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | | | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Xiaofei Chi
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Alyssa Harris
- Center for Advanced Analytics & Informatics, Vizient Inc., Irving, Texas
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11
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COVID-19-Associated Paediatric Inflammatory Multisystem Syndrome (PIMS-TS) in Intensive Care: A Retrospective Cohort Trial (PIMS-TS INT). CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020348. [PMID: 36832477 PMCID: PMC9955007 DOI: 10.3390/children10020348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a new disease in children and adolescents that occurs after often asymptomatic or mild COVID-19. It can be manifested by different clinical symptomatology and varying severity of disease based on multisystemic inflammation. The aim of this retrospective cohort trial was to describe the initial clinical presentation, diagnostics, therapy and clinical outcome of paediatric patients with a diagnosis of PIMS-TS admitted to one of the 3 PICUs. All paediatric patients who were admitted to the hospital with a diagnosis of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) during the study period were enrolled in the study. A total of 180 patients were analysed. The most common symptoms upon admission were fever (81.6%, n = 147), rash (70.6%, n = 127), conjunctivitis (68.9%, n = 124) and abdominal pain (51.1%, n = 92). Acute respiratory failure occurred in 21.1% of patients (n = 38). Vasopressor support was used in 20.6% (n = 37) of cases. Overall, 96.7% of patients (n = 174) initially tested positive for SARS-CoV-2 IgG antibodies. Almost all patients received antibiotics during in-hospital stays. No patient died during the hospital stay or after 28 days of follow-up. Initial clinical presentation and organ system involvement of PIMS-TS including laboratory manifestations and treatment were identified in this trial. Early identification of PIMS-TS manifestation is essential for early treatment and proper management of patients.
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12
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Li S, Xu Y, Wu Y, Huang H, Sun C, Xu S, Li H, Zhang X, Zhao S, Huang L. Heparin-Binding Protein: A Prognostic Biomarker Associated with Severe or Complicated Community-Acquired Pneumonia in Children. J Inflamm Res 2023; 16:321-331. [PMID: 36726792 PMCID: PMC9885876 DOI: 10.2147/jir.s393600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/24/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose Heparin-binding protein (HBP) is a novel biomarker for inflammatory diseases. This study aimed to investigate the role of serum HBP in community-acquired pneumonia (CAP) in children and the association of HBP with the severity and prognosis. Patients and Methods A total of 125 children with CAP admitted to the hospital were enrolled in this retrospective study. We analyzed the differences in clinical characteristics and examination findings between patients with different levels of HBP. The severe or complicated CAP was defined as having severe radiographic findings and/or systemic manifestations. Receiver operator characteristic (ROC) curves detected the performance of biomarkers in identifying patients with severe or complicated pneumonia. The multivariate logistic regression models assessed the association between HBP levels and the severity and prognosis. Finally, we constructed a predictive model based on HBP. Results The rate of severe or complicated CAP for patients with upper-quartile HBP concentration (≥60 ng/mL) was 54.8%, significantly higher than that of patients with lower HBP concentration (26.6%). The level of HBP is substantially correlated with neutrophil counts, C-reactive protein, erythrocyte sedimentation rate, and serum amyloid A protein (r = 0.31, 0.26, 0.36, and 0.26, respectively). HBP achieved the highest level of discrimination for severe or complicated CAP among the biomarkers. Higher HBP concentration (≥60 ng/mL) was associated with a three-fold higher risk of severe or complicated CAP (adjusted odds ratio = 3.11, p < 0.05). A predictive model including four characteristics (HBP, lactate dehydrogenase, age and non-viral infection) for predicting severe or complicated CAP (with area under the ROC curve = 0.75) was built to create a nomogram. Conclusion Substantially elevated serum HBP is significantly associated with severe or complicated CAP and poor prognosis in children. This finding warrants further investigation of the function of HBP in the pathogenesis of CAP.
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Affiliation(s)
- Shuang Li
- Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People’s Republic of China,Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yanwen Xu
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yuhang Wu
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Heyu Huang
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Chen Sun
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shanshan Xu
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Huajun Li
- Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, People’s Republic of China,Shiyong Zhao, Department of Infectious Diseases, Hangzhou Children’s Hospital, 195 Wenhui Road, Hangzhou, Zhejiang Provinve, 310005, People’s Republic of China, Email
| | - Lisu Huang
- Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People’s Republic of China,Department of Infectious Diseases, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China,Correspondence: Lisu Huang, Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, Zhejiang Province, 310052, People’s Republic of China, Email
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13
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SARS-CoV-2 infection in the context of Kawasaki disease and multisystem inflammatory syndrome in children. Med Microbiol Immunol 2023; 212:3-12. [PMID: 36396785 PMCID: PMC9672612 DOI: 10.1007/s00430-022-00756-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
Recent studies have noted an increasing number of Kawasaki-like cases in the pediatric population following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the literature, the condition is described as multiple inflammatory syndrome in children (MIS-C) or pediatric inflammatory syndrome (PIMS). A similar clinical course of Kawasaki disease (KD) and MIS-C causes difficulties in distinguishing between both conditions. However, the differential diagnosis is crucial since patients with MIS-C can present severe symptoms (myocardial dysfunction, fever, mucocutaneous symptoms) and require more extensive monitoring during treatment than children diagnosed with KD. Along with assessing epidemiological and genetic factors, it is imperative to estimate the risk of developing MIS-C in KD patients with confirmed SARS-CoV-2 infection. Genetic predispositions, such as the ITPKC gene polymorphism in KD, ACE deletion (D) polymorphism in SARS-CoV-2, and inborn errors of immunity (IEIs) in MIS-C affect the regulation of immune system complex clearances and cellular adaptations. The virus has a tropism for both vascular and respiratory cells, which further causes additional symptoms necessitating standard therapy with antithrombotic treatment. The diagnostic criteria for KD, MIS-C, and SARS-CoV-2 help differentiate each condition and optimize treatment strategies. Unfortunately, long-term outcomes in KD patients who develop MIS-C due to SARS-CoV-2 infection have been inadequately documented due to the timing of the pandemic, further displaying the need for longitudinal studies in these patients. This review underlines the differences in diagnosis and treatment of KD and MIS-C. Overall, children with KD may develop MIS-C in the setting of SARS-CoV-2 infection, but further research is needed to outline specific etiologies, prognostic factors, and diagnoses.
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14
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Aelami MH, Malek A, Saeidinia A. Coronavirus disease 2019-related Kawasaki syndrome: a case report. J Med Case Rep 2022; 16:432. [PMID: 36352417 PMCID: PMC9645345 DOI: 10.1186/s13256-022-03589-z] [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: 06/19/2021] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 has changed the pattern of some diseases in the world, especially in pediatrics. Despite data suggesting that the pediatric population is less affected by coronavirus disease-19 infection, new concerns have been raised owing to reported cases with hyperinflammatory conditions such as Kawasaki disease. CASE PRESENTATION We report herein the case of a pediatric patient diagnosed and treated for classic Kawasaki disease in the setting of confirmed coronavirus disease 2019 infection. She was an 8-year-old, previously healthy, and fully immunized Iranian girl who initially presented to the pediatric emergency department with 5 days of intermittent fever, followed by abdominal pain, nausea, and vomiting. She was admitted for fever and abdominal pain to the surgery service of Akbar Hospital with suspected appendicitis. CONCLUSIONS This case report may serve as a useful reference to other clinicians caring for pediatric patients affected by coronavirus disease 2019 infection. Standard therapeutic interventions for Kawasaki disease must be performed to prevent critical coronary aneurysm-related complications in the coronavirus disease 2019 era.
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Affiliation(s)
- Mohammad Hasan Aelami
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Malek
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Saeidinia
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Fakouri Boulevard, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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15
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Characterization of the nasopharyngeal microbiome in patients with Kawasaki disease. An Pediatr (Barc) 2022; 97:300-309. [DOI: 10.1016/j.anpede.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/16/2021] [Indexed: 11/07/2022] Open
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16
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Pouletty M, Dingulu G, Ouldali N, Corseri O, Ducrocq C, Meinzer U, Faye A, Galeotti C, Melki I. Response to: 'Exaggerated neutrophil extracellular trap formation in Kawasaki disease: a key phenomenon behind the outbreak in western countries?' by Yamashita et al. Ann Rheum Dis 2022; 81:e178. [PMID: 32826274 DOI: 10.1136/annrheumdis-2020-218644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
| | - Glory Dingulu
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Olivier Corseri
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
| | - Camille Ducrocq
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- Center for Research on Inflammation, UMR1149, INSERM, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Caroline Galeotti
- Department of Pediatric Rheumatology, Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
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17
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Konukoglu O, Dogan A, Sever K, Akcay A, Balkanay M, Mansuroglu D. Left ventricular assist device implantation following multisystem inflammatory syndrome in children due to SARS-CoV-2. J Card Surg 2022; 37:3947-3950. [PMID: 35921070 PMCID: PMC9538311 DOI: 10.1111/jocs.16821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS‐C) is rare, however, severe hyperinflammatory condition in children generally weeks after acute SARS‐CoV‐2 infection. A subset of MIS‐C patients is presented with severe heart failure. We hereby report 8‐year‐old girl presenting acute severe left ventricular failure. Various medical treatments including inotropic agents and drugs related to SARS‐CoV‐2 infection and MIS‐C were applied. However, venoarterial extracorporeal membrane oxygenation (ECMO) was needed to be performed. Due to unsuccessful attempts for ECMO weaning, left ventricular assist device was implanted to the patient with temporary right ventricular support from ECMO.
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Affiliation(s)
- Oguz Konukoglu
- Gaziosmanpasa Hospital Cardiovascular Surgery Department, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Ali Dogan
- Gaziosmanpasa Hospital Cardiology Department, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Kenan Sever
- Gaziosmanpasa Hospital Cardiovascular Surgery Department, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Arzu Akcay
- Pathology Department, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Mehmet Balkanay
- Gaziosmanpasa Hospital Cardiovascular Surgery Department, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Denyan Mansuroglu
- Gaziosmanpasa Hospital Cardiovascular Surgery Department, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
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18
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Sánchez-Manubens J, Henares D, Muñoz-Almagro C, Brotons de los Reyes P, Timoneda N, Antón J. Caracterización del microbioma nasofaríngeo en pacientes con enfermedad de Kawasaki. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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BORDEA M, COSTACHE C, GRAMA A, FLORIAN A, LUPAN I, SAMAȘCA G, DELEANU D, MAKOVICKY P, MAKOVICKY P, RIMAROVA K. Cytokine Cascade in Kawasaki Disease Versus Kawasaki-Like Syndrome. Physiol Res 2022; 71:17-27. [DOI: 10.33549/physiolres.934672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is a medium vessel systemic vasculitis that predominantly occurs in children below five years of age. It is an acute febrile condition in which coronary artery aneurysms and myocarditis are the most common cardiovascular complications. It is most often characterized by hypercytoki-nemia. The etiopathogenesis of KD is not fully understood. The present review synthesizes the recent advances in the pathophysiology and treatment options of KD. According to different studies, the genetic, infections and autoimmunity factors play a major role in pathogenesis. Several susceptibility genes (e.g. caspase 3) and cytokines (e.g. IL-2, IL-4, IL-6, IL-10, IFN-γ and TNF-α) have been identified in KD. Patients with high cytokine levels are predisposed to KD shock syndrome. The importance of respiratory viruses in the pathogenesis of the disease is unclear. Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce in children and adults an abnormal systemic inflammatory response. This syndrome shares characteristics with KD. It has been called by many terms like MIS-C (Multisystem Inflammatory Syndrome in Children), PIMS-TS (pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2), hyperinflammatory shock syndrome, cytokine storm (cytokine release syndrome) or simply, Kawasaki-like syndrome. The cytokine’s role in the development of KD or Kawasaki-like syndrome being triggered by COVID-19 is controversial. The presences of the antiendothelial cell autoantibodies (AECAs) together with the newly developed hypothesis of immunothrombosis are considered potential pathogenic mechanisms for KD. In consequence, the diagnosis and treatment of KD and Kawasaki-like syndrome, one of the most common causes of acquired heart disease in developed countries, are challenging without a clearly defined protocol.
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Affiliation(s)
- M BORDEA
- Emergency Hospital for Children, Cluj-Napoca, Romania
| | - C COSTACHE
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - A GRAMA
- Emergency Hospital for Children, Cluj-Napoca, Romania
| | - A FLORIAN
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - I LUPAN
- Department of Molecular Biology, Babes Bolyai University, Cluj-Napoca, Romania
| | - G SAMAȘCA
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D DELEANU
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - P MAKOVICKY
- Cancer Research Institute, Biomedical Research Centre of the Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - P MAKOVICKY
- Department of Biology, Faculty of Education, J. Selye University, Komárno, Slovak Republic
| | - K RIMAROVA
- Department of Public Health and Hygiene, Faculty of Medicine, P. J. Šafárik University, Košice, Slovak Republic
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20
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Shahbaz FF, Martins RS, Umair A, Ukrani RD, Jabeen K, Sohail MR, Khan E. A Review of Coronaviruses Associated With Kawasaki Disease: Possible Implications for Pathogenesis of the Multisystem Inflammatory Syndrome Associated With COVID-19. Clin Med Insights Pediatr 2022; 16:11795565221075319. [PMID: 35197719 PMCID: PMC8859668 DOI: 10.1177/11795565221075319] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C), representing a new entity in the spectrum of manifestations of COVID-19, bears symptomatic resemblance with Kawasaki Disease (KD). This review explores the possible associations between KD and the human coronaviruses and discusses the pathophysiological similarities between KD and MIS-C and proposes implications for the pathogenesis of MIS-C in COVID-19. Since 2005, when a case-control study demonstrated the association of a strain of human coronavirus with KD, several studies have provided evidence regarding the association of different strains of the human coronaviruses with KD. Thus, the emergence of the KD-like disease MIS-C in COVID-19 may not be an unprecedented phenomenon. KD and MIS-C share a range of similarities in pathophysiology and possibly even genetics. Both share features of a cytokine storm, leading to a systemic inflammatory response and oxidative stress that may cause vasculitis and precipitate multi-organ failure. Moreover, antibody-dependent enhancement, a phenomenon demonstrated in previous coronaviruses, and the possible superantigenic behavior of SARS-CoV-2, possibly may also contribute toward the pathogenesis of MIS-C. Lastly, there is some evidence of complement-mediated microvascular injury in COVID-19, as well as of endotheliitis. Genetics may also represent a possible link between MIS-C and KD, with variations in FcγRII and IL-6 genes potentially increasing susceptibility to both conditions. Early detection and treatment are essential for the management of MIS-C in COVID-19. By highlighting the potential pathophysiological mechanisms that contribute to MIS-C, our review holds important implications for diagnostics, management, and further research of this rare manifestation of COVID-19.
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Affiliation(s)
| | | | - Abdullah Umair
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Kausar Jabeen
- Section of Microbiology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - M Rizwan Sohail
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erum Khan
- Section of Microbiology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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21
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Kang JM, Jung J, Kim YE, Huh K, Hong J, Kim DW, Kim MY, Jung SY, Kim JH, Ahn JG. Temporal Correlation Between Kawasaki Disease and Infectious Diseases in South Korea. JAMA Netw Open 2022; 5:e2147363. [PMID: 35129593 PMCID: PMC8822386 DOI: 10.1001/jamanetworkopen.2021.47363] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Infections are proposed to be triggering factors for Kawasaki disease (KD), although its etiological factors remain unknown. Recent reports have indicated a 4- to 6-week lag between SARS-CoV-2 infection and multisystem inflammatory syndrome in children with a similar presentation to that of KD. OBJECTIVE To investigate the temporal correlation between KD and viral infections, focusing on respiratory viruses. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among individuals aged 0 to 19 years diagnosed with KD between January 2010 and September 2020 from the Korean National Health Insurance Service. Data on infectious disease outbreaks from 2016 to 2019 were collected from the Korea Disease Control and Prevention Agency, Korean Influenza and Respiratory Virus Monitoring System, Korea Enteroviruses Surveillance System, and the Enteric Pathogens Active Surveillance Network in South Korea. Data were analyzed from December 2020 to October 2021. MAIN OUTCOMES AND MEASURES National databases for infectious diseases were used for a time-series analysis of the correlation between viral infections and KD. The temporal correlation between infectious disease outbreaks and KD outbreaks was evaluated using the Granger causality test (G-test), which is a useful tool to estimate correlations between 2 time series of diseases based on time lags. RESULTS Overall, 53 424 individuals with KD were identified, including 22 510 (42.1%) females and 30 914 (57.9%) males and 44 276 individuals (82.9%) younger than 5 years. Intravenous immunoglobulin-resistant KD was identified in 9042 individuals (16.9%), and coronary artery abnormalities were identified in 384 individuals (0.7%). Of 14 infectious diseases included in the analyses, rhinovirus infection outbreaks were identified as significantly correlated at 1 to 3 months before KD outbreaks in South Korea (r = 0.3; 1 month: P < .001; 2 months: P < .001; 3 months: P < .001). Outbreaks of respiratory syncytial virus infection were identified as significantly correlated with KD outbreaks by 2 months (r = 0.5; 2 months: P < .001). Additionally, varicella outbreaks were identified as significantly correlated at 2 and 3 months before KD outbreaks (r = 0.7; 2 months: P < .001; 3 months: P < .001). CONCLUSIONS AND RELEVANCE In this cohort study with a time series analysis of children and youth in South Korea with KD, respiratory infections caused by rhinovirus and respiratory syncytial virus and varicella outbreaks were significantly correlated with KD at 1 to 3 months before KD outbreaks.
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Affiliation(s)
- Ji-Man Kang
- Department of Pediatrics, Severance Children’s Hospital, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, South Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinwook Hong
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Dong Wook Kim
- Department of Information and Statistics, Research Institute of Natural Science, Gyeongsang National University, South Korea
| | - Min Young Kim
- Department of Pediatrics, Severance Children’s Hospital, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children’s Hospital, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
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22
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Grasa CD, Fernández-Cooke E, Sánchez-Manubens J, Carazo-Gallego B, Aracil-Santos J, Anton J, Lirola MJ, Mercader B, Villalobos E, Bustillo M, Giralt G, Rocandio B, Escribano LM, Domínguez-Rodríguez S, Calvo C. Kawasaki disease in children younger than 6 months of age: characteristics of a Spanish cohort. Eur J Pediatr 2022; 181:589-598. [PMID: 34459958 DOI: 10.1007/s00431-021-04215-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/20/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes.Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients.
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Affiliation(s)
- Carlos D Grasa
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain.
| | - Elisa Fernández-Cooke
- Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain.,imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain.,RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain
| | | | - Begoña Carazo-Gallego
- Department of Pediatric Infectious Diseases, Hospital Regional Universitario, Malaga, Spain
| | - Javier Aracil-Santos
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - María José Lirola
- Department of Pediatric Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Virgen de La Arrixaca, Murcia, Spain
| | | | - Matilde Bustillo
- Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain
| | - Gemma Giralt
- Department of Pediatric Cardiology, Hospital Vall D'Hebron, Barcelona, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario Donostia, San Sebastián, Spain
| | - Lucía M Escribano
- Department of Pediatric Cardiology, Hospital General de Albacete, Albacete, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain.,imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain.,RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain.,IdiPaz, Institute for Health Research From La Paz Hospital, Madrid, Spain
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23
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Castellar-López J, Villamizar-Villamizar W, Amaranto-Pallares A, Rosales-Rada W, De Los Angeles Vélez Verbel M, Chang A, Jiménez FT, Mendoza-Torres E. Recent Insights into COVID-19 in Children and Clinical Recommendations. Curr Pediatr Rev 2022; 18:121-137. [PMID: 34872479 DOI: 10.2174/1573396317666211206124347] [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: 04/02/2021] [Revised: 06/30/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
Pediatric coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) have been recognized in multiple countries globally. In this review, we provide recent insights into SARS-CoV-2 infection in children from epidemiological, clinical, and laboratory perspectives, including reports on the disease course and therapy. We highlight key features of SARS-CoV-2 infection in children, the relationship between MIS-C and Kawasaki disease, and summarize treatment guidelines for COVID-19 in children from institutional protocols from Colombia, case reports, recommendations based on expert consensus, and official statements from organizations such as the World Health Organization (WHO), United States Center for Disease Control (CDC), Colombian Association of Infectious Diseases, and the Colombian Society of Pediatrics. Finally, we discuss gaps in research with suggestions for future research on the pathogenesis underlying pediatric COVID-19.
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Affiliation(s)
- Jairo Castellar-López
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Barranquilla, Colombia
| | | | - Aldo Amaranto-Pallares
- Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
| | - Wendy Rosales-Rada
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Barranquilla, Colombia.,Department of Medicine, Grupo de Investigación en Biotecnología. Division of Health Sciences. Universidad del Norte, Colombia
| | | | - Aileen Chang
- Department of Medicine, George Washington University, Washington D.C., USA
| | - Franklin Torres Jiménez
- Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
| | - Evelyn Mendoza-Torres
- Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
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24
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Systemic inflammatory syndrome in COVID-19-SISCoV study: systematic review and meta-analysis. Pediatr Res 2022; 91:1334-1349. [PMID: 34006982 PMCID: PMC8128982 DOI: 10.1038/s41390-021-01545-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/27/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There has been a recent upsurge in the cases of Multisystem inflammatory syndrome in children (MIS-C) associated with Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis on the demographic profile, clinical characteristics, complications, management, and prognosis of this emerging novel entity. METHODS Using a predefined search strategy incorporating MeSH terms and keywords, all known literature databases were searched up till 10th July 2020. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD4202019757). RESULTS Of the 862 identified publications, 18 studies comprising 833 patients were included for meta-analysis. The socio-demographic profile showed male predilection (p = 0.0085) with no significant racial predisposition. A higher incidence of gastrointestinal symptoms (603/715, 84.3%), myocarditis (191/309, 61.8%), left ventricular dysfunction (190/422, 45.0%), pericardial (135/436, 31.0%) and neurological symptoms (138/602, 22.9%) was reported. Serological evidence of SARS-CoV-2 had higher sensitivity compared to rtPCR (291/800, 36.4% vs 495/752, 65.8%; p < 0.001). Coronary artery anomaly (CAA) was reported in 117/681 in 9 publications (17.2%). A total of 13 (1.6%) fatalities were reported. CONCLUSION Clinicians need to be vigilant in identifying the constellation of these symptoms in children with clinical or epidemiologic SARS-CoV-2 infection. Early diagnosis and treatment lead to a favorable outcome. IMPACT Key message This review analyses the demographic profile, clinical spectrum, management strategies, prognosis, and pathophysiology of MIS-C among children with SARS-CoV-2 infection. The stark differences of MIS-C from Kawasaki disease with respect to demographics and clinical spectrum is addressed. Over-reliance on rtPCR for diagnosis can miss the diagnosis of MIS-C. New addition to existing literature The first systematic review and meta-analysis of published literature on MIS-C associated with COVID-19. IMPACT The article will serve to spread awareness among the clinicians regarding this emerging novel entity, so that diagnosis can be made early and management can be initiated promptly.
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25
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Ohnishi T, Sato S, Noda A, Tanaka M, Suganuma E. A case of concurrent rhinovirus infection and Kawasaki disease complicated with acute encephalopathy. Pediatr Int 2022; 64:e15167. [PMID: 35791037 DOI: 10.1111/ped.15167] [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: 12/02/2021] [Revised: 01/08/2022] [Accepted: 02/03/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Takuma Ohnishi
- Division of Infectious Diseases, Immunology and Allergy, Saitama Children's Medical Center, Saitama, Japan
| | - Satoshi Sato
- Division of Infectious Diseases, Immunology and Allergy, Saitama Children's Medical Center, Saitama, Japan
| | - Anzu Noda
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Manabu Tanaka
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Eisuke Suganuma
- Division of Infectious Diseases, Immunology and Allergy, Saitama Children's Medical Center, Saitama, Japan
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26
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Rajebhosale P, Mohamed M, Swilem M, Abdelmogheth A, Nabawi M, Farahat AA, Alsabbagh W, Lanqawi N, Addas H. Clinical profile and immediate outcome of the multisystem inflammatory syndrome in children: Retrospective observational single center study from the United Arab Emirates. JOURNAL OF PEDIATRIC CRITICAL CARE 2022. [DOI: 10.4103/jpcc.jpcc_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Salih AF, Hamasalih K, Rahman HS, Mohammed GA. Pediatric COVID-19 infection in Sulaimaniyah Governorate, Iraq. Am J Otolaryngol 2022; 43:103199. [PMID: 34560597 PMCID: PMC8413489 DOI: 10.1016/j.amjoto.2021.103199] [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] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2. OBJECTIVE To study the demographic and clinical presentations of COVID-19 with their types including MIS-C and Kawasaki among children who were admitted to Doctor Jamal Ahmad Rashid Pediatric Teaching Hospital (DJARPTH) at Sulaimaniyah city, Iraq. PATIENTS AND METHODS A prospective cohort study was conducted from June to December 2020 in which 50 cases suspected of COVID-19 were enrolled in the study that was admitted at the first visit to the emergency department of DJARPTH and their age ranged between 3 months to 14 years. Then, the collected data were divided into 3 groups: COVID-19, Kawasaki disease (KD), and MIS-C. RESULTS The fever was the most common presented symptom in all cases with COVID-19 regardless of the severity. COVID-19 may be presented as KD as well as MIS-C. There is an increase in the number of Kawasaki cases since 2019 by 6.7 fold due to the increased number of COVID-19 cases in children. Death was more related to MIS-C and primary COVID-19 diseases. Most COVID-19 cases presented with pericardial effusion; although coronary involvement and LV dysfunction mostly seen with MIS-C cases. CONCLUSION COVID-19 is not uncommon in pediatric patients and it presents as either primary, MIS-C, and KD. Most of the deaths and ICU outcomes were related to MIS-C presentations.
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28
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Gracia-Ramos AE, Martin-Nares E, Hernández-Molina G. New Onset of Autoimmune Diseases Following COVID-19 Diagnosis. Cells 2021; 10:3592. [PMID: 34944099 PMCID: PMC8700122 DOI: 10.3390/cells10123592] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
There is growing evidence that coronavirus disease 2019 (COVID-19) can lead to a dysregulation of the immune system with the development of autoimmune phenomena. The consequence of this immune dysregulation ranges from the production of autoantibodies to the onset of rheumatic autoimmune disease. In this context, we conducted a systematic review to analyze the current data regarding the new-onset systemic and rheumatic autoimmune diseases in COVID-19 patients. A literature search in PubMed and Scopus databases from December 2019 to September 2021 identified 99 patients that fulfilled the specific diagnostic/classification criteria and/or nomenclature for each rheumatic autoimmune disease. The main diseases reported were vasculitis and arthritis. Idiopathic inflammatory myopathies, systemic lupus erythematosus, and sarcoidosis were also reported in a limited number of patients, as well as isolated cases of systemic sclerosis and adult-onset Still's disease. These findings highlight the potential spectrum of systemic and rheumatic autoimmune diseases that could be precipitated by SARS-CoV-2 infection. Complementary studies are needed to discern the link between the SARS-CoV-2 and new onset-rheumatic diseases so that this knowledge can be used in early diagnosis and the most suitable management.
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Affiliation(s)
- Abraham Edgar Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Eduardo Martin-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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29
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Patra PK, Das RR, Banday AZ, Singh M, Goyal K, Jindal AK, Singh S. Non-SARS, non-MERS human coronavirus infections and risk of Kawasaki disease: a meta-analysis. Future Virol 2021. [PMID: 34858515 PMCID: PMC8629369 DOI: 10.2217/fvl-2021-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022]
Abstract
Aim: To study the association between non-SARS, non-MERS human coronavirus (HCoV) infections and Kawasaki disease (KD). Methods: Meta-analysis of observational studies published until 1 May 2021. Results: Out of 571 papers retrieved through database search, 10 provided data of 17,732 children. Age ranged from 2 months-14.9 years with 66% being male and 71% being complete KD. Compared with controls, there was an increased risk of developing KD in those detected to have HCoV infection (OR: 2.3 [95% CI: 1.06-4.99]; p = 0.03). The GRADE evidence for all outcomes was of 'low-certainty'. Conclusion: A 'low certainty' of evidence suggests an increased risk of KD in children infected with HCoV. We need multi-center, prospective studies to support or refute this finding. PROSPERO protocol registration: CRD42021251582.
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Affiliation(s)
- Pratap Kumar Patra
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, 801507, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Aaqib Zaffar Banday
- Department of Pediatrics, Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Mini Singh
- Department of Virology, PGIMER, Chandigarh, 160012, India
| | - Kapil Goyal
- Department of Virology, PGIMER, Chandigarh, 160012, India
| | - Ankur Kumar Jindal
- Department of Pediatrics, Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
| | - Surjit Singh
- Department of Pediatrics, Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
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30
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Katsumata N, Harama D, Toda T, Sunaga Y, Yoshizawa M, Kono Y, Hasebe Y, Koizumi K, Hoshiai M, Saito T, Hokibara S, Kobayashi K, Goto M, Sano T, Tsuruta M, Nakamura M, Mizorogi S, Ohta M, Mochizuki M, Sato H, Yokomichi H, Inukai T. Prevention Measures for COVID-19 and Changes in Kawasaki Disease Incidence. J Epidemiol 2021; 31:573-580. [PMID: 34483151 PMCID: PMC8502831 DOI: 10.2188/jea.je20210132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Kawasaki disease is suspected to be triggered by previous infection. The prevention measures for coronavirus disease 2019 (COVID-19) have reportedly reduced transmission of certain infectious diseases. Under these circumstances, the prevention measures for COVID-19 may reduce the incidence of Kawasaki disease. METHODS We conducted a retrospective study using registration datasets of patients with Kawasaki disease who were diagnosed in all 11 inpatient pediatric facilities in Yamanashi Prefecture. The eligible cases were 595 cases that were diagnosed before the COVID-19 pandemic (from January 2015 through February 2020) and 38 cases that were diagnosed during the COVID-19 pandemic (from March through November 2020). Incidence of several infectious disease were evaluated using data from the Infectious Disease Weekly Report conducted by the National Institute of Infectious Diseases. RESULTS Epidemics of various infectious diseases generally remained at low levels during the first 9 months (March through November 2020) of the COVID-19 pandemic. Moreover, the incidence of COVID-19 was 50-80 times lower than the incidence in European countries and the United States. The total number of 38 cases with Kawasaki disease for the 9 months during the COVID-19 pandemic was 46.3% (-3.5 standard deviations [SDs] of the average [82.0; SD, 12.7 cases] for the corresponding 9 months of the previous 5 years. None of the 38 cases was determined to be triggered by COVID-19 based on their medical histories and negative results of severe acute respiratory syndrome coronavirus 2 testing at admission. CONCLUSION These observations provide a new epidemiological evidence for the notion that Kawasaki disease is triggered by major infectious diseases in children.
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Affiliation(s)
- Nobuyuki Katsumata
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
- Departments of Neonatology, Yamanashi Central Prefectural Hospital, Yamanashi, Japan
| | - Daisuke Harama
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
- Department of Pediatrics, Yamanashi Central Prefectural Hospital, Yamanashi, Japan
| | - Takako Toda
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Yuto Sunaga
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | | | - Yosuke Kono
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Yohei Hasebe
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Keiichi Koizumi
- Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan
| | - Minako Hoshiai
- Department of Pediatrics, Yamanashi Central Prefectural Hospital, Yamanashi, Japan
| | - Tomohiro Saito
- Department of Pediatrics, Yamanashi Central Prefectural Hospital, Yamanashi, Japan
| | - Sho Hokibara
- Department of Pediatrics, Kofu Municipal Hospital, Kofu, Yamanashi, Japan
| | - Koji Kobayashi
- Department of Pediatrics, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Miwa Goto
- Department of Pediatrics, National Hospital Organization Kofu National Hospital, Yamanashi, Japan
| | - Tomoaki Sano
- Department of Pediatrics, Yamanashi Red Cross Hospital, Yamanashi, Japan
| | - Makoto Tsuruta
- Department of Pediatrics, Kofu-kyoritsu Hospital, Yamanashi, Japan
| | - Makoto Nakamura
- Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan
| | - Sonoko Mizorogi
- Department of Pediatrics, Nirasaki City Hospital, Yamanashi, Japan
| | - Masanori Ohta
- Department of Pediatrics, Tsuru Municipal General Hospital, Yamanashi, Japan
| | - Mie Mochizuki
- Department of Pediatrics, Kyonan Medical Center Fujikawa Hospital, Yamanashi, Japan
| | - Hiroki Sato
- Department of Pediatrics, Suwa Central Hospital, Nagano, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
| | - Takeshi Inukai
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
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31
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Naranjo Arango YA, Farfán Cortés AYAA, García Henao JP, Arango Slingsby C, Saldarriaga Rivera LM. Síndrome inflamatorio multisistémico en niños con COVID-19: una visión desde la reumatología. REVISTA COLOMBIANA DE REUMATOLOGÍA 2021. [PMCID: PMC7568207 DOI: 10.1016/j.rcreu.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La enfermedad por coronavirus 2019 (COVID-19), producida por el SARS-CoV-2, ha tomado una gran importancia en los últimos meses y se encuentra bajo constante investigación por distintas áreas de la medicina, incluida la reumatología, en la búsqueda de la mejor evidencia científica. En el caso de la población pediátrica cobra especial importancia puesto que en un principio se pensaba que el impacto de la pandemia en esta población sería menor, debido a la baja presencia de casos severos, pero la evidencia actual reporta la existencia de cuadros clínicos en niños con diagnóstico de COVID-19 que se caracterizan por un estado inflamatorio alterado consistente en una tormenta de citocinas proinflamatorias que produce manifestaciones similares a las presentadas en enfermedades autoinmunes como la enfermedad de Kawasaki. Se le ha denominado síndrome inflamatorio multisistémico en niños asociado temporalmente con SARS-CoV-2, el cual en muchos casos precisa internación en unidades de cuidados intensivos pediátricos y el manejo multidisciplinario por diversas especialidades.
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32
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de Cevins C, Luka M, Smith N, Meynier S, Magérus A, Carbone F, García-Paredes V, Barnabei L, Batignes M, Boullé A, Stolzenberg MC, Pérot BP, Charbit B, Fali T, Pirabakaran V, Sorin B, Riller Q, Abdessalem G, Beretta M, Grzelak L, Goncalves P, Di Santo JP, Mouquet H, Schwartz O, Zarhrate M, Parisot M, Bole-Feysot C, Masson C, Cagnard N, Corneau A, Brunaud C, Zhang SY, Casanova JL, Bader-Meunier B, Haroche J, Melki I, Lorrot M, Oualha M, Moulin F, Bonnet D, Belhadjer Z, Leruez M, Allali S, Gras-Leguen C, de Pontual L, Fischer A, Duffy D, Rieux-Laucat F, Toubiana J, Ménager MM. A monocyte/dendritic cell molecular signature of SARS-CoV-2-related multisystem inflammatory syndrome in children with severe myocarditis. MED 2021; 2:1072-1092.e7. [PMID: 34414385 PMCID: PMC8363470 DOI: 10.1016/j.medj.2021.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is generally milder than in adults, but a proportion of cases result in hyperinflammatory conditions often including myocarditis. Methods To better understand these cases, we applied a multiparametric approach to the study of blood cells of 56 children hospitalized with suspicion of SARS-CoV-2 infection. Plasma cytokine and chemokine levels and blood cellular composition were measured, alongside gene expression at the bulk and single-cell levels. Findings The most severe forms of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 that resulted in myocarditis were characterized by elevated levels of pro-angiogenesis cytokines and several chemokines. Single-cell transcriptomics analyses identified a unique monocyte/dendritic cell gene signature that correlated with the occurrence of severe myocarditis characterized by sustained nuclear factor κB (NF-κB) activity and tumor necrosis factor alpha (TNF-α) signaling and associated with decreased gene expression of NF-κB inhibitors. We also found a weak response to type I and type II interferons, hyperinflammation, and response to oxidative stress related to increased HIF-1α and Vascular endothelial growth factor (VEGF) signaling. Conclusions These results provide potential for a better understanding of disease pathophysiology. Funding Agence National de la Recherche (Institut Hospitalo-Universitaire Imagine, grant ANR-10-IAHU-01; Recherche Hospitalo-Universitaire, grant ANR-18-RHUS-0010; Laboratoire d’Excellence ‘‘Milieu Intérieur,” grant ANR-10-LABX-69-01; ANR-flash Covid19 “AIROCovid” and “CoVarImm”), Institut National de la Santé et de la Recherche Médicale (INSERM), and the “URGENCE COVID-19” fundraising campaign of Institut Pasteur. Children with SARS-CoV-2 infection were initially thought to have only mild COVID-19 symptoms. However, several weeks into the first wave of SARS-CoV-2 infections, there was a surge of a postacute pathology called multisystem inflammatory syndrome in children (MIS-C). The authors recruited a cohort of children with suspicion of SARS-CoV-2 infection and uncovered hyperinflammation, hypoxic conditions, exacerbation of TNF-α signaling via NF-κB, and absence of responses to type I and type II IFN secretion in the most severe forms of MIS-C with severe myocarditis. This work led the authors to identify in monocytes and validate in peripheral blood mononuclear cells a molecular signature of 25 genes that allows discrimination of the most severe forms of MIS-C with myocarditis.
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Affiliation(s)
- Camille de Cevins
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
- Molecular Biology and Genomics, Translational Sciences, Sanofi R&D, Chilly-Mazarin, France
| | - Marine Luka
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
| | - Nikaïa Smith
- Translational Immunology Lab, Department of Immunology, Institut Pasteur, 75015 Paris, France
| | - Sonia Meynier
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Aude Magérus
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Francesco Carbone
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
| | - Víctor García-Paredes
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
| | - Laura Barnabei
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Maxime Batignes
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Alexandre Boullé
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Marie-Claude Stolzenberg
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Brieuc P Pérot
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Bruno Charbit
- Cytometry and Biomarkers UTechS, CRT, Institut Pasteur, 75015, Paris, France
| | - Tinhinane Fali
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Vithura Pirabakaran
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Boris Sorin
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Quentin Riller
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Ghaith Abdessalem
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Maxime Beretta
- Humoral Immunology Laboratory, Department of Immunology, Institut Pasteur, 75015, Paris, France
- INSERM U1222, Institut Pasteur, 75015, Paris, France
| | - Ludivine Grzelak
- Virus and Immunity Unit, Department of Virology, Institut Pasteur, 75015, Paris, France
| | - Pedro Goncalves
- INSERM U1223, Institut Pasteur, 75015, Paris, France
- Innate Immunity Unit, Department of Immunology, Institut Pasteur, 75015, Paris, France
| | - James P Di Santo
- INSERM U1223, Institut Pasteur, 75015, Paris, France
- Innate Immunity Unit, Department of Immunology, Institut Pasteur, 75015, Paris, France
| | - Hugo Mouquet
- Humoral Immunology Laboratory, Department of Immunology, Institut Pasteur, 75015, Paris, France
- INSERM U1222, Institut Pasteur, 75015, Paris, France
| | - Olivier Schwartz
- Virus and Immunity Unit, Department of Virology, Institut Pasteur, 75015, Paris, France
| | - Mohammed Zarhrate
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Mélanie Parisot
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Christine Bole-Feysot
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Cécile Masson
- Bioinformatics Platform, Structure Fédérative de Recherche Necker, INSERM UMR1163, Université de Paris, Imagine Institute, Paris, France
| | - Nicolas Cagnard
- Bioinformatics Platform, Structure Fédérative de Recherche Necker, INSERM UMR1163, Université de Paris, Imagine Institute, Paris, France
| | - Aurélien Corneau
- Sorbonne Université, UMS037, PASS, Plateforme de Cytométrie de la Pitié-Salpêtrière CyPS, 75013 Paris, France
| | - Camille Brunaud
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Shen-Ying Zhang
- Université de Paris, Imagine Institute, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Jean-Laurent Casanova
- Université de Paris, Imagine Institute, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Department of Paediatric Immuno-Haematology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Immuno-Haematology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Julien Haroche
- Department of Immunology and Infectious Disease (CIMI-Paris), Pitié-Salpêtrière University Hospital, Sorbonne Université, AP-HP, 75013 Paris, France
| | - Isabelle Melki
- Department of Paediatric Immuno-Haematology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), 75015 Paris, France
- Department of Pediatrics, Robert-Debré University Hospital, AP-HP, Université de Paris, Paris, France
| | - Mathie Lorrot
- Department of Pediatrics, Armand-Trousseau University Hospital, AP-HP, 75012 Paris, France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | - Florence Moulin
- Pediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | | | | | - Marianne Leruez
- Virology Laboratory, Necker-Enfants Malades University Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | - Slimane Allali
- Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 75015 Paris, France
| | - Christèle Gras-Leguen
- Pediatric Department, Nantes University Hospital, CIC 1413, INSERM, 44000 Nantes, France
| | - Loïc de Pontual
- Department of Pediatrics, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Bondy, France
| | - Alain Fischer
- Department of Paediatric Immuno-Haematology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), 75015 Paris, France
- Université de Paris, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
- Collège de France, Paris, France
| | - Darragh Duffy
- Translational Immunology Lab, Department of Immunology, Institut Pasteur, 75015 Paris, France
- Cytometry and Biomarkers UTechS, CRT, Institut Pasteur, 75015, Paris, France
| | - Fredéric Rieux-Laucat
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Julie Toubiana
- Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université de Paris, 75015 Paris, France
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Mickaël M Ménager
- Université de Paris, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
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Fölster-Holst R. Infectious exanthemas in childhood. J Dtsch Dermatol Ges 2021; 18:1128-1155. [PMID: 33112060 DOI: 10.1111/ddg.14301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
Most childhood exanthemas are harmless. However, recognizing serious diseases with life-threatening complications at an early stage is important for the timely initiation of adequate therapy. This requires knowledge of the specific patterns of the exanthema, obtained from the medical history and the clinic, including the patient's general condition and physical examination. In unclear cases, additional diagnostic measures are undertaken, such as blood tests and smears (cutaneous, mucocutaneous). Viruses are the most common cause of childhood exanthemas. New variants of infectious agents, improved diagnostics and stays in tropical and subtropical countries have expanded the spectrum of infectious exanthemas.
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Affiliation(s)
- Regina Fölster-Holst
- Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
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Lim JH, Kim YK, Min SH, Kim SW, Lee YH, Lee JM. Seasonal Trends of Viral Prevalence and Incidence of Kawasaki Disease: A Korea Public Health Data Analysis. J Clin Med 2021; 10:jcm10153301. [PMID: 34362085 PMCID: PMC8347058 DOI: 10.3390/jcm10153301] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
Kawasaki disease (KD) is a systemic vasculitis that occurs mainly in children under 5 years of age and is often accompanied by coronary artery lesions. The cause of the disease remains undetermined, but it is estimated to result from viral or bacterial infections. Certain studies have shown infection as a leading cause of KD. The purpose of this study was to investigate the relationship between KD incidence and viral infections in different pediatric age groups, using the Health Insurance Review and Assessment (HIRA) Open Access Big Data Platform, to confirm seasonal trends by analyzing monthly patterns. We investigated the HIRA data of KD patients (M30.3) who were treated with intravenous immunoglobulin from 2015 to 2018. Weekly virus positive detection rate data (PDR) for this period was obtained from the Korea Disease Control and Prevention Agency for human adenovirus (HAdV), human parainfluenza virus (HPIV), human respiratory syncytial virus (HRSV), influenza virus (IFV), human coronavirus (HCoV), human rhinovirus (HRV), human bocavirus (HBoV), human metapneumovirus (HMPV), rotavirus, norovirus, and astrovirus. We then analyzed the weekly/monthly virus PDR and its association with KD incidence, including monthly incidence patterns, and seasonal trends. Seasonal trend analysis of the virus PDR was performed using the time series analysis method through ARIMA (Autoregressive Integrated Moving Average). Correlations between KD incidence and PDR at 1- and 2-month intervals were analyzed using the Granger test. A total of 16,740 patients were diagnosed with KD during the study period, mainly young children, with a male-to-female ratio of 1.35. Specifically, 15,635 (93%) patients were under 5 years of age, with an incidence rate of 172.4/100,000 person-years. Annually, the cumulative number of cases per month was the highest in January, with an average of 469 cases, and was the lowest in September, with an average of 291 cases, although most were diagnosed with KD in winter (29.3%). Granger tests showed that PDR for HRSV, rotavirus, and norovirus were related with KD incidence by 1 month, while PDR for HRSV, HRV, rotavirus, and norovirus by 2 months. This study found that detection rates of respiratory and enteric viruses preceded KD by 1–2 months. Further research is needed to confirm the association between these viruses and KD.
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Affiliation(s)
- Jae Hee Lim
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.H.L.); (Y.K.K.); (S.H.M.)
| | - Yu Kyeong Kim
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.H.L.); (Y.K.K.); (S.H.M.)
| | - So Hyeon Min
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.H.L.); (Y.K.K.); (S.H.M.)
| | - Sang Won Kim
- Medical Research Center, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Young Hwan Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Korea
- Correspondence: (Y.H.L.); (J.M.L.); Tel.: +82-53-640-6999 (Y.H.L.); +82-53-620-3536 (J.M.L.)
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Korea
- Correspondence: (Y.H.L.); (J.M.L.); Tel.: +82-53-640-6999 (Y.H.L.); +82-53-620-3536 (J.M.L.)
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Abstract
Introduction COVID-19 has caused unprecedented hardships in the 21st century with more than 150 million infections. Various immunological phenomena have been described during the course of the infection, and this infection has also triggered autoimmunity. Rheumatological illnesses have been described following resolution of the acute infection; hence we sought to conduct a review of the rheumatological complications of COVID-19. Methods We conducted a literature search for articles relating to sequelae of COVID-19 from Jan 2020 to 30th April 2021. Results We found a number of reports of inflammatory arthritis after SARS-CoV-2 infection. SLE and renal disease have been described, and vasculitis also appears to be a common complication. Rhabdomyolysis and myositis has also been reported in a number of patients. We also found some evidence of large vessel vasculitis in ‘long COVID’ patients. Conclusions This review highlights a number of important complications such as inflammatory arthritis, lupus-like disease, myostis and vasculitis following SARS-CoV-2 infection.
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Banday AZ, Arul A, Vignesh P, Singh MP, Goyal K, Singh S. Kawasaki disease and influenza-new lessons from old associations. Clin Rheumatol 2021; 40:2991-2999. [PMID: 33387094 PMCID: PMC7778392 DOI: 10.1007/s10067-020-05534-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022]
Abstract
Kawasaki disease (KD), an enigmatic medium vessel vasculitis, presents as an acute febrile illness predominantly affecting young children. KD appears to be a hyper-inflammatory response elicited by environmental or infectious agents (including respiratory viruses) in genetically predisposed individuals. Numerous reports from the current era of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have described the occurrence of KD/KD-like illness in close temporal proximity to SARS-CoV-2 infection or exposure. Notably, KD has been reported in association with H1N1-pdm09 virus that caused the previous pandemic a decade ago. Non-H1N1 influenza infections as well as influenza vaccination have also been reported to trigger KD. Herein, we report a case of H1N1-pdm09 influenza who developed KD. We review the published literature on influenza infection or vaccination triggering KD. This may help in a better understanding of the KD/KD-like illness associated with SARS-CoV-2. Besides, we also evaluate the safety of aspirin in influenza-triggered KD as aspirin administration in children with influenza is associated with the risk of development of Reye syndrome.
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Affiliation(s)
- Aaqib Zaffar Banday
- Allergy Immunology Unit, Advanced Pediatrics Centre (APC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Ashwini Arul
- Allergy Immunology Unit, Advanced Pediatrics Centre (APC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Pandiarajan Vignesh
- Allergy Immunology Unit, Advanced Pediatrics Centre (APC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | | | - Kapil Goyal
- Department of Virology, PGIMER, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Advanced Pediatrics Centre (APC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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Ghodsi A, Sarabi M, Malek A, Khakshour A. Current Treatment Guidelines of SARS-CoV-2 Related Multisystem Inflammatory Syndrome in Children: A Literature Review and Expert Opinion. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1731077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractMultisystem inflammatory syndrome in children (MIS-C) is a systemic disorder that seems to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since April 2020, there have been multiple reports about children with this new condition worldwide, including Europe, Asia, Latin America, and North America. The symptoms of this syndrome mimic the clinical manifestations of Kawasaki disease; therefore, the treatment of Kawasaki disease, as well as supportive care, was the management of choice in children with MIS-C in the early days of recognizing it. It is important to precisely ascertain the risk of COVID-19 infection and its severity in children and to acknowledge the management of this syndrome, with reliable data from cohorts, trials, and experts' opinions. In the current review, we summarize the current management guidelines for MIS-C and present our own protocol to answer some clinical questions regarding MIS-C management during the COVID-19 pandemic.
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Affiliation(s)
- Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Sarabi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Malek
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Khakshour
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Yang CA, Huang YL, Chiang BL. Innate immune response analysis in COVID-19 and kawasaki disease reveals MIS-C predictors. J Formos Med Assoc 2021; 121:623-632. [PMID: 34193364 PMCID: PMC8214167 DOI: 10.1016/j.jfma.2021.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/09/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/PURPOSE The association between dysregulated innate immune responses seen in Kawasaki disease (KD) with predisposition to Kawasaki-like multisystem inflammatory syndrome in children (MIS-C) remains unclear. We aimed to compare the innate immunity transcriptome signature between COVID-19 and KD, and to analyze the interactions of these molecules with genes known to predispose to KD. METHODS Transcriptome datasets of COVID-19 and KD cohorts (E-MTAB-9357, GSE-63881, GSE-68004) were downloaded from ArrayExpress for innate immune response analyses. Network analysis was used to determine enriched pathways of interactions. RESULTS Upregulations of IRAK4, IFI16, STING, STAT3, PYCARD, CASP1, IFNAR1 and CD14 genes were observed in blood cells of acute SARS-CoV-2 infections with moderate severity. In the same patient group, increased expressions of TLR2, TLR7, IRF3, and CD36 were also noted in blood drawn a few days after COVID-19 diagnosis. Elevated blood PYCARD level was associated with severe COVID-19 in adults. Similar gene expression signature except differences in TLR8, NLRP3, STING and IRF3 levels was detected in KD samples. Network analysis on innate immune genes and genes associated with KD susceptibility identified enriched pathways of interactions. Furthermore, higher expression levels of KD susceptibility genes HLA-DOB, PELI1 and FCGR2A correlated with COVID-19 of different severities. CONCLUSION Our findings suggest that most enriched innate immune response pathways were shared between transcriptomes of KD and COVID-19 with moderate severity. Genetic polymorphisms associated with innate immune dysregulation and KD susceptibility, together with variants in STING and STAT3, might predict COVID-19 severity and potentially susceptibility to COVID-19 related MIS-C.
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Affiliation(s)
- Chin-An Yang
- College of Medicine, China Medical University, Taichung, 40402, Taiwan; Divisions of Laboratory Medicine and Pediatrics, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County, 302, Taiwan
| | - Ya-Ling Huang
- Divisions of Laboratory Medicine and Pediatrics, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County, 302, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Saad MA, Alfishawy M, Nassar M, Mohamed M, Esene IN, Elbendary A. COVID-19 and Autoimmune Diseases: A Systematic Review of Reported Cases. Curr Rheumatol Rev 2021; 17:193-204. [PMID: 33121413 DOI: 10.2174/1573397116666201029155856] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Over 4.9 million cases of Coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide pandemic began. Since the emergence of COVID-19, a number of confirmed cases reported autoimmune manifestations. Herein, we reviewed the reported COVID-19 cases with associated autoimmune manifestations. METHODS We searched PubMed database using all available keywords for COVID-19. All related studies between January 1st, 2020 to May 22nd, 2020 were reviewed. Only studies published in English language were considered. Articles were screened based on titles and abstracts. All reports of confirmed COVID-19 patients who have associated clinical evidence of autoimmune disease were selected. RESULTS Among the 10006 articles, searches yielded thirty-two relevant articles for full-text assessment. Twenty studies has met the eligibility criteria. The twenty eligible articles reported 33 cases of confirmed COVID-19 diagnosis who developed an autoimmune disease after the onset of covid-19 symptoms. Ages of patients varied from a 6 months old infant to 89 years old female (Mean=53.9 years of 28 cases); five cases had no information regarding their age. The time between symptoms of viral illness and onset of autoimmune symptoms ranged from 2 days to 33 days (Mean of the 33 cases=9.8 days). Autoimmune diseases were one case of subacute thyroiditis (3%), two cases of Kawasaki Disease (6.1%), three cases of coagulopathy and antiphospholipid syndrome (9.1%), three cases of immune thrombocytopenic purpura (9.1%), eight cases of autoimmune hemolytic anemia (24.2%), and sixteen cases of Guillain-Barré syndrome (48.5%). CONCLUSION COVID-19 has been implicated in the development of a range of autoimmune diseases, which may shed light on the association between autoimmune diseases and infections.
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Affiliation(s)
- Mariam Ahmed Saad
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Egypt
| | - Mahmoud Nassar
- Internal Medicine Department, Beni Suef University, Beni Suef, Egypt
| | - Mahmoud Mohamed
- Nephrology division, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Amira Elbendary
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Gámez-González LB, Ulloa-Gutierrez R, Murata C, Yamazaki-Nakashimada MA, Kim E, Estripeaut D, Del Águila O, Garrido-García LM, Gómez V, Faugier-Fuentes E, Miño G, Beltrán S, Cofré F, Chacón-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Tremoulet AH, Astigarraga N. Kawasaki disease presenting with hoarseness: A multinational study of the REKAMLATINA network. Pediatr Int 2021; 63:643-648. [PMID: 33099854 DOI: 10.1111/ped.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki disease (KD). The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS We used prospective data from the multinational Red de Enfermedad de Kawasaki en America Latina (REKAMLATINA) network. A total of 865 patients from 20 countries were enrolled during the 3 year study period. Data on hoarseness were available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger than those with KD without hoarseness (median age 18 vs 26 months; P = 0.002) and presented with lower hemoglobin (10.7 g/dL vs 11.3 g/dL; P = 0.040) and hematocrit levels (32% vs 33%, P = 0.048). CONCLUSIONS Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.
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Affiliation(s)
- Luisa B Gámez-González
- Servicio Inmunología y Alergia, Hospital Infantil Especialidades de Chihuahua, Chihuahua, México
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional Pediatría, Mexico City, Mexico
| | | | - Elissa Kim
- Department of Pediatrics, University of California San Diego & Rady Children's Hospital, San Diego, CA, USA
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño, Ciudad Panamá, Panamá
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins-Lima-Perú, Lince, Perú
| | | | - Virgen Gómez
- Servicio de Infectología, Centro Médico, Universidad Central del Este Hospital y Hospital Infantil "Dr Robert Reid Cabral", Santo Domingo, República Dominicana
| | | | - Greta Miño
- Servicio de Infectología, Hospital del Niño "Francisco de Ycaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología, Clínica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | | | | | | | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego & Rady Children's Hospital, San Diego, CA, USA
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Bahrami A, Vafapour M, Moazzami B, Rezaei N. Hyperinflammatory shock related to COVID-19 in a patient presenting with multisystem inflammatory syndrome in children: First case from Iran. J Paediatr Child Health 2021; 57:922-925. [PMID: 32640066 PMCID: PMC7361532 DOI: 10.1111/jpc.15048] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Ahmad Bahrami
- Division of Allergy and ImmunologyAli‐Asghar Hospital, Iran University of Medical SciencesTehranIran
| | - Maryam Vafapour
- Ali‐Asghar Hospital, Department of PediatricsIran University of Medical SciencesTehranIran
| | - Bobak Moazzami
- Research Center for ImmunodeficienciesChildren's Medical Center, Tehran University of Medical SciencesTehranIran
- Department of ImmunologySchool of Medicine, Tehran University of Medical SciencesTehranIran
| | - Nima Rezaei
- Research Center for ImmunodeficienciesChildren's Medical Center, Tehran University of Medical SciencesTehranIran
- Department of ImmunologySchool of Medicine, Tehran University of Medical SciencesTehranIran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)Universal Scientific Education and Research Network (USERN)TehranIran
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Keshavarz P, Yazdanpanah F, Azhdari S, Kavandi H, Nikeghbal P, Bazyar A, Rafiee F, Nejati SF, Sadabad FE, Rezaei N. Coronavirus disease 2019 (COVID-19): A systematic review of 133 Children that presented with Kawasaki-like multisystem inflammatory syndrome. J Med Virol 2021; 93:5458-5473. [PMID: 33969513 PMCID: PMC8242327 DOI: 10.1002/jmv.27067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/13/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
Kawasaki-like disease (KLD) and multisystem inflammatory syndrome in children (MIS-C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID-19). A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS-C associated with COVID-19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS-C, or inflammatory shock syndromes were included. A total number of 133 children in 45 studies were reviewed. A total of 74 (55.6%) cases had been admitted to pediatric intensive care units (PICUs). Also, 49 (36.8%) patients had required respiratory support, of whom 31 (23.3%) cases had required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4%) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. Similar outcomes had not been reported in other patients. Approximately two-thirds of the children with KLD associated with COVID-19 had been admitted to PICUs, around one-fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children that present with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID-19.
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Affiliation(s)
- Pedram Keshavarz
- Department of Diagnostic and Interventional Radiology, New Hospitals LTD, Tbilisi, Georgia.,School of Science and Technology, The University of Georgia, Tbilisi, Georgia
| | - Fereshteh Yazdanpanah
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz, Iran
| | - Sara Azhdari
- Department of Anatomy and Embryology, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Hadiseh Kavandi
- Department of Rheumatology, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parisa Nikeghbal
- Department of Radiology, Medical ImagingResearch Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Bazyar
- Department of Radiology, Medical ImagingResearch Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Rafiee
- Department of Radiology, Medical ImagingResearch Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Faraz Nejati
- Department of Radiology, Medical ImagingResearch Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Ebrahimian Sadabad
- Department of Radiology, Medical ImagingResearch Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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43
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Kawasaki Disease Complicated by Salmonella oranienburg Coinfection. Case Rep Pediatr 2021; 2021:5584514. [PMID: 33936828 PMCID: PMC8055415 DOI: 10.1155/2021/5584514] [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: 01/15/2021] [Revised: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
Kawasaki disease is a medium vessel vasculitis with a multisystem presentation affecting 9-20 per 100,000 children under 5 years of age in the United States. Salmonella coinfection has not been previously described. We present a 12-month-old vaccinated male with Kawasaki disease in the setting of Salmonella bacteremia. Initial intervention for the Kawasaki disease with IVIG was ineffective, prompting adjunctive therapy with anakinra, with eventual full recovery. Concurrent Kawasaki disease and bacteremia may confound diagnosis and necessitate nontraditional treatment approaches.
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44
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Yıldırım DG, Demirdağ TB, Tokgöz ST, Tapısız A, Bakkaloğlu SA, Buyan N. Viral infections associated with Kawasaki disease. Turk Arch Pediatr 2021; 56:272-274. [PMID: 34104922 DOI: 10.5152/turkarchpediatr.2021.20250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Deniz Gezgin Yıldırım
- Department of Paediatric Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Tuğba Bedir Demirdağ
- Department of Paediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Turkey
| | | | - Anıl Tapısız
- Department of Paediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Paediatric Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Necla Buyan
- Department of Paediatric Rheumatology, Gazi University School of Medicine, Ankara, Turkey
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45
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Wang L, Zhang S, Ma J, Ni J, Wang J, Li X, Mu Z, Han W, He G, Ma L, Shah J, Shah J, Jiao F. Kawasaki Disease- Management Strategies Given Symptoms Overlap to COVID-19: A Review. JNMA J Nepal Med Assoc 2021; 59:417-424. [PMID: 34508537 PMCID: PMC8369595 DOI: 10.31729/jnma.5698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/07/2021] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease is an acute, self-limiting vasculitis in children. Early treatment is necessary to prevent cardiovascular complications. The acute phase of Kawasaki disease may present with hemodynamic instability. An association between viral respiratory infections and Kawasaki disease has been reported. Studies have shown that Kawasaki and Kawasaki-like disease may be associated with and have symptoms overlapping COVID-19. Children with COVID-19 may present as Kawasaki-like disease with pediatric inflammatory multisystem syndrome, or macrophage activation syndrome. Clinicians need to be aware of the early diagnosis and management of Kawasaki disease to prevent the development of coronary artery aneurysms. The symptoms overlap of multisystem inflammatory disease seen in COVID-19 adds to the difficulties in timely diagnosis and treatment. Children with Kawasaki disease require regular follow-up plans for coronary artery aneurysms. This adds to the difficulties during the changed environment of COVID-19 for control and prevention. Missed diagnosis and early treatment of Kawasaki disease with immunoglobulin and aspirin results in the development of coronary artery aneurysm in up to 25% of cases, with grave consequences. Here, we briefly review the management of typical and atypical Kawasaki disease which has symptoms overlapping with the multisystem inflammatory disease as seen in COVID-19.
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Affiliation(s)
- Linna Wang
- Xi'an Medical University, Xi'an, 710068, China
| | - Sheng Zhang
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Ji Ma
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Jing Ni
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Juyan Wang
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Xiaohong Li
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Zhilong Mu
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Wei Han
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Gaitao He
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Lei Ma
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
| | - Jenifei Shah
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jay Shah
- Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Fuyong Jiao
- Children's Hospital of Shaanxi Provincial People's Hospital, 3 Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an Shanxi, 710001, China
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46
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Abstract
Immune-related manifestations are increasingly recognized conditions in patients with COVID-19, with around 3,000 cases reported worldwide comprising more than 70 different systemic and organ-specific disorders. Although the inflammation caused by SARS-CoV-2 infection is predominantly centred on the respiratory system, some patients can develop an abnormal inflammatory reaction involving extrapulmonary tissues. The signs and symptoms associated with this excessive immune response are very diverse and can resemble some autoimmune or inflammatory diseases, with the clinical phenotype that is seemingly influenced by epidemiological factors such as age, sex or ethnicity. The severity of the manifestations is also very varied, ranging from benign and self-limiting features to life-threatening systemic syndromes. Little is known about the pathogenesis of these manifestations, and some tend to emerge within the first 2 weeks of SARS-CoV-2 infection, whereas others tend to appear in a late post-infectious stage or even in asymptomatic patients. As the body of evidence comprises predominantly case series and uncontrolled studies, diagnostic and therapeutic decision-making is unsurprisingly often based on the scarcely reported experience and expert opinion. Additional studies are required to learn about the mechanisms involved in the development of these manifestations and apply that knowledge to achieve early diagnosis and the most suitable therapy.
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47
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Sadeghi P, Izadi A, Mojtahedi SY, Khedmat L, Jafari M, Afshin A, Yarahmadi P, Hosseinali Beigi E. A 10-year cross-sectional retrospective study on Kawasaki disease in Iranian children: incidence, clinical manifestations, complications, and treatment patterns. BMC Infect Dis 2021; 21:368. [PMID: 33874899 PMCID: PMC8056507 DOI: 10.1186/s12879-021-06046-2] [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: 01/17/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022] Open
Abstract
Background Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. Methods A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008–2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. Results Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. Conclusion As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.
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Affiliation(s)
- Payman Sadeghi
- Department of Pediatrics, Bahrami Hospital, Tehran University of Medical Sciences, Shahid Kiaee Street (Ghasem Abad), Damavand Street, Tehran, 1641744991, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Jafari
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pourya Yarahmadi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children Hospital, Tehran University of Medical Science, Tehran, Iran
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48
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The Blood Gene Expression Signature for Kawasaki Disease in Children Identified with Advanced Feature Selection Methods. BIOMED RESEARCH INTERNATIONAL 2021; 2020:6062436. [PMID: 32685506 PMCID: PMC7327570 DOI: 10.1155/2020/6062436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis, accompanied by coronary artery aneurysm, coronary artery dilatation, arrhythmia, and other serious cardiovascular diseases. So far, the etiology of KD is unclear; it is necessary to study the molecular mechanism and related factors of KD. In this study, we analyzed the expression profiles of 75 DB (identifying bacteria), 122 DV (identifying virus), 71 HC (healthy control), and 311 KD (Kawasaki disease) samples. 332 key genes related to KD and pathogen infections were identified using a combination of advanced feature selection methods: (1) Boruta, (2) Monte-Carlo Feature Selection (MCFS), and (3) Incremental Feature Selection (IFS). The number of signature genes was narrowed down step by step. Subsequently, their functions were revealed by KEGG and GO enrichment analyses. Our results provided clues of potential molecular mechanisms of KD and were helpful for KD detection and treatment.
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49
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Andina D, Belloni‐Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, Diociaiuti A, El‐Hachem M, Fertitta L, Gysel D, Hernández‐Martín A, Hubiche T, Luca C, Martos‐Cabrera L, Maruani A, Mazzotta F, Akkaya AD, Casals M, Ferrando J, Grimalt R, Grozdev I, Kinsler V, Morren MA, Munisami M, Nanda A, Novoa MP, Ott H, Pasmans S, Salavastru C, Zawar V, Torrelo A. Skin manifestations of COVID-19 in children: Part 2. Clin Exp Dermatol 2021; 46:451-461. [PMID: 33166429 PMCID: PMC9275399 DOI: 10.1111/ced.14482] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/09/2023]
Abstract
The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults, as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discussed one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions. In this part of the review, we describe other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.
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Affiliation(s)
- D. Andina
- Department of Dermatology Hospital Infantil Universitario Niño Jesús Madrid
Spain
| | - A. Belloni‐Fortina
- Pediatric Dermatology Unit Department of Medicine DIMED University of Padua
Padua Italy
| | - C. Bodemer
- Department of Dermatology Hospital Necker Enfants MaladesParis Centre
University Paris France
| | - E. Bonifazi
- Dermatologia Pediatrica Association Bari Italy
| | | | - I. Colmenero
- Department of Pathology Hospital Infantil Universitario Niño Jesús Madrid
Spain
| | - A. Diociaiuti
- Dermatology Unit Bambino Gesù Children’s HospitalIRCCS Rome
Italy
| | - M. El‐Hachem
- Dermatology Unit Bambino Gesù Children’s HospitalIRCCS Rome
Italy
| | - L. Fertitta
- Department of Dermatology Hospital Necker Enfants MaladesParis Centre
University Paris France
| | - D. Gysel
- Department of Pediatrics O. L. Vrouw Hospital Aalst Belgium
| | - A. Hernández‐Martín
- Department of Dermatology Hospital Infantil Universitario Niño Jesús Madrid
Spain
| | - T. Hubiche
- Department of Dermatology Université Côte d'Azur Nice France
| | - C. Luca
- Nicolina Medical Center Iasi Romania
| | - L. Martos‐Cabrera
- Department of Dermatology Hospital Infantil Universitario Niño Jesús Madrid
Spain
| | - A. Maruani
- Department of Dermatology Unit of Pediatric Dermatology University of
ToursSPHERE‐INSERM1246, CHRU Tours Tours France
| | - F. Mazzotta
- Dermatologia Pediatrica Association Bari Italy
| | - A. D. Akkaya
- Department of Dermatology Ulus Liv Hospital Istanbul Turkey
| | - M. Casals
- Department of Dermatology Hospital Universitari de Sabadell Barcelona
Spain
| | - J. Ferrando
- Department of Dermatology Hospital Clìnic Barcelona Spain
| | - R. Grimalt
- Faculty of Medicine and Health Sciences Universitat Internacional de
Catalunya Barcelona Spain
| | - I. Grozdev
- Department of Dermatology Children's University Hospital Queen Fabiola
Brussels Belgium
| | - V. Kinsler
- Department of Paediatric Dermatology Great Ormond Street Hospital for
Children NHS Foundation Trust London UK
| | - M. A. Morren
- Pediatric Dermatology Unit Department of Pediatrics and Dermato‐Venereology
University Hospital Lausanne and University of Lausanne Lausanne
Switzerland
| | - M. Munisami
- Department of Dermatology and Sexually Transmitted Diseases Jawaharlal
Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry
India
| | - A. Nanda
- As'ad Al‐Hamad Dermatology Center Kuwait City Kuwait
| | - M. P. Novoa
- Department of Dermatology Hospital San Jose Bogota Colombia
| | - H. Ott
- Division of Pediatric Dermatology Children’s Hospital Auf der Bult Hannover
Germany
| | - S. Pasmans
- Erasmus MC University Medical Center RotterdamSophia Children's Hospital
Rotterdam The Netherlands
| | - C. Salavastru
- Department of Paediatric Dermatology Colentina Clinical HospitalCarol
Davila University of Medicine and Pharmacy Bucharest Romania
| | - V. Zawar
- Department of Dermatology Dr Vasantrao Pawar Medical College Nashik
India
| | - A. Torrelo
- Correspondence: Dr Antonio Torrelo, Department of Dermatology, Hospital
Niño Jesús, Menendez Pelayo 65, Madrid 28034, Spain E‐mail:
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50
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Martelli Júnior H, Machado RA, Martelli DRB, Barbosa MC, Bonan PRF, Coletta RD. Potential link between SARS-CoV-2 and Kawasaki disease: importance of dentists for the diagnosis. Braz Oral Res 2021; 35:e047. [PMID: 33729297 DOI: 10.1590/1807-3107bor-2021.vol35.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 01/04/2023] Open
Abstract
Kawasaki disease (KD) is a vasculitis with predilection for coronary arteries. Due to a lack of reliable confirmatory laboratory tests, the diagnosis of KD is based on a characteristic pattern of clinical findings that appear in a typical temporal sequence. The diagnostic criteria have been periodically modified and the American Heart Association has proposed the most recent guidelines for its diagnosis. However, patients may have incomplete or atypical forms of KD and diagnosis can often be difficult. Because oropharyngeal manifestations are a common and important feature for diagnosing KD and recent studies have hypothesized a possible association between KD and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in this review we highlight the importance of dentists in the diagnosis of KD and its potential association with SARS-CoV-2.
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Affiliation(s)
- Hercílio Martelli Júnior
- Universidade de Montes Claros - Unimontes, Dental School Health Sciences Postgraduate Program, Montes Claros, MG, Brazil
| | - Renato Assis Machado
- Universidade de São Paulo - USP, School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, SP, Brazil
| | | | - Mauro Costa Barbosa
- Universidade de Montes Claros - Unimontes, Dental School, Department of Oral Diagnosis, Montes Claros, MG, Brazil
| | | | - Ricardo Della Coletta
- Universidade Estadual de Campnas - Unicamp, School of Dentistry, Department of Oral Diagnosis, Piracicaba, SP, Brazil
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