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Alolayan A, Aldamegh AS, Alkhayrat A. Use of Continuous Intravenous Anakinra Infusion in Multisystem Inflammatory Syndrome in Children. Case Rep Crit Care 2023; 2023:8530060. [PMID: 36895203 DOI: 10.1155/2023/8530060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
Coronavirus disease (COVID-19) is an emergency pandemic with a high mortality rate worldwide. One of its complications in children is developing multisystemic inflammatory syndrome related to cytokine storm. Anakinra is a recombinant human interleukin-1 (IL-1) receptor antagonist used to suppress the exaggerated inflammatory response in such conditions, and it is potentially lifesaving in a cytokine storm. We present the case of a patient with critical COVID-19 associated with multisystem inflammatory syndrome in children (MIS-C) successfully treated with anakinra intravenous (IV) infusion.
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Khani E, Shahrabi M, Rezaei H, Pourkarim F, Afsharirad H, Solduzian M. Current evidence on the use of anakinra in COVID-19. Int Immunopharmacol 2022; 111:109075. [PMID: 35905562 PMCID: PMC9296834 DOI: 10.1016/j.intimp.2022.109075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023]
Abstract
Despite the progressing knowledge in COVID-19 management, remdesivir is the only agent that got approval to inhibit viral replication. However, there are limited data about effective immunomodulatory agents to prevent cytokine release in COVID-19. Cytokine release syndrome in COVID-19 resembles secondary hemophagocytic lymphohistiocytosis, in which interleukin-1 (IL-1) plays a key role. Anakinra is the first recombinant IL-1 receptor antagonist studied for off-label use in COVID-19 treatment. This study reviews the current clinical evidence on the role of interleukin-1 in COVID-19-related cytokine storm, therapeutic effects, significant clinical concerns, and pros and cons of anakinra administration in the management of COVID-19 patients. In this review, four items are shown to be important for achieving the optimal therapeutic effects of anakinra in COVID-19 patients. These items include duration of treatment ≥ 10 days, doses ≥ 100 mg, intravenous administration, and early initiation of therapy. Also, anakinra might be more beneficial in the early stages of the disease when higher levels of cytokines are yet to be observed, which could prevent progression to severe illness and mechanical ventilation. Further studies are required to address the SARS-CoV-2 induced cytokine release syndrome and the role of anakinra in identifying ideal treatment approaches for COVID-19 patients based on their clinical status.
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Affiliation(s)
- Elnaz Khani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marzieh Shahrabi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Rezaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pourkarim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hoda Afsharirad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Solduzian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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生物制剂在儿童感染SARS-CoV-2后多系统炎症综合征的应用研究进展. Zhongguo Dang Dai Er Ke Za Zhi 2022; 24. [PMID: 35209989 DOI: 10.7499/j.issn.1008-8830.2111005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a type of hyperinflammatory symptoms similar to Kawasaki disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and is commonly observed in children aged 8-10 years. Primary therapeutic medications for MIS-C are intravenous immunoglobulins and glucocorticoids. It has been reported that biologics, such as IL-1 receptor antagonist anakinra, IL-6 receptor antagonist tocilizumab, and TNF-α receptor antagonist infliximab, can be used as an option for critically ill patients. This article elaborates on the mechanism of action of the above biologics and discusses the efficacy and safety biologics in the treatment of MIS-C after SARS-CoV-2 infection, in order to provide methods for the treatment of MIS-C with severe symptoms.
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Woolf NT. The Current Role for Biologic Medications in the Treatment of Pediatric COVID-19 and MIS-C. Pediatr Ann 2022; 51:e57-e62. [PMID: 35156889 DOI: 10.3928/19382359-20220114-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Severe cases of coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) are characterized by hyperinflammation and multiorgan dysfunction. Although the incidence and mortality of these illnesses are low in the pediatric population, they occur with enough frequency to necessitate well-defined treatment strategies with demonstrated clinical efficacy. Biologic medications include small molecules or monoclonal antibodies that target specific receptors, enzymes or other proteins that play key roles in human disease. Biologic medications that inhibit proinflammatory cytokines and signaling pathways represent an emerging and valuable tool for the treatment of both severe COVID-19 and MIS-C in pediatric patients. This article discusses current theories regarding the pathogenesis of both diseases, and it will summarize the latest evidence supporting each biologic medication used for their treatment. [Pediatr Ann. 2022;51(2):e57-e62.].
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Abstract
INTRODUÇÃO: A potencial associação da COVID-19 com fenômenos inflamatórios e autoimunes abre um novo capítulo na prática clínica. Entre várias condições inflamatórias descritas no pós-COVID-19, destacam-se a doença de Kawasaki e uma nova afecção denominada síndrome inflamatória multissistêmica.OBJETIVOS: Revisar, de forma prática e concisa, conceito e critérios diagnósticos da síndrome inflamatória multisistêmica, as sobreposições com a doença de Kawasaki, assim como a imunopatogênese e o tratamento desta nova e intrigante enfermidade.MÉTODOS: Revisão da literatura disponível na base de dados Pubmed, com ênfase em revisões sistemáticas com metaanálises.RESULTADOS: A síndrome inflamatória multisistêmica se configura como uma condição hiperinflamatória multiorgânica pós-viral. A condição é primordialmente pediátrica, e os primeiros casos foram descritos na Inglaterra em maio de 2020. Os critérios diagnósticos são ainda imprecisos, e incluem algumas manifestações doença de Kawasaki-símiles. A síndrome inflamatória multisistêmica difere da doença de Kawasaki, entretanto, por geralmente acometer crianças acima cinco anos e de raças negras ou hispânicas; em termos clínicos, se distingue pela alta frequência de gastroenteropatia, miocardiopatia e choque. O diagnóstico diferencial inclui sepse bacteriana, síndrome de ativação macrofágica e formas sistêmicas de artrite reumatoide. Uma hiperexpressão de interferons e de outras citocinas inflamatórias caracteriza patogenicamente a síndrome inflamatória mulsistêmica. A enfermidade é, via de regra, responsiva a cuidados de terapia intensiva, corticóides, imunoglobulina intravenosa e imunobiológicos.CONCLUSÕES: A síndrome inflamatória multisistêmica é uma nova e complexa afecção hiperinflamatória associada à exposição prévia ao SARS-CoV-2. Apresenta instigantes interfaces com a doença de Kawasaki. Apesar da descrição recente, a literatura já é quantitativamente robusta, e algumas pendências de imunopatogênese, critérios diagnósticos e terapêutica deverão ser esclarecidas em breve.
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Uka A, Buettcher M, Bernhard-Stirnemann S, Fougère Y, Moussaoui D, Kottanattu L, Wagner N, Zimmermann P, Ritz N. Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study. Eur J Pediatr 2022; 181:1245-1255. [PMID: 34845526 PMCID: PMC8628837 DOI: 10.1007/s00431-021-04276-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0-14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50; p-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%], p-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%], p-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%], p-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.Conclusion: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children. What is Known: • Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission. • Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children. What is New: • The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common. • Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children. • Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.
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Affiliation(s)
- Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Children’s Hospital Lucerne, Luzern, Switzerland
| | | | - Yves Fougère
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Dehlia Moussaoui
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Lisa Kottanattu
- Ente Ospedaliero Cantonale, Istituto Pediatrico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Noémie Wagner
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children’s Research Institute, Parkville, Australia
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
- University Children’s Hospital Basel UKBB, Spitalstrasse 33, CH-4031 Basel, Switzerland
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Emeksiz S, Çelikel Acar B, Kibar AE, Özkaya Parlakay A, Perk O, Bayhan Gİ, Cinel G, Özbek N, Azılı MN, Çelikel E, Akça H, Dibek Mısırlıoğlu E, Bayrakçı US, Çetin İİ, Neşe Çıtak Kurt A, Boyraz M, Hızlı Ş, Şenel E. Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19. Int J Clin Pract 2021; 75:e14471. [PMID: 34107136 PMCID: PMC8237077 DOI: 10.1111/ijcp.14471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Although the initial reports of COVID-19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow-up of patients with MIS-C. METHODS The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. CONCLUSION Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C.
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Affiliation(s)
- Serhat Emeksiz
- Department of Pediatric Intensive Care UnitAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Banu Çelikel Acar
- Department of Pediatric RheumatologyAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Ayşe Esin Kibar
- Department of Pediatric CardiologyAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious DiseasesAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Oktay Perk
- Department of Pediatric Intensive Care UnitAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Gülsüm İclal Bayhan
- Department of Pediatric Infectious DiseasesAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Güzin Cinel
- Department of PulmonologyAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Namık Özbek
- Department of Pediatric HematologyAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Müjdem Nur Azılı
- Department of Pediatric SurgeryAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Elif Çelikel
- Department of Pediatric Intensive Care UnitAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Halise Akça
- Department of Pediatric Emergency MedicineAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Emine Dibek Mısırlıoğlu
- Department of Pediatric Allergy/ImmunologyAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Umut Selda Bayrakçı
- Department of Pediatric NephrologyAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - İbrahim İlker Çetin
- Department of Pediatric CardiologyAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Ayşegül Neşe Çıtak Kurt
- Department of Pediatric NeurologyAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Mehmet Boyraz
- Department of Pediatric Endocrinology and MetabolismAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Şamil Hızlı
- Department of Pediatric Gastroenterology Hepatology and NutritionAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | - Emrah Şenel
- Department of Pediatric SurgeryAnkara City HospitalAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
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Abstract
Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.
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Affiliation(s)
- Houda Ajmi
- Department of Pediatrics, Sahloul University Hospital, 4054, Sousse, Tunisia.
| | - Wissem Besghaier
- Department of Pediatrics, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Wafa Kallala
- Department of Virology, Sahloul University Hospital, 4054, Sousse, Tunisia
| | | | - Saoussan Abroug
- Department of Pediatrics, Sahloul University Hospital, 4054, Sousse, Tunisia
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Ali FEM, Mohammedsaleh ZM, Ali MM, Ghogar OM. Impact of cytokine storm and systemic inflammation on liver impairment patients infected by SARS-CoV-2: Prospective therapeutic challenges. World J Gastroenterol 2021; 27:1531-1552. [PMID: 33958841 PMCID: PMC8058655 DOI: 10.3748/wjg.v27.i15.1531] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a devastating worldwide pandemic infection caused by a severe acute respiratory syndrome namely coronavirus 2 (SARS-CoV-2) that is associated with a high spreading and mortality rate. On the date this review was written, SARS-CoV-2 infected about 96 million people and killed about 2 million people. Several arguments disclosed the high mortality of COVID-19 due to acute respiratory distress syndrome or change in the amount of angiotensin-converting enzyme 2 (ACE2) receptor expression or cytokine storm strength production. In a similar pattern, hepatic impairment patients co-infected with SARS-CoV-2 exhibited overexpression of ACE2 receptors and cytokine storm overwhelming, which worsens the hepatic impairment and increases the mortality rate. In this review, the impact of SARS-CoV-2 on hepatic impairment conditions we overviewed. Besides, we focused on the recent studies that indicated cytokine storm as well as ACE2 as the main factors for high COVID-19 spreading and mortality while hinting at the potential therapeutic strategies.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Zuhair M Mohammedsaleh
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Mahmoud M Ali
- Pre-graduated students, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Osama M Ghogar
- Pre-graduated students, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
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Moscatelli A, Pezzato S, Buratti S, Lampugnani E, Di Mascio A, Damasio MB, Caorsi R, Gattorno M, Castagnola E. COVID-19 Pneumomediastinum: Possible Role of Transesophageal Echo in Bedside Percutaneous Bicaval Double-Lumen ECMO Cannulation in Children. A Case Report. Front Pediatr 2021; 9:740853. [PMID: 34778132 PMCID: PMC8578850 DOI: 10.3389/fped.2021.740853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
COVID-19 is generally uneventful in children. Only 8% of severe acute respiratory distress syndrome corona virus 2 pediatric patients require intensive care; of these, 1% may need extracorporeal membrane oxygenation. Preexisting medical conditions are an independent risk factor for pediatric intensive care unit admission. We describe the case of an 11-year-old girl with adenosine deaminase 2 deficiency who presented severe COVID-19 acute respiratory distress syndrome, complicated by a massive air leak syndrome. The respiratory failure, refractory to conventional support, required veno-venous extracorporeal membrane oxygenation. To prevent viral diffusion, bicaval double-lumen cannulation was performed percutaneously at the bedside under exclusive echo guidance. Because of pneumomediastinum, pneumothorax, and subcutaneous emphysema, ultrasound visualization of the heart was possible only with transesophageal echo. To our knowledge, this is the first description of a transesophageal echo guided bedside percutaneous bicaval double-lumen extracorporeal membrane oxygenation cannulation in a pediatric patient. Pitfalls of the technique are highlighted.
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Affiliation(s)
- Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Pezzato
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Lampugnani
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alberto Di Mascio
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Roberta Caorsi
- Rheumatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- Rheumatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elio Castagnola
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Kaleda MI, Nikishina IP, Fedorov ES, Nasonov EL. Coronavirus Desease 2019 (COVID-19) in Children: Lessons from Pediatric Rheumatology. Naučno-praktičeskaâ revmatologiâ 2020. [DOI: 10.47360/1995-4484-2020-469-479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The clinical presentation and outcomes of infection with the novel coronavirus (COVID-19) are characterized by exceptional variability in manifestations, which depend on many factors, one of which is the patient’s age. One of the severe life-threatening manifestations in adults is severe acute respiratory syndrome (SARS-CoV-2), in some cases accompanied by the development of multiple organ failure. During the first two to three months of the COVID-19 pandemic, the global medical community was of the opinion that this disease in children is usually mild and not fatal. However, with the accumulation of new information, it became clear that there is a growing recognition of the existence of multisystem inflammatory syndrome in children, chronologically associated with SARS-CoV-2, which can lead to serious consequences. The article presents the main epidemiological, clinical and laboratory characteristics of the syndrome, as well as discusses the issues of its pathogenesis, differential diagnosis with a number of other acute conditions associated with an dysbalance of cytokines.
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Affiliation(s)
- M. I. Kaleda
- V.A. Nasonova Research Institute of Rheumatology
| | | | | | - E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia
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12
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Consolini R, Costagliola G, Gattorno M. The Challenge of Managing Children With Periodic Fever Syndromes in the Era of COVID-19. Front Pediatr 2020; 8:620621. [PMID: 33490003 PMCID: PMC7815684 DOI: 10.3389/fped.2020.620621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rita Consolini
- Section of Clinical Immunology and Rheumatology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Costagliola
- Section of Clinical Immunology and Rheumatology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, Genoa, Italy
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Della Paolera S, Valencic E, Piscianz E, Moressa V, Tommasini A, Sagredini R, Kiren V, Comar M, Taddio A. Case Report: Use of Anakinra in Multisystem Inflammatory Syndrome During COVID-19 Pandemic. Front Pediatr 2020; 8:624248. [PMID: 33708752 PMCID: PMC7940350 DOI: 10.3389/fped.2020.624248] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
During COVID-19 outbreak, a large number of children with severe inflammatory disease has been reported. This condition, named Pediatric Multi-inflammatory Syndrome temporally associated with COVID-19 (PIMS-TS) or Multisystem Inflammatory Syndrome associated with Coronavirus Disease 2019 (MIS-C), shares some clinical features with Kawasaki disease and is frequently complicated by myocarditis or shock. It has been suggested that MIS-C belongs to the group of cytokine storm syndromes triggered by SARS-CoV-2 infection. So far, intravenous immunoglobulin (IVIG) and systemic glucocorticoids are the most common therapeutic approaches reported in this group of patients. However, the use of anakinra in patients with severe forms of COVID-19 is showing promising results. Here we reported two patients with multisystem inflammatory syndrome complicated with shock. Both the patients presented a poor response to IVIG and systemic glucocorticoids and received anakinra. Treatment with IL-1 receptor antagonist showed a rapid improvement of clinical conditions and biochemical analysis in both patients and demonstrated a good safety profile. Thus, we look forward for future controlled clinical trials with the aim to demonstrate the effectiveness of anakinra in patients with MIS-C and established precise criteria for its use.
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Affiliation(s)
- Sara Della Paolera
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Erica Valencic
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elisa Piscianz
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Valentina Moressa
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alberto Tommasini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Raffaella Sagredini
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Valentina Kiren
- Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manola Comar
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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