Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic

OBJECTIVE

We aimed to delineate the distinctive characteristics that aid in distinguishing between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with KD-like manifestations during the pandemic.

MATERIALS AND METHODS

We evaluated KD patients and MIS-C patients with KD-like symptoms admitted during the pandemic (between January 2021 and December 2022).

RESULTS

Thirty-three MIS-C patients and 15 KD patients were included. Kawasaki disease patients were younger than MIS-C patients (3.4 vs. 7.6 years). Rash (P = .044, 100% vs. 75.7%), oral mucosal changes (P = .044, 100% vs. 75.7%), and cervical lymphadenopathy (P = .001, 93.3% vs. 42.4%) were more common in KD. Multisystem inflammatory syndrome in children: patients had more hypotension (P = .002, 45.4% vs. 0), gastrointestinal (P .001, 72.7% vs. 13.3%), and respiratory symptoms (P = .044, 24.2% vs. 0). Multisystem inflammatory syndrome in children patients also had low lymphocyte and thrombocyte counts and elevated levels of d-dimer, ferritin, and cardiac parameters, unlike KD patients. Multisystem inflammatory syndrome in children patients exhibited a notable reduction in left ventricular systolic function in echocardiography. Another significant difference with regard to management was the anakinra treatment, which was prescribed for MIS-C patients.

CONCLUSION

Although MIS-C patients might display a clinical resemblance to KD, several features could help differentiate between MIS-C and classical KD. Specific clinical (hypotension, gastrointestinal, and respiratory symptoms) and laboratory (low lymphocyte and thrombocyte counts with higher C-reactive protein, ferritin, d-dimer, and cardiac parameters) features are characteristic of MIS-C. In addition, divergence in management strategies is evident between the 2 diseases, as biologic drugs were more prevalently employed in MIS-C patients than in classical KD patients.

Acute appendicitis during the clinical course of COVID-19 in a 13-year-old boy: Complication or coincidental?

Gastrointestinal symptoms appear to be one of the most common presentations of SARS‐CoV‐2 infection, later named COVID‐19. The symptoms such as nausea, emesis, abdominal pain, and diarrhoea may be recognised as either a finding of COVID‐19 or prominent presentation of multi‐inflammatory syndrome in children (MIS‐C). COVID‐19 may present with acute appendicitis and/or may mimic its clinical findings. Although, coexistence of acute appendicitis and COVID‐19 has been well documented, it is not clear whether appendicitis is a complication of COVID‐19 or coincidence in children. A 13‐year‐old boy who developed acute appendicitis during the clinical course of COVID‐19 is presented to discuss the possibility of causal relationship between appendicitis and COVID‐19 in children.

Characteristics and Management of Children with COVID-19 in Turkey

Aims

Limited data about disease management strategies are available for pediatric patients with coronavirus disease-2019, particularly in Turkey. This study aimed to share the data on patients aged under 18 years in our country to be beneficial for understanding the disease course in children.

Methods

A retrospective review of the medical records of pediatric patients aged under 18 years who were confirmed as coronavirus disease-2019 between March 11, and June 23, 2020, and were admitted to our hospitals was conducted.

Results

A total of 220 pediatric patients with coronavirus disease-2019 were evaluated, of which 48.2% were boys, with a median age of 10 years, and 9.5% had underlying diseases. Patients were classified according to severity, with the percentages of asymptomatic, mild, moderate, and critical/severe cases determined to be 25.5%, 45%, 26.8%, and 2.7%, respectively. Extracorporeal membrane oxygenation was required in two patients (0.9%) and mechanical ventilation in three (1.4%). Targeted therapies were used in six patients (2.7%), with hydroxychloroquine being the most commonly used agent either alone (one patient) or in combination with favipiravir (five patients). Two patients (0.9%) died, and nine (4.1%) were still hospitalized during the study period.

Conclusion

Although the disease course of coronavirus disease-2019 seems to be mild in children, critical illness is significant, and the treatment strategy primarily should consist of supportive care according to our preliminary observations.

Vancomycin-resistant Enterococcus bacteremia in a child with acute myeloid leukemia: successful treatment with daptomycin

Multiple-drug-resistant enterococcal infections canbe a serious problem in pediatric patients particularly concomitance with severe underlying diseases and lead to significant morbidity and mortality. The treatment options in children are limited compared with adults. We report a 3-year old-boy with acute myeloid leukemia (AML)-M7 and vancomycin-resistant enterococcus bacteremia successfully treated with daptomycin. Daptomycin may be an alternative therapy for VRE infections in children; more studies are needed for extended usage.

Pulmonary Mycobacterium abscessus Infection in a Patient with Triple A Syndrome

Gastroesophageal disorders such as achalasia can be associated with pulmonary disorders because of non-tuberculous mycobacteria, frequently masquerading as aspiration pneumonia. The optimal therapeutic regimen and duration of treatment for non-tuberculous mycobacteria lung disease is not well established. Here, we present an 11 year old male patient with Mycobacterium abscessus pulmonary disease and underlying triple A syndrome, who was successfully treated with 2 months of imipenem, amikacin, clarithromycin and continued for long-term antibiotic treatment.

[Atypical presentation in hydatid disease: hemoptysis]

Hydatid disease is an infectious disease caused by the larval stage of Echinococcus granulosus. It constitutes a major public health problem worldwide. This disease may present in several atypical forms, causing difficulty in diagnosis. In this article it is stressed that the diagnosis of hydatid disease should be kept in mind in patients presenting with hemoptysis, although this presentation is very rare.