scholarly journals Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during COVID-19 Pandemic

2020 ◽  
Vol 87 (9) ◽  
pp. 745-747 ◽  
Author(s):  
Abdul Rauf ◽  
Ajay Vijayan ◽  
Shaji Thomas John ◽  
Raghuram Krishnan ◽  
Abdul Latheef
Keyword(s):  
Kawasaki Disease ◽  
Atypical Kawasaki Disease ◽  
Inflammatory Syndrome

scholarly journals Affinché non MIS-Cappi il caso: la sindrome infiammatoria multisistemica SARS-CoV-2-correlata

2021 ◽  
Vol 24 (10) ◽  
pp. 289-297
Author(s):  
Salvatore Giordano ◽  
Ilaria Pirrone ◽  
Giulia Angela Restivo ◽  
Filippo Collura ◽  
Giovanni Francesco Saia ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Rare Condition ◽  
Good Prognosis ◽  
Left Ventricular ◽  
Case Definition ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reactive Protein ◽  
Atypical Kawasaki Disease ◽  
Inflammatory Syndrome

Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes incidence as well as clinical, laboratoristic and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

scholarly journals Multisystem inflammatory syndrome in Indian adolescents associated with SARS-CoV-2 infection: a case report

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Rahul D. Bhiwgade ◽  
M. C. Nischitha ◽  
Bhushan Shahare ◽  
Shobhna Bitey
Keyword(s):  
Kawasaki Disease ◽  
Severe Disease ◽  
Late Presentation ◽  
Case Presentation ◽  
Empiric Antibiotics ◽  
Non Invasive ◽  
Indian Adolescents ◽  
Atypical Kawasaki Disease ◽  
Polymerase Chain ◽  
Inflammatory Syndrome

Abstract Background Adolescents with coronavirus disease 2019 (COVID-19) associated multisystem inflammatory syndrome (MIS) can present with shock and myocardial injury and mimic Kawasaki disease. Case presentation We describe 4 previously well adolescents (age 13–14 years), presenting with clinical features of MIS in children (MIS-C). All patients had nearly similar clinical presentation. Hematological investigations revealed elevated inflammatory markers, anemia, thrombocytopenia, and decreased neutrophil:lymphocyte ratio. All patients were negative on real-time polymerase chain reaction against severe acute respiratory syndrome coronavirus 2, but had elevated immunoglobulin G titers. Two patients had atypical Kawasaki disease. Three patients had severe disease with hypotensive shock and required intensive care with fluids and inotropes. Two patients required non-invasive respiratory support for dyspnea and one patient had biventricular dysfunction. All received empiric antibiotics, low-molecular weight heparin, steroids, and intravenous immunoglobulin. One patient succumbed, while others recovered well. Conclusions MIS-C may be a late presentation in adolescent with COVID-19. Individualized treatment with empiric antibiotics, immunomodulation, and thromboprophylaxis can result in significantly better outcome.

scholarly journals Multisystem inflammatory syndrome with features of Atypical Kawasaki disease during COVID-19 pandemic: Report of a case from India

2020 ◽  
Author(s):  
Abdul Rauf ◽  
Ajay Vijayan ◽  
Shaji Thomas John ◽  
Raghuram A Krishnan ◽  
Abdul Latheef
Keyword(s):  
Kawasaki Disease ◽  
Elevated Serum ◽  
Febrile Illness ◽  
Left Ventricular ◽  
Number Of Children ◽  
Inflammatory Parameters ◽  
Lv Dysfunction ◽  
Atypical Kawasaki Disease ◽  
Kerala State ◽  
Inflammatory Syndrome

Abstract There is a global concern of increasing number of children presenting with inflammatory syndrome with clinical features simulating Kawasaki disease, during ongoing COVID-19 pandemic. We report a very similar case of 5-year-old boy from a COVID-19 hotspot area in Kerala state of India who presented in late April 2020 with acute febrile illness with abdominal pain and loose stools followed by shock. On examination, child had bulbar conjunctivitis and extremity edema. Initial investigations showed high inflammatory parameters, elevated serum creatinine and liver enzymes. Echocardiography showed moderate LV dysfunction and normal coronaries. Cardiac enzymes were also elevated, suggesting myocarditis. He was treated with inotropic support, respiratory support with High Flow Nasal Cannula, IV Immunoglobulins, aspirin, steroids and diuretics. RT PCR for SARS-CoV-2 was negative twice. His clinical condition improved rapidly, was afebrile from day 2, inflammatory parameters decreased, left ventricular function improved and was discharged after 6 days of hospital stay.

scholarly journals Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199661
Author(s):  
Anuja R. Shikhare ◽  
Rimsha M. Iqbal ◽  
Rabail Tariq ◽  
Daniel R. Turner ◽  
Bassam M. Gebara ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Asymptomatic Infection ◽  
Cardiac Monitoring ◽  
Delayed Presentation ◽  
Terminal Ileitis ◽  
Serologic Evidence ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.

scholarly journals Perspective of Immunopathogenesis and Immunotherapies for Kawasaki Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Lung Chang ◽  
Horng-Woei Yang ◽  
Tang-Yu Lin ◽  
Kuender D. Yang
Keyword(s):  
Kawasaki Disease ◽  
Macrophage Activation ◽  
Clinical Symptoms ◽  
Human Leukocyte ◽  
T Helper 17 ◽  
Leukocyte Antigen ◽  
Ivig Resistance ◽  
Risk Patients ◽  
Phenotypic Variations ◽  
Inflammatory Syndrome

Kawasaki Disease (KD) is an acute inflammatory illness that mostly occurs in children below 5 years of age, with intractable fever, mucocutaneous lesions, lymphadenopathy, and lesions of the coronary artery (CAL). KD is sharing clinical symptoms with systemic inflammatory syndrome in children (MIS-C) which is related to COVID-19. Certain genes are identified to be associated with KD, but the findings usually differ between countries and races. Human Leukocyte Antigen (HLA) allele types and toll-like receptor (TLR) expression are also correlated to KD. The acute hyperinflammation in KD is mediated by an imbalance between augmented T helper 17 (Th17)/Th1 responses with high levels of interleukin (IL)-6, IL-10, IL-17A, IFN-γ, and IP-10, in contrast to reduced Th2/Treg responses with lower IL-4, IL-5, FoxP3, and TGF-β expression. KD has varying phenotypic variations regarding age, gender, intravenous immunoglobulin (IVIG) resistance, macrophage activation and shock syndrome. The signs of macrophage activation syndrome (MAS) can be interpreted as hyperferritinemia and thrombocytopenia contradictory to thrombocytosis in typical KD; the signs of KD with shock syndrome (KDSS) can be interpreted as overproduction of nitric oxide (NO) and coagulopathy. For over five decades, IVIG and aspirin are the standard treatment for KD. However, some KD patients are refractory to IVIG required additional medications against inflammation. Further studies are proposed to delineate the immunopathogenesis of IVIG-resistance and KDSS, to identify high risk patients with genetic susceptibility, and to develop an ideal treatment regimen, such as by providing idiotypic immunoglobulins to curb cytokine storms, NO overproduction, and the epigenetic induction of Treg function.

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