scholarly journals Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features

2020 ◽  
Vol 224 ◽  
pp. 129-132 ◽  
Author(s):  
Anne H. Rowley
Keyword(s):  
Kawasaki Disease ◽  
Clinical Features ◽  
Inflammatory Syndrome

scholarly journals COVID-19 Inflammatory Syndrome With Clinical Features Resembling Kawasaki Disease

PEDIATRICS ◽  
2020 ◽  
Vol 146 (3) ◽  
pp. e20201845
Author(s):  
Robert Spencer ◽  
Ryan C. Closson ◽  
Mark Gorelik ◽  
Alexis D. Boneparth ◽  
Rebecca F. Hough ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Features ◽  
Inflammatory Syndrome

scholarly journals “Kawasaki disease shock syndrome in the COVID-19 pandemic”

2021 ◽  
pp. 1-8
Author(s):  
Luisa B. Gámez-González ◽  
Moises J. Ramírez-López ◽  
Marcela Colmenero-Rascón ◽  
Marco A. Yamazaki-Nakashimada
Keyword(s):  
Kawasaki Disease ◽  
Diagnostic Criteria ◽  
Clinical Features ◽  
Unique Form ◽  
Representative Case ◽  
Inflammatory Syndrome

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is a new entity with association with SARS-CoV2. Clinical features of Kawasaki disease (KD) were noted from the first reported cases of MIS-C. Before the COVID-19 pandemic, Kawasaki disease shock syndrome (KDSS) was considered to be a distinct and unique form of KD. We present a representative case which prove the current difficulty in clearly distinguishing MIS-C from Pre-COVID-19-KDSS and emphasize the overlap of the diagnostic criteria.

scholarly journals Similarities and Differences Between COVID-19-Related Multisystem Inflammatory Syndrome in Children and Kawasaki Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Min-Sheng Lee ◽  
Yi-Ching Liu ◽  
Ching-Chung Tsai ◽  
Jong-Hau Hsu ◽  
Jiunn-Ren Wu
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Kawasaki Disease ◽  
Clinical Features ◽  
Toxic Shock Syndrome ◽  
The United States ◽  
Toxic Shock ◽  
First Case ◽  
Similarities And Differences ◽  
Inflammatory Syndrome

In December 2019, the first case of coronavirus disease (COVID-19) was first reported in Wuhan, China. As of March 2021, there were more than 120 million confirmed cases of COVID-19 and 2.7 million deaths. The COVID-19 mortality rate in adults is around 1–5%, and only a small proportion of children requires hospitalization and intensive care. Recently, an increasing number of COVID-19 cases in children have been associated with a new multisystem inflammatory syndrome. Its clinical features and laboratory characteristics are similar to those of Kawasaki disease (KD), KD shock syndrome, and toxic shock syndrome. However, this new disorder has some distinct clinical features and laboratory characteristics. This condition, also known as multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, has been observed mostly in Europe and the United States. This emerging phenomenon has raised the question of whether this disorder is KD triggered by SARS-CoV-2 or a syndrome characterized by multisystem inflammation that mimics KD. This narrative review is to discuss the differences between MIS-C and KD with the aim of increasing pediatricians' awareness of this new condition and guide them in the process of differential diagnosis.

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.

scholarly journals Superantigenic TCR Vbeta 21.3 signature in Multisystem Inflammatory Syndrome in Children

2021 ◽  
Author(s):  
Marion Moreews ◽  
Kenz Le Gouge ◽  
Alicia Bellomo ◽  
Christophe Malcus ◽  
Rémi Pescarmona ◽  
...  
Keyword(s):  
Immune Response ◽  
T Cells ◽  
T Cell ◽  
Kawasaki Disease ◽  
T Cell Activation ◽  
Toxic Shock Syndrome ◽  
Healthy Children ◽  
Toxic Shock ◽  
Hla Dr ◽  
Inflammatory Syndrome

AbstractObjectivesMultiple Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric form of COVID-19 and occurs in previously healthy children. MIS-C combines features of Kawasaki disease and Toxic Shock Syndrome (TSS).MethodsChildren with suspected MIS-C were included within the first week of diagnosis and a large scale immunoassay was performed to determein the immunologic signature of these patients.ResultsWe characterized the immunological profile of 27 MIS-C cases in comparison with 4 KD and 4 TSS cases. Similarly to TSS, an increase of serum inflammatory cytokines (IL-6, TNF-a, CD25s) was observed in MIS-C contrasting with low expression of HLA-DR monocytes, a feature often associated with immune paralysis. Expansions of T cells expressing the Vβ21.3 T cell receptor β chain variable region were detected in both CD4 and CD8 subsets in almost 50% of patients and Vβ21.3-positive T cells expressed high level of HLA-DR highlighting their specific activation. TCR sequencing uncovered the polyclonal nature of the Vβ 21.3+ population. SARS-CoV2 antigene-specific production of interferon gamma in T cells was not increased in MIS-C T cells compared to COVID-19 patients suggesting the antigen-specific immune response in MIS-C patients is not pivotal to the manifestation.ConclusionsOur findings argue in favor of a strong activation of the immune system related to a superantigenic immune response in MIS-C with a specific polyclonal Vβ21.3 T cell expansion.Key messagesWhat is already known about this subject ?MIS-C occurs 3-5 weeks after acute SARS-CoV2 infection and overlap features of Toxic Shock syndrome and Kawasaki disease.MIS-C appears different in term of cytokine and autoantibodies generation from KD with subtle signs of T cells activationWhat does this study add?This study demonstrates that Vβ21.3+ CD4 and CD8 T cells are highly increased in about 50% of MIS-C and distinctive of the Vβ2+ expansion observed in toxic shock syndrome in This reflects a specific T cell activation and cytokine release syndrome similar to toxic shock syndromeHow mich this impact on clinical practice or future developments?Vβ21.3+ signature can be available on a short term basis by flowcytometry and represents a signature of the MIS-C.As for TSS, immunomodulating therapies may revert the superantigenic activation and resolve this life threatening pediatric condition.

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