FULMINANT MYOCARDITIS AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN, IN THE LIGHT OF CORONA VIRUS

We are in the midst of pandemic of corona virus disease (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome corona virus-2 (SARS-CoV-2). A clinical entity with hyperinflammatory syndrome, defined by World Health Organization (WHO) as multisystem inflammatory syndrome in children (MIS-C) and adolescents, temporarily related to COVID-19, is being reported in this pandemic from several countries. MIS-C has overlapping clinical features of Kawasaki disease (KD). KD has been described in association with various organisms including dengue, scrub typhus. MIS-C with concomitant infection has rarely been reported in literature till date. We report on ten sick pediatric patients presented with clinical features of MIS-C, in whom diagnosis of concomitant scrub typhus were also made. This retrospective study was conducted in the department of pediatric medicine of a medical college, in a district town of West Bengal, India. SARS-CoV-2 immunoglobulin G level was elevated in all of them and they were also positive with Scrub typhus serology. We reviewed and analysed their basic informations, clinical manifestations, epidemiological history, laboratory findings, treatment and short term outcome. Median age was 24 months (range 4 months-8 years), male: female was 1:1. All the patients survived. Concomitant tropical infection in a patient with MIS-C may play an important role in determining the prognosis of such patients. Early detection and intervention will result in better management and intact survival of them.

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Severe Multi-inflammatory syndrome in children amidst tropical fevers– an overlapping spectrum, its clinical and laboratory attributes from a tertiary care centre in India.

10.21203/rs.3.rs-570509/v1 ◽

2021 ◽

Author(s):

Arpita Chattopadhyay ◽

Karnika Saigal Kalra ◽

Diganta Saikia ◽

Varshanjali Yadav ◽

Juhi Chouksey ◽

...

Keyword(s):

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Laboratory Data ◽

Case Series ◽

World Health ◽

Fulminant Myocarditis ◽

Critically Ill Children ◽

Care Hospital ◽

Prospective Case Series ◽

Inflammatory Syndrome

Abstract Objective: We aim to describe our experience in terms of clinical and laboratory attributes in children with Multi – inflammatory syndrome in children temporally related to COVID-19 (MISC) presenting amidst other prevalent tropical infections.Design: Prospective case series.Setting: A tertiary care hospital pediatric intensive care unit (PICU).Patients: Seventeen children with severe MIS-C managed in PICU.Methods: We did a prospective case series of children (aged ≤ 12 years), admitted to PICU betweenMay 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analysed routinely collected demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors.Results: 17 critically ill children with no previous comorbidities fulfilled the WHO/CDC classification of MIS-C. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammation markers were highly raised - median C- reactive protein (mg/L) showed serial reduction in levels - from (median/IQR) 210 (132.6, 246.9) at admission to PICU to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n=12) was 690 (203, 1324), serum LDH (IU/L) (n=12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n=7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Although neutrophilia was seen in 16 patients [Mean (SD) - 14,952.9/μl (7175.2)], lymphopenia was uncommon and seen in only 4/17, median (IQR) [3000/μl (2245, 4508)]. 12 patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six patients expired.Conclusions: With our case series we wish to highlight the pattern of clinical and laboratory features in a cohort of severe MISC who were positive for SARSCOV2 antibody. We suggest refining the spectra of phenotypes of MIS-C for tropical countries keeping other exanthematous infections that present with fulminant myocarditis and refractory shock in perspective.

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Multisystem inflammatory syndrome-neonate: youngest COVID survivor

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20213330 ◽

2021 ◽

Vol 8 (9) ◽

pp. 1615

Author(s):

Sushil Singla ◽

Mohitesh Kumar ◽

Yaswanth C. Raavi

Keyword(s):

Virus Disease ◽

Age Groups ◽

Severe Infection ◽

Health Concern ◽

The Novel ◽

Global Public Health ◽

Limited Data ◽

Corona Virus ◽

Inflammatory Syndrome ◽

Respiratory Droplets

The novel corona virus disease (COVID-19) caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a global public health concern, primarily transmitted through respiratory droplets; though other routes of transmission are documented but not been fully demonstrated. At risk included all age groups, somehow for reasons unknown infants and children appears to be at a lower risk of severe infection, but recently children with hyper inflammatory syndrome and multi-organ dysfunction associated with COVID-19 have been increasingly reported. We report a case of 31-week neonate of 1.292 kg confirmed with SARS-CoV-2 infection, at birth, born to a COVID positive mother, initially developed respiratory distress at birth and abrupt progression to severe distress and later developed pneumothorax and hyper-inflammation (MIS-N). Respiratory support, corticosteroids, enoxaparin, antimicrobials, and other preterm care were given, and finally recovered and discharged after 30 days (1.812 kg). This case highlights the severe presentation of COVID-19 in a pre-term neonate. To the best of our knowledge this is apparently the youngest covid survivor till date reported in world. Clinical data on COVID-19 in new-born is extremely limited, so it is important to understand that these conclusions are based on limited data and our understanding will continue to evolve.

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110: ACUTE FULMINANT MYOCARDITIS ASSOCIATED WITH COVID-19 MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS

Critical Care Medicine ◽

10.1097/01.ccm.0000806764.20106.14 ◽

2021 ◽

Vol 50 (1) ◽

pp. 38-38

Author(s):

Taranika Sarkar ◽

Angela Li ◽

Rajiv Jauhar ◽

Suresh Jain

Keyword(s):

Fulminant Myocarditis ◽

Inflammatory Syndrome

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Evidence of SARS-CoV-2-Specific T-Cell-Mediated Myocarditis in a MIS-A Case

Frontiers in Immunology ◽

10.3389/fimmu.2021.779026 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kevin M. Vannella ◽

Cihan Oguz ◽

Sydney R. Stein ◽

Stefania Pittaluga ◽

Esra Dikoglu ◽

...

Keyword(s):

T Cell ◽

High Frequency ◽

Tissue Repair ◽

Cytotoxic T Cells ◽

Molecular Targets ◽

Myocardial Necrosis ◽

Cell Receptor ◽

Fulminant Myocarditis ◽

Cell Clones ◽

Inflammatory Syndrome

A 26-year-old otherwise healthy man died of fulminant myocarditis. Nasopharyngeal specimens collected premortem tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Histopathological evaluation of the heart showed myocardial necrosis surrounded by cytotoxic T-cells and tissue-repair macrophages. Myocardial T-cell receptor (TCR) sequencing revealed hyper-dominant clones with highly similar sequences to TCRs that are specific for SARS-CoV-2 epitopes. SARS-CoV-2 RNA was detected in the gut, supporting a diagnosis of multisystem inflammatory syndrome in adults (MIS-A). Molecular targets of MIS-associated inflammation are not known. Our data indicate that SARS-CoV-2 antigens selected high-frequency T-cell clones that mediated fatal myocarditis.

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Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis

PLoS ONE ◽

10.1371/journal.pone.0253625 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253625

Author(s):

Shazia S. Mohsin ◽

Qalab Abbas ◽

Devyani Chowdhary ◽

Farah Khalid ◽

Abdul Sattar Sheikh ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Laboratory ◽

Tertiary Care ◽

Viral Myocarditis ◽

Intravenous Immunoglobulins ◽

Left Ventricular ◽

World Health ◽

Fulminant Myocarditis ◽

Severe Left Ventricular Dysfunction ◽

Inflammatory Syndrome

Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes.

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Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02304-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael I. Gurin ◽

Yue J. Lin ◽

Samuel Bernard ◽

Randal I. Goldberg ◽

Navneet Narula ◽

...

Keyword(s):

Case Report ◽

Cardiogenic Shock ◽

Endomyocardial Biopsy ◽

Myocardial Injury ◽

Fulminant Myocarditis ◽

Hemodynamic Compromise ◽

Biventricular Function ◽

Histologic Pattern ◽

Biventricular Failure ◽

Inflammatory Syndrome

Abstract Background With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. Case presentation A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. Conclusions MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient’s biventricular function recovered with IVIg and steroids.

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