COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

2021 ◽  
pp. 1-3
Author(s):  
Lesya G. Tomlinson ◽  
Mitchell I. Cohen ◽  
Rebecca E. Levorson ◽  
Megan B. Tzeng
Keyword(s):  
Inflammatory Process ◽  
Myocardial Dysfunction ◽  
Sinus Node ◽  
Qtc Prolongation ◽  
Mild Disease ◽  
Abnormal Immune Response ◽  
Idioventricular Rhythm ◽  
Inflammatory Syndrome ◽  
Electrocardiographic Abnormalities ◽  
Post Infectious

Abstract SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.

scholarly journals 18F-FDG PET/CT findings in post COVID Multisystem inflammatory syndrome in adults (MIS-A)

2021 ◽  
Author(s):  
BOBY VARKEY MARAMATTOM ◽  
Geetha Philips ◽  
Shagos Gopalan Nair Santhamma
Keyword(s):  
Fdg Pet ◽  
Myocardial Dysfunction ◽  
Emission Tomography ◽  
Prompt Treatment ◽  
Ct Findings ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Inflammatory Syndrome ◽  
Post Infectious

Abstract We describe 18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET-CT) findings in a patient that inadvertently betrayed features of MIS-A. The findings were suggestive of an exaggerated Systemic inflammatory response syndrome (SIRS)- a prequel to MIS-A. MIS-A has been recently described in 2020 as a post-infectious or para-infectious sequela of COVID-19. Within 12 weeks of symptomatic or asymptomatic COVID-19 illness (diagnosed by serum SARS CoV2 antibodies), patients present with an illness requiring hospitalization that can rapidly progress to myocardial dysfunction and cardiogenic shock. (1) As with any illness, there is a period of ‘quiet before the storm’. Identification of patients early in the course of the illness and prompt treatment can improve clinical outcomes in MIS-A.

scholarly journals Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C

Blood ◽  
2021 ◽  
Author(s):  
Hilary Baker Whitworth ◽  
Sarah E Sartain ◽  
Riten Kumar ◽  
Katherine Armstrong ◽  
Lance Ballester ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Multivariable Analysis ◽  
Venous Catheter ◽  
Central Venous ◽  
Mild Disease ◽  
Thrombotic Complications ◽  
Associated Risk Factors ◽  
Inflammatory Syndrome ◽  
Present On Admission ◽  
Post Infectious

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19 related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a post-infectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and to evaluate associated risk factors. We classified patients into one of three groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (426 COVID-19, 138 MIS-C, and 289 asymptomatic SARS-CoV-2) in 814 patients, there were 20 patients with thrombotic events (TE) (including 1 stroke). Patients with MIS-C had the highest incidence (6.5%, 9/138) versus COVID-19 (2.1%, 9/426) or asymptomatic SARS-CoV-2 (0.7%, 2/289). In patients with COVID-19 or MIS-C, the majority of thrombotic events (89%) occurred in patients ≥12 years. Patients > 12 years with MIS-C had the highest rate of thrombosis at 19% (9/48). Notably, 71% of TE that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ≥12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13/564), but was 28% (5/18) in patients with thrombotic events. Our findings may help inform pediatric thromboprophylaxis strategies.

HEART INJURY IN PATIENTS WITH MULTISYSTEM INFLAMMATORY SYNDROME ASSOCIATED WITH SARS-CоV-2: A DESCRIPTION OF A SERIES OF CLINICAL CASES

2021 ◽  
Vol 100 (5) ◽  
pp. 35-45
Author(s):  
K.E. Belozerov ◽  
◽  
A.D. Kupreeva ◽  
I.S. Avrusin ◽  
V.V. Masalova ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Inflammatory Process ◽  
Scientific Data ◽  
Patient Treatment ◽  
Review Of Literature ◽  
Treatment Regimens ◽  
The World ◽  
Heart Injury ◽  
Inflammatory Syndrome ◽  
Clinical Cases

Multisystem inflammatory syndrome in children and adolescents associated with SARS-CoV-2 (MBS-D) is a new challenge for pediatricians around the world. Scientific data is updated daily and patient treatment regimens are developed. The involvement of the heart in the inflammatory process complicates the course of the disease and further rehabilitation of patients. The article describes 12 patients with heart disease in the structure of MVS-D, who underwent laboratory tests and instrumental studies, including MRI of the heart, and also provides detailed descriptions of three clinical cases and a review of literature data.

Multisystem Inflammatory Syndrome (MIS-C) in Neonates (MIS-N) Following Maternal SARS CoV-2 COVID-19 Infection

2021 ◽  
Author(s):  
Satyan Lakshminrusimha ◽  
Mark Hudak ◽  
Victoria Dimitriades ◽  
Rosemary Higgins
Keyword(s):  
Current Literature ◽  
Case Reports ◽  
Maternal Infection ◽  
Diagnosis And Management ◽  
Inflammatory Syndrome ◽  
Post Infectious

Children present with multisystem inflammatory syndrome (MIS-C), a post-infectious syndrome presenting a few weeks following an acute SARS CoV-2 infection. A few case reports of neonates presenting with a similar syndrome following maternal infection have been reported. This article summarizes the current literature and outlines the controversies surrounding the diagnosis and management of MIS-C in neonates (MIS-N).

scholarly journals Immunological assessment of pediatric multisystem inflammatory syndrome related to COVID-19

2020 ◽  
Author(s):  
Serge Grazioli ◽  
Fedora Tavaglione ◽  
Giulia Torriani ◽  
Noemie Wagner ◽  
Marie Rohr ◽  
...  
Keyword(s):  
T Cell ◽  
T Cell Activation ◽  
Neutralizing Antibodies ◽  
Cell Activation ◽  
Nk Cell ◽  
University Hospitals ◽  
Positive Serology ◽  
Recent Infection ◽  
Inflammatory Syndrome ◽  
Post Infectious

Abstract Background Recently, cases of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 have been reported worldwide. Negative RT-PCR testing associated with positive serology in most cases suggests a post-infectious syndrome. Because the pathophysiology of this syndrome is still poorly understood, extensive virological and immunological investigations are needed. Methods We report a series of four pediatric patients admitted to Geneva University Hospitals with persistent fever and laboratory evidence of inflammation meeting published definition of MIS-C related to COVID-19, to whom an extensive virological and immunological workup was performed. Results RT-PCRs on multiple anatomical compartments were negative whereas anti-SARS-CoV-2 IgA and IgG were strongly positive by ELISA and immunofluorescence. Both pseudo- and full virus neutralization assays showed the presence of neutralizing antibodies in all children, confirming a recent infection with SARS-CoV-2. Analyses of cytokine profiles revealed an elevation in all cytokines, as reported in adults with severe COVID-19. Although differing in clinical presentation, some features of MIS-C show phenotypic overlap with haemophagocytic lymphohistiocytosis (HLH). In contrast to patients with primary HLH, our patients showed normal perforin expression and NK cell degranulation. The levels of soluble IL-2 receptor (sIL-2R) correlated with the severity of disease, reflecting recent T-cell activation. Conclusion Our findings suggest that MIS-C related to COVID-19 is caused by a post-infectious inflammatory syndrome associated with elevation in all cytokines, and markers of recent T-cell activation (sIL-2R) occurring despite a strong and specific humoral response to SARS-CoV2. Further functional and genetic analyses are essential to better understand the mechanisms of host-pathogen interactions.

scholarly journals A typical Kawasaki syndrome in COVID-19 infection: a case report of a multisystem inflammatory syndrome in a child (MIS-C)

2021 ◽  
Vol 55 (2) ◽  
pp. 64-67
Author(s):  
Justice Sylverken ◽  
Priscilla Afari ◽  
Charles Martyn-Dickens ◽  
Sheila A. Owusu ◽  
Emmanuel Oppong ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Black Children ◽  
Tertiary Hospital ◽  
Severe Form ◽  
Kawasaki Syndrome ◽  
Toxic Shock ◽  
Mild Disease ◽  
First Case ◽  
Inflammatory Syndrome

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10-year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care.

scholarly journals Efficacy of CytoSorb in a Pediatric Case of Severe Multisystem Infammatory Syndrome (MIS-C): A Clinical Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Gabriella Bottari ◽  
Valerio Confalone ◽  
Nicola Cotugno ◽  
Isabella Guzzo ◽  
Salvatore Perdichizzi ◽  
...  
Keyword(s):  
Clinical Case ◽  
Myocardial Dysfunction ◽  
Interleukin 10 ◽  
Refractory Shock ◽  
Sublingual Microcirculation ◽  
Reactive Protein ◽  
Extracorporeal Blood Purification ◽  
Life Threatening ◽  
Inflammatory Syndrome ◽  
First Time

Background: Multisystem inflammatory syndrome in children (MIS-C) has emerged during the COVID-19 pandemic as a new SARS-CoV-2-related entity, potentially responsible for a life-threatening clinical condition associated with myocardial dysfunction and refractory shock.Case: We describe for the first time in a 14-year-old girl with severe MIS-C the potential benefit of an adjuvant therapy based on CytoSorb hemoperfusion and continuous renal replacement therapy with immunomodulatory drugs.Conclusions: We show in our case that, from the start of extracorporeal blood purification, there was a rapid and progressive restoration in cardiac function and hemodynamic parameters in association with a reduction in the most important inflammatory biomarkers (interleukin 6, interleukin 10, C-reactive protein, ferritin, and D-dimers). Additionally, for the first time, we were able to show with analysis of the sublingual microcirculation a delayed improvement in most of the important microcirculation parameters in this clinical case of MIS-C.

scholarly journals A Comprehensive Clinical Description of Pediatric SARS-CoV-2 Infection in Western Pennsylvania

2020 ◽  
Author(s):  
Megan Culler Freeman ◽  
Kristina Gaietto ◽  
Leigh Anne DiCicco ◽  
Sherry Rauenswinter ◽  
Joseph R Squire ◽  
...  
Keyword(s):  
Primary Care ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Medical Center ◽  
Pediatric Primary Care ◽  
Mild Disease ◽  
Hispanic Patients ◽  
Western Pennsylvania ◽  
Clinical Description ◽  
Inflammatory Syndrome

Objective: We sought to characterize clinical presentation and healthcare utilization for pediatric COVID-19 in Western Pennsylvania (PA). Methods: We established and analyzed a registry of pediatric COVID-19 in Western PA that includes cases in patients <22 years of age cared for by the pediatric quaternary medical center in the area and its associated pediatric primary care network from March 11 through August 20, 2020. Results: Our cohort included 424 pediatric COVID-19 cases (mean age 12.5 years, 47.4% female); 65% reported exposure and 79% presented with symptoms. The most common initial healthcare contact was through telehealth (45%). Most cases were followed as outpatients, but twenty-two patients (4.5%) were hospitalized: 19 with acute COVID-19 disease, and three for multisystem inflammatory syndrome of children (MIS-C). Admitted patients were younger (p<0.001) and more likely to have pre-existing conditions (p<0.001). Black/Hispanic patients were 5.8 times more likely to be hospitalized than white patients (p=0.012). Five patients (1.2%) were admitted to the PICU, including all three MIS-C cases; two required BiPAP and one mechanical ventilation. All patients survived. Conclusions: We provide a comprehensive snapshot of pediatric COVID-19 disease in an area with low to moderate incidence. In this cohort, COVID-19 was generally a mild disease; however, ~5% of children were hospitalized. Pediatric patients can be critically ill with this infection, including those presenting with MIS-C.

scholarly journals 474. Unique Treatment Challenges with Multisystem Inflammatory Syndrome in Children (MIS-C) compared to Kawasaki Disease Shock Syndrome

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S338-S339
Author(s):  
Rachel Downey Quick ◽  
Keren Hasbani ◽  
Donald Murphey ◽  
Mariosl Fernandez ◽  
Kenneth Shaffer ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Ivig Treatment ◽  
Medical Treatments ◽  
Cardiac Recovery ◽  
Prompt Treatment ◽  
Hospital Comparison ◽  
Inflammatory Syndrome ◽  
Ivig Administration

Abstract Background Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 present similarly with mucocutaneous symptoms and fever. Both syndromes can progress to shock. Successful treatments for MIS-C are largely based on proven KD management. As more patients with MIS-C are treated, protocols are adjusted. Infectious Diseases (ID) specialists are often early consultants in these cases. Understanding differences in how body systems are affected in MIS-C versus KD is essential for management. Figure 1. Cardiac changes among patients with Kawasaki Disease shock syndrome (KDSS) and Muti-system Inflammatory Syndrome (MIS-C) Methods This is a single hospital comparison of 25 cases of MIS-C with mucocutaneous presentation and symptoms of shock and 25 consecutive cases of KD Shock Syndrome (KDSS). Cases were compared for demographics, symptoms, cardiac abnormalities, medical treatments, and cardiac recovery. Results Patients with MIS-C develop symptoms of shock including sustained hypotension and tachycardia at 3 times the rate of patients with KD (45% vs 13%; p&lt; 0.001). On echocardiogram, left ventricular myocardial dysfunction, assessed by ejection fraction, is more commonly noted in cases of MIS-C than KDSS (fig 1). About half of patients with MIS-C show left ventricular myocardial dysfunction initially with normalization by 6 months post-presentation in the majority (96%). Conclusion Cardiac changes and shock events related to KD and MIS-C are thought to be caused by differing inflammatory mediators. By comparing these two syndromes, we can determine ways to manage each optimally. MIS-C often results in left ventricular myocardial dysfunction, which is rarer in KD cases. Fluid resuscitation with multiple fluid boluses followed by inotropes to treat hypotension in cases of in MIS-C puts increased strain on the already weakened myocardium. Early intravenous immunoglobulin (IVIG) administration, even in the presence of mild hypotension, can simultaneously provide the patient with additional fluid and decrease the underlying inflammatory process. This prompt treatment might reduce the need for pressor support while protecting the myocardium from further damage. As early consultants in MIS-C, ID providers should be educated regarding the unique cardiac challenges of MIS-C and avoid delay in IVIG treatment and cardiologist and intensivist consultation. Disclosures All Authors: No reported disclosures

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