An Arab Adolescent with Multisystem Inflammatory Syndrome Associated with COVID-19: A Report from Syria

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a rare and critical condition that affects children following exposure to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, leading to multiorgan dysfunction and shock. MIS-C has been reported from different parts of the world but rarely from Arab countries. In this report, we describe a 15-year-old Arab boy who was admitted to the ICU during the surge of Coronavirus transmission in Syria with a clinical picture consistent with MIS-C, including high-grade fever, gastrointestinal symptoms, rash, multiorgan dysfunction, and shock. Laboratory profile showed significant elevation of inflammatory markers, negative SARS-CoV-2 RT-PCR testing but positive serologic testing for SARS-CoV-2. The patient received intravenous immunoglobulins (IVIG) and glucocorticoids with remarkable cardiac improvement and significant alleviation in inflammatory markers. To our knowledge, this is the first reported case of MIS-C from Syria, which adds to the epidemiological data about this new syndrome.

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Kawasaki-like disease and acute myocarditis in the SARS-CoV-2 pandemic – reports of three adolescents

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2020.5037 ◽

2020 ◽

Author(s):

Stasa Krasic ◽

Sergej Prijic ◽

Predrag Minic ◽

Gordana Petrovic ◽

Dejan Nesic ◽

...

Keyword(s):

Early Recognition ◽

Acute Myocarditis ◽

Systolic Dysfunction ◽

Acute Infection ◽

Clinical Signs ◽

Gastrointestinal Symptoms ◽

Intravenous Immunoglobulins ◽

Nasopharyngeal Swab ◽

Term Outcome ◽

Inflammatory Syndrome

The novel coronavirus disease (COVID-19) may induce multisystem inflammatory syndrome in children, which may be associated with Kawasaki-like disease, and cardiac injury. In this study, we presented three male adolescents with multisystem inflammatory syndrome and myocardial injury admitted to the hospital during the peak of COVID-19 pandemic. All of the three patients had a history of fever, gastrointestinal symptoms, polymorph rash, non-exudative conjunctivitis, and signs of acute myocarditis. One of them had renal failure. Previously, they did not have an acute infection. Upon admission, they were hypotensive and tachycardic. A nasopharyngeal swab for SARS-CoV-2 on reverse transcription-polymerase chain reaction (PCR) assay was negative, but neutralizing viral antibodies were positive. In combination with blood tests, ECG, echocardiography and computerized tomography (CT), a multisystem inflammatory syndrome associated with acute myocarditis with mild to moderate systolic dysfunction and dilated coronary arteries were diagnosed. Two of three patients had shock syndrome and required inotropic support. All patients were treated with intravenous immunoglobulins. The second patient had a fever up to 102.2°F (39°C) three days after intravenous immunoglobulins. Further, he was treated according to protocols for refractory Kawasaki disease, with an intravenous methylprednisolone pulse therapy and aspirin. After a few hours, he became afebrile and the clinical signs disappeared. The favorable short-term outcome may reflect the early recognition and adequate therapy; however, the long-term outcomes are currently unknown.

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NEW CORONAVIRUS INFECTION AS TRIGGER FACTOR FOR MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: LITERATURE REVIEW AND ANALYSIS OF ORIGINAL DATA

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2020-99-6-127-134 ◽

2020 ◽

Vol 99 (6) ◽

pp. 127-134

Author(s):

S.R. Rodionovskaya ◽

◽

L.N. Mazankova ◽

I.M. Osmanov ◽

E.R. Samitova ◽

...

Keyword(s):

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Epidemiological Data ◽

Original Data ◽

Trigger Factor ◽

Laboratory Markers ◽

Systemic Glucocorticoids ◽

Coronavirus Infection ◽

Characteristic Features ◽

Inflammatory Syndrome

The article presents data on the epidemiology, pathogenesis, features of clinical manifestations and diagnosis of multisystem inflammatory syndrome in children (MIS-C) associated with a new coronavirus infection. Objective of the research: to identify clinical manifestations and results of laboratory and instrumental examination of pediatric patients with confirmed MIS-C caused by a new coronavirus infection, the most characteristic features of this pathology and to analyze the amount of therapy based on the assessment of epidemiological data. Results: median age – 8 years (6; 9,5), median duration of the disease at the time of hospitalization – 6 days (3; 6). A positive result of SARS-CoV-2 analysis in rhinopharyngeal swabs by PCR was in 3 patients, antibodies to SARS-CoV-2 by ELISA were detected in 10. Clinical manifestations included prolonged febrile fever in 11 patients, gastrointestinal symptoms of varying severity – in 10, polymorphic rash was noted in 7 cases, conjunctivitis/scleritis – in 7, edema of the eyelids, face, extremities – in 4. CNS lesion manifested itself with general cerebral and meningeal symptoms. All patients had an increase in the level of inflammation laboratory markers. In 2 children chest MSCT revealed characteristic changes for SARS-CoV-2, interpreted as CT 3–4. Therapy included intravenous immunoglobulin infusions, systemic glucocorticoids, antiviral and antibacterial drugs, anticoagulants; two patients received tocilizumab infusions.

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The “Golden Hours” Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C)

Global Pediatric Health ◽

10.1177/2333794x21990339 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199033

Author(s):

Sanaa Mahmoud ◽

Eman M Fouda ◽

Alyaa Kotby ◽

Hanan M Ibrahim ◽

Mervat Gamal ◽

...

Keyword(s):

Gastrointestinal Symptoms ◽

Pediatric Intensive Care ◽

Risk Groups ◽

Intravenous Immunoglobulins ◽

High Risk Group ◽

Circulatory Support ◽

Clinical Approach ◽

Number Of Children ◽

Isolation Ward ◽

Inflammatory Syndrome

The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.

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Multisystem Inflammatory Syndrome in Children; an Emerging Global Threat - A Review

International Journal of Research and Review ◽

10.52403/ijrr.20210768 ◽

2021 ◽

Vol 8 (7) ◽

pp. 481-485

Author(s):

AR Shabaraya ◽

Archana KU

Keyword(s):

Kawasaki Disease ◽

Gastrointestinal Symptoms ◽

High Grade Fever ◽

Management Options ◽

Methyl Prednisolone ◽

Markers Of Inflammation ◽

Clinical Presentations ◽

Global Threat ◽

Available Information ◽

Inflammatory Syndrome

MIS C (Multisystem Inflammatory Syndrome in Children) is a disease related to post COVID-19 sequelae. Differential diagnosis includes Kawasaki disease, Bacterial sepsis, toxic shock syndrome, Appendicitis, Macrophage activation syndrome. Clinical Presentations include high grade fever, rashes, Gastrointestinal symptoms like (abdominal pain, vomiting, diarrhea), hypotension and shock. The pathogenesis of MIS-C is unknown, and a postinfective etiology has been hypothetical but unproven. Antibodies to SARS-CoV-2 appear in the second week following infection, although their existence does not suggest infection resolution. Laboratory markers of inflammation, such as CRP, are elevated. IVIG, Glucocorticoids such as methyl prednisolone, Antibiotics, thromboprophylaxis with Light Molecular Weight Heparin are the management options. Since the available information doesn't allow to formulate well-established guidelines or recommendations for MIS-C treatment, and therefore the long-term sequelae of the illness aren't yet known. Keywords: MIS C, IVIG, Kawasaki disease.

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Short follow-up of multisystem inflammatory syndrome after covid19 infection in children: case report

10.21203/rs.3.rs-379656/v1 ◽

2021 ◽

Author(s):

Angelo M. Acquafredda ◽

Chiara Lorusso ◽

Anna L. S. Di Giovinazzo ◽

Anna Maria Pastoressa ◽

Maria Simone ◽

...

Keyword(s):

Total Cholesterol ◽

Inflammatory Markers ◽

Lung Ultrasound ◽

Gastrointestinal Symptoms ◽

Recovery Phase ◽

Kawasaki Syndrome ◽

Clinical Recovery ◽

Interstitial Disease ◽

Inflammatory Syndrome

Abstract Background: covid19 infection, in children compared to adults, often occurs in a pauci and/or asymptomatic manner, but in some cases, a multisystem inflammatory syndrome (MIS) may occur in the 4-6 weeks following the infection. There are few data on the features of MIS after the clinical recovery phase, therefore we have described three cases of children with post-covid19 infection syndrome. Case presentation: out of the three cases described, in two children the onset clinical symptoms were similar to Kawasaki syndrome, while in the other neurological impairment was prevalent. In none of the three there were gastrointestinal symptoms, while the signs of interstitial disease were constant on lung ultrasound. In all of them, there was an increase in the inflammatory markers, high levels of ferritin, lymphocytopenia and thrombocytopenia only in one case. The lipid profile at onset was characterized by an increase in triglyceride levels. In all cases the course was benign with resolution of the symptoms upon admission within 4-5 days. After 1 month from the clinical recovery phase, the patients showed normalization of cytokines, inflammatory markers and triglyceride levels, while the total cholesterol value increased. Covid19 infection leads to an acute phase response with increase of the triglyceride in addition to inflammatory markers and the signs of interstitial disease on lung ultrasound. Conclusions: the inflammatory markers and lung involvement normalize over 30 days, while an initial increase of the triglyceride - and later in total cholesterol - suggest a direct relationship between triglyceride and inflammatory markers at the beginning, and between total cholesterol and host immune response during the follow-up.

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Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

BMJ ◽

10.1136/bmj.m2094 ◽

2020 ◽

pp. m2094 ◽

Cited By ~ 175

Author(s):

Julie Toubiana ◽

Clément Poirault ◽

Alice Corsia ◽

Fanny Bajolle ◽

Jacques Fourgeaud ◽

...

Keyword(s):

Kawasaki Disease ◽

Observational Study ◽

Hospital Stay ◽

Children And Adolescents ◽

Prospective Observational Study ◽

African Ancestry ◽

Gastrointestinal Symptoms ◽

Biological Data ◽

Rt Pcr ◽

Inflammatory Syndrome

Abstract Objectives To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design Prospective observational study. Setting General paediatric department of a university hospital in Paris, France. Participants 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020. Main outcome measures The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus. Results 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home. Conclusions The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

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Multisystem Inflammatory Syndrome in Children and Adolescents (MIS-C) under the Setting of COVID-19: A Review of Clinical Presentation, Workup and Management

Infectious Diseases Research and Treatment ◽

10.1177/11786337211026642 ◽

2021 ◽

Vol 14 ◽

pp. 117863372110266

Author(s):

Ayesha Farooq ◽

Fatima Alam ◽

Asma Saeed ◽

Farooq Butt ◽

Muhammad Azeem Khaliq ◽

...

Keyword(s):

Kawasaki Disease ◽

Children And Adolescents ◽

Past History ◽

Multiorgan Failure ◽

Gastrointestinal Symptoms ◽

Respiratory Illness ◽

Intravenous Immunoglobulins ◽

Cardiac Complications ◽

Inflammatory Syndrome

Earlier in its course, SARS-CoV-2 was primarily identified to cause an acute respiratory illness in adults, the elderly and immunocompromised, while children were known to be afflicted with milder symptoms. However, since mid-April of 2020, latent effects of the virus have begun emerging in children and adolescents, which is characterised by a multisystem hyperinflammatory state; thus, the term Multisystem Inflammatory Syndrome in Children (MIS-C) was introduced by the WHO and CDC. The syndrome manifests itself approximately 4 weeks after COVID-19 infection, with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome. Demographically, MIS-C peaks in children aged 5 to 14 years, with clusters in Europe, North and Latin America seen, later followed by Asia. Although the exact pathophysiology behind the syndrome is unknown, recent studies have proposed a post-infectious immune aetiology, which explains the increased levels of immunoglobulins seen in affected patients. Patient presentation includes, but is not limited to, persistent fever, rash, gastrointestinal symptoms and cardiac complications including myocarditis. These patients also have raised inflammatory markers including C reactive protein, ferritin and interleukin-6. In poorly controlled patients, the syndrome can lead to multiorgan failure and death. The mainstay of treatment includes the use of intravenous immunoglobulins, steroids, immune modulators and aspirin. Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation. Currently very little is known about the syndrome, highlighting the need for awareness amongst healthcare workers and parents. Moreover, with increased cases of COVID-19 as a result of the second wave, it is essential to keep MIS-C in mind when attending patients with a past history of COVID-19 exposure or infection. Additionally, once these patients have been identified and treated, strict follow-up must be done in order carry out long term studies, and to identify possible sequelae and complications.

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The Epidemiology of Cystic Fibrosis in Arab Countries: A Systematic Review

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-00756-z ◽

2021 ◽

Vol 3 (2) ◽

pp. 490-498

Author(s):

Samer Hammoudeh ◽

Wessam Gadelhaq ◽

Yahya Hani ◽

Nadia Omar ◽

Darine El Dimassi ◽

...

Keyword(s):

Cystic Fibrosis ◽

United Arab Emirates ◽

Autosomal Recessive ◽

Arab World ◽

Life Quality ◽

Epidemiological Data ◽

Arab Countries ◽

Inclusion Criteria ◽

Multiple Systems ◽

Endocrine Symptoms

AbstractCystic fibrosis (CF) is a genetic autosomal recessive disease that involves multiple systems. Both life quality and expectation are affected by the debilitating multi-system involvement of the disease which includes pulmonary, gastrointestinal, reproductive, and endocrine symptoms. Very few studies have covered the epidemiological aspects of the disease among Arab countries. To systematically review the available epidemiological literature on cystic fibrosis in order to describe the epidemiological state of this disease in the Arab world, this review used PubMed to search for relevant articles related to patients with cystic fibrosis, with no restriction on gender or age. Google scholar and the snowballing technique were used to locate further articles. A total of 17 articles met the inclusion criteria for this review. These articles were from Bahrain, Egypt, Jordan, Kuwait, Morocco, Oman, Saudi Arabia, Tunisia, and the United Arab Emirates. The articles scored 1.5–6.5 out of 8 on the quality assessment. The epidemiological data reported varied based on country and type of study. The establishment of CF registries is definitely a priority in the region, as well as the need for more research involving CF patients particularly those involving the epidemiological and clinical characteristics of these patients.

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Ocular and Systemic Manifestations in Paediatric Multisystem Inflammatory Syndrome Associated with COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10132953 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2953

Author(s):

Tzu-Chen Lo ◽

Yu-Yen Chen

Keyword(s):

Serum Antibody ◽

Case Series ◽

Pooled Analysis ◽

Rt Pcr ◽

Laboratory Findings ◽

Systemic Manifestations ◽

Polymerase Chain ◽

Exposure History ◽

Systemic Symptoms ◽

Inflammatory Syndrome

This study aimed to achieve a better understanding of the epidemiological and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). We searched PubMed and Embase between December 2019 and March 2021 and included only peer-reviewed clinical studies or case series. The proportions of patients who had conjunctivitis, systemic symptoms/signs (s/s), Kawasaki disease (KD), and exposure history to suspected/confirmed COVID-19 cases were obtained. Moreover, positive rates of the nasopharyngeal real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serum antibody for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recorded. Overall, 32 studies with 1458 patients were included in the pooled analysis. Around half of the patients had conjunctivitis. The five most common systemic manifestations were fever (96.4%), gastrointestinal s/s (76.7%), shock (61.5%), rash (57.1%), and neurological s/s (36.8%). Almost one-third presented complete KD and about half had exposure history to COVID-19 cases. The positivity of the serology (82.2%) was higher than that of the nasopharyngeal RT-PCR (37.0%). MIS-C associated with COVID-19 leads to several features similar to KD. Epidemiological and laboratory findings suggest that post-infective immune dysregulation may play a predominant role. Further studies are crucial to elucidate the underlying pathogenesis.

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

Global Pediatric Health ◽

10.1177/2333794x21996613 ◽

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.

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