scholarly journals Systemic inflammation and microbial translocation are characteristic features of SARS-CoV2 related Multi-system Inflammatory Syndrome in Children

2021 ◽  
Author(s):  
Nathella Pavan Kumar ◽  
Aishwarya Venkataraman ◽  
Luke Elizabeth Hanna ◽  
Sulochana Putlibai ◽  
M Karthick ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Acute Phase Proteins ◽  
Severe Disease ◽  
Microbial Translocation ◽  
Reactive Protein ◽  
Rare Manifestation ◽  
Characteristic Features ◽  
And Control ◽  
Inflammatory Syndrome ◽  
Amyloid P

Abstract Background Multisystem Inflammatory Syndrome in children (MIS-C) is a rare manifestation of SARS-CoV2 infection in children that can result in increased morbidity and mortality. The inflammatory underpinnings of MIS-C have not been examined in detail. Methods We examined the plasma levels of acute phase proteins and microbial translocation markers in MIS-C, acute COVID-19 infection (COVID-19), SARS-CoV-2 seropositive and control children. Findings MIS-C children exhibited significantly higher levels of C-reactive protein (CRP), alpha2 macroglobulin (a2M), Serum Amyloid P (SAP), lipopolysaccharide (LPS), sCD14 and LPS binding protein (LBP) and significantly lower levels of haptoglobin (Hp) in comparison to seropositive, control and/or COVID-19 children. In addition, COVID-19 children exhibited significantly higher levels of most of the above markers in comparison to seropositive and control children. PCA analysis using a set of these markers could clearly discriminate MIS-C and COVID-19 from seropositive and control children. MIS-C children requiring PICU admission and COVID-19 children with severe disease had higher levels of CRP, SAP and/or sCD14 at admission. Conclusion Our study describes the role of systemic inflammation and microbial translocation markers in children with MIS-C and COVID-19 and therefore helps in advancing our understanding of the pathogenesis of different presentations of SARS-CoV-2 infection in children.

scholarly journals X-Linked Lymphoproliferative Disease Mimicking Multisystem Inflammatory Syndrome in Children—A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Seraina Prader ◽  
Nicole Ritz ◽  
Frédéric Baleydier ◽  
Maya C. Andre ◽  
Noémie Stähli ◽  
...  
Keyword(s):  
Case Report ◽  
Severe Disease ◽  
Intravenous Immunoglobulins ◽  
Lymphoproliferative Disease ◽  
Number Of Children ◽  
Barr Virus ◽  
Reactive Protein ◽  
Fatal Liver Failure ◽  
Epstein Barr ◽  
Inflammatory Syndrome

Most children with a SARS-CoV-2 infection are asymptomatic or exhibit mild symptoms. However, a small number of children develop features of substantial inflammation temporarily related to the COVID-19 also called multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), clinically similar to Kawasaki disease, toxic shock syndrome and hemophagocytic lymphohistiocytosis (HLH). It is well-known that genetic pre-disposition plays an important role in virally-triggered diseases such as Epstein-Barr virus (EBV)-associated HLH, while this has not yet been established for patients with MIS-C. Here we describe a male patient fulfilling the diagnostic criteria of MIS-C, who was initially treated according to current consensus guidelines. Presence of hypofibrinogenemia, normal lymphocyte counts and C-reactive protein, but substantial hyperferritinemia distinguish this patient from others with MIS-C. The clinical course following initial presentation with acute respiratory distress syndrome was marked by fatal liver failure in the context of EBV-associated HLH despite treatment with steroids, intravenous immunoglobulins, interleukin (IL)-1 receptor blockade and eventually HLH-directed treatment. X-linked lymphoproliferative disease type 1 (XLP1), a subtype of primary HLH was diagnosed in this patient post-mortem. This case report highlights the importance of including HLH in the differential diagnosis in MIS-C with severe disease course to allow specific, risk-adapted treatment and genetic counseling.

ON THE ISSUE OF DIFFERENTIAL DIAGNOSIS OF BACTERIAL INFECTIONS AND PEDIATRIC MULTISYSTEM INFLAMMATORY SYNDROME DURING THE COVID-19 PANDEMIC

2021 ◽  
Vol 100 (6) ◽  
pp. 162-167
Author(s):  
L.N. Mazankova ◽  
◽  
O.V. Molochkova ◽  
O.В. Kovalev ◽  
O.V. Shamsheva ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Systemic Inflammation ◽  
Inflammatory Reaction ◽  
Bacterial Infections ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Systemic Inflammatory Reaction ◽  
Comprehensive Examination ◽  
Severe Intoxication ◽  
Inflammatory Syndrome

During the COVID-19 pandemic, it is necessary to be wary of the development of pediatric multisystem inflammatory syndrome in children (PMIS) who have had a COVID-19 and had antibodies to the SARS-CoV-2 virus. The aim of this work is to describe two clinical cases in children with antibodies to SARS-CoV-2 against the background of yersiniosis in a 12-year-old child and salmonellosis in a 3-year-old child, which proceeded with a pronounced inflammatory reaction and required a differential diagnosis with multisystem inflammatory syndrome. These bacterial infections proceeded with severe intoxication and fever, had a polymorphic clinical picture with exanthema syndrome, conjunctivitis/scleritis, swelling of the palms/feet, diarrhea and toxic kidney damage, with a pronounced systemic inflammatory reaction – high leukocytosis with neutrophilia and lymphopenia, a significant increase in C-reactive protein, procalcitonin, hypercoagulability (increased fibrinogen, D-dimer). Etiotropic antibiotic therapy led to recovery in both cases. Conclusions: During the COVID-19 pandemic, if antibodies to the SARS-CoV-2 virus are detected in children in the presence of signs of systemic inflammation and corresponding symptoms, the alertness of doctors and a timely comprehensive examination are necessary to exclude bacterial infections, also characterized by signs of systemic inflammation, for the purpose of differential diagnosis of PMIS.

scholarly journals Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study

2021 ◽  
pp. 1-10
Author(s):  
Rodney Alexander Rosalia ◽  
Petar Ugurov ◽  
Dashurie Neziri ◽  
Simona Despotovska ◽  
Emilija Kostoska ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Inflammatory Markers ◽  
Severe Disease ◽  
Blood Purification ◽  
Reactive Protein ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Continuous Venovenous Haemofiltration ◽  
Inflammatory State ◽  
And Control

<b><i>Introduction:</i></b> Coronavirus disease 2019 (COVID-19) is characterized by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and with critical cases progressing to acute respiratory distress syndrome. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation. With this work, we evaluated the longitudinal changes of systemic inflammatory markers in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) haemofilter. <b><i>Methods:</i></b> We performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing haemofilter (CAH) according to local practice; we visualize longitudinal results of biochemical, inflammatory, blood gas, and vital sign parameters focussing on systemic levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin. <b><i>Results:</i></b> All patients were treated with ≥1 cycle extracorporeal continuous venovenous haemofiltration (CVVH) with CAH; of these, 30 severe patients received CVVH-CAH within 4–12 h of admission after recognizing a hyper-inflammatory state. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and were placed on EBP during hospitalization. The treatment was associated with a reduction of ferritin, CRP, fibrinogen, several inflammatory markers, and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3%. <b><i>Conclusion:</i></b> EBP with CAH was associated with a decrease in CRP, and control of IL-6 and procalcitonin.

scholarly journals Extracorporeal Blood Purification in moderate and severe COVID-19 patients: a prospective cohort study

2020 ◽  
Author(s):  
Rodney Alexander Rosalia ◽  
Petar Ugurov ◽  
Dashurie Neziri ◽  
Simona Despotovska ◽  
Emilja Kostoska ◽  
...  
Keyword(s):  
Acute Phase Proteins ◽  
Severe Disease ◽  
Blood Purification ◽  
Blood Gas ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Extracorporeal Blood ◽  
Variation Of Parameters ◽  
Extracorporeal Blood Purification ◽  
Therapeutic Avenue

AbstractIntroductionCOVID-19 is characterised by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and critical cases progressing to ARDS. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation.With this work, we describe the longitudinal variation of parameters of systemic inflammation in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) hemodiafilter.MethodsWe performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing hemodiafilter; we visualise longitudinal results of biochemical, inflammatory, blood gas- and vital sign parameters.ResultsBlood purification was indicated for suspected hyperinflammation or hypercoagulation, (= CRP ≥ 100 mg/L and/or IL-6 ≥ 40 pg/mL and/or Ferritin ≥ 500 ng/mL and/or Lactate Dehydrogenase > 365 U/L or D-dimers > 2000 ng/mL). All patients were treated with ≥ 1 cycle extracorporeal continuous venovenous hemofiltration (CVVHF) with cytokine adsorbing hemodiafilter (CAH); of these, 30 severe patients received CVVHF-CAH within 4 – 12 hours of hospitalisation. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and placed on EBP during the course of hospitalisation. The treatment was associated with a reduction of Ferritin, C-reactive protein, Fibrinogen, several inflammatory markers and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3% across the cohort.ConclusionExtracorporeal blood purification with cytokine adsorbing hemofilter was associated with a decrease in the acute phase proteins CRP, Ferritin, and resolution of numerous cytopenias. Repetitive hemofiltration has been associated with lower levels of IL-6 in COVID-19 patients.

scholarly journals Hamster female protein. A new Pentraxin structurally and functionally similar to C-reactive protein and amyloid P component.

1981 ◽  
Vol 153 (4) ◽  
pp. 977-991 ◽  
Author(s):  
J E Coe ◽  
S S Margossian ◽  
H S Slayter ◽  
J A Sogn
Keyword(s):  
Acute Phase ◽  
Acute Phase Proteins ◽  
Hormonal Control ◽  
Normal Female ◽  
C Reactive Protein ◽  
Parent Molecule ◽  
Ancestral Gene ◽  
Amyloid P Component ◽  
Reactive Protein ◽  
Amyloid P

Female protein (FP), a serum protein present in normal female hamsters was found to be similar to acute-phase reactant, C-reactive protein (CRP) and serum amyloid P component (SAP) in the following ways: (a) hamster FP complexed with phosphorylcholine (PC) in a Ca++-dependent fashion as shown by its isolation from serum by affinity chromatography with PC-Sepharose and selective elution with free PC or EDTA; (b) electron microscopy of FP indicated a pentameric structure similar in size and appearance to other pentraxins; (c) the parent molecule of FP (150,000 mol wt) was composed of five noncovalantly assembled subunits of 30,000 mol wt; and (d) the amino acid analysis and terminal NH2 sequence of FP clearly showed homology with SAP-CRP. Although FP evolved from an ancestral gene common to SAP and CRP, and shares functional, morphological and structural properties with these acute-phase proteins, the biological homology of FP appears quite diverse as this protein is a prominent serum constituent (1-2 mg/ml) of normal female hamsters and under hormonal control (testosterone suppression) in males.

scholarly journals Interleukin-6 Producing Pheochromocytoma: A Rare Cause of Systemic Inflammatory Response Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Nelson Carvalho Cunha ◽  
Leonor Gomes ◽  
Joana Saraiva ◽  
Isabel Paiva
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Interleukin 6 ◽  
Cushing Syndrome ◽  
Systemic Inflammatory Response ◽  
Normocytic Anemia ◽  
Reactive Protein ◽  
First Case ◽  
Rare Manifestation ◽  
Inflammatory Syndrome

Systemic inflammatory response syndrome (SIRS) can be a rare manifestation of pheochromocytoma, since this adrenal tumor may produce cytokines and other hormones or neuropeptides besides catecholamines. We report the case of a 53-year-old female patient with a pheochromocytoma that presented with fever and weight loss of 5% in one month along with normocytic anemia, thrombocytosis, leukocytosis, and elevated C-reactive protein. In this setting, interleukin-6 (IL-6) was requested and was elevated [26.7ng/L (<7.0)]. She also presented biochemical evidence of ACTH-independent cortisol production without overt Cushing syndrome. After adrenalectomy, the inflammatory syndrome resolved and all biochemical parameters normalized, including IL-6 and ACTH. To our knowledge, this is the first case report of IL6-producing pheochromocytoma along with autonomous cortisol production.

The Effect of Sedation, Oral Examination, and Odontoplasty on Systemic Inflammation as Measured by Serum Amyloid A in the Adult Performance Horse

2019 ◽  
Vol 36 (3) ◽  
pp. 198-201
Author(s):  
Sheri S. W. Birmingham ◽  
Rocky M. Mason
Keyword(s):  
Systemic Inflammation ◽  
Serum Amyloid A ◽  
Acute Phase Proteins ◽  
Systemic Disease ◽  
Oral Examination ◽  
Serum Amyloid ◽  
Amyloid A ◽  
Adult Performance ◽  
Normal Limits ◽  
Time Periods

Serum amyloid A (SAA) is one of the major acute phase proteins in horses. It serves as a marker for systemic inflammation and infection, as the concentration can increase 100- to even 1000-fold during systemic disease processes. The objective of this study was to evaluate the effect of sedation, oral examination, and odontoplasty on systemic inflammation as measured by SAA in the adult performance horse. This study included 32 clinically healthy adult performance horses. Blood samples were collected immediately prior to sedation, oral examination, and odontoplasty and 48 and 72 hours afterward. Serum amyloid A levels were measured directly after venipuncture using a commercially available stall-side lateral flow immunoassay test developed and validated for equine SAA levels. Serum amyloid A values were within normal limits for each of the time periods and there were no significant differences in SAA values between the time periods. The results of this study suggest that sedation, oral examination, and odontoplasty have no systemic inflammatory effects as measured by SAA.

scholarly journals Effects of Obesity on Airway and Systemic Inflammation in Asthmatic Children

2021 ◽  
pp. 1-11
Author(s):  
Emine Vezir ◽  
Ersoy Civelek ◽  
Emine Dibek Misirlioglu ◽  
Muge Toyran ◽  
Murat Capanoglu ◽  
...  
Keyword(s):  
Airway Inflammation ◽  
Systemic Inflammation ◽  
Adiponectin Level ◽  
Inflammatory Cells ◽  
Prick Test ◽  
Asthmatic Children ◽  
Asthmatic Patients ◽  
Reactive Protein ◽  
Type 2 Cytokines ◽  
Asthma In Children

Background: Obese asthma is a complex syndrome with certain phenotypes that differ in children and adults. There is no clear evidence regarding the presence of additive or synergistic pathological interaction between obesity and asthma in children. Objectives: Our aim was to demonstrate the interaction of obesity and asthma in children in terms of airway and systemic inflammation by a controlled observational study. Methods: Four groups were formed: asthma obese (AO), asthma nonobese (ANO), non-AO (NAO), nonasthma nonobese (NANO). Spirometry test, fractional exhaled nitric oxide (FeNO) test, skin prick test, serum inflammatory biomarkers (C-reactive protein, C3, C4, adiponectin, leptin, resistin, periostin, YKL-40, Type 1, and Type 2 cytokines) were conducted and evaluated in all participants. Sputum inflammatory cells (sputum eosinophils and neutrophils) were evaluated in patients who could produce induced sputum and obesity-asthma interactions were determined. Results: A total of 153 participants aged 6–18 years were included in the study, including the AO group (n = 46), the ANO group (n = 45), the NAO group (n = 30), and the NANO group (n = 32). IL-4 (p < 0.001), IL-5 (p < 0.001), IL-13 (p < 0.001), resistin (p < 0.001), and YKL-40 (p < 0.001) levels were higher in patients with asthma independent of obesity. The lowest adiponectin level was found in the AO group and obesity-asthma interaction was detected (p < 0.001). Sputum eosinophilia (p < 0.01), sputum neutrophilia (p < 0.01), and FeNO levels (p = 0.07) were higher in asthmatic patients independent of obesity. In the group with paucigranulocytic inflammation, resistin and YKL-40 levels were significantly lower than in the group without paucigranulocytic inflammation (p < 0.01). Conclusion: No interaction was found between obesity and asthma in terms of airway inflammation. Interaction between obesity and asthma was shown in terms of adiponectin level and resistin/adiponectin and leptin/adiponectin ratios. It was found that serum YKL-40 and resistin levels could be associated with airway inflammation.

scholarly journals Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

2021 ◽  
Vol 10 (10) ◽  
pp. 2077
Author(s):  
Yi-Min Huang ◽  
Chiao Lo ◽  
Chiao-Feng Cheng ◽  
Cheng-Hsun Lu ◽  
Song-Chou Hsieh ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severe Disease ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Serum Biomarkers ◽  
Healthy Controls ◽  
Granulomatous Mastitis ◽  
C Reactive Protein ◽  
Idiopathic Granulomatous Mastitis ◽  
Reactive Protein

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking breast cancer. Limited research has been conducted on the application of serum biomarkers. This study aims to investigate the association of serum biomarkers with disease severity in patients with IGM. From November 2011 to March 2020, medical records of patients with IGM were reviewed. Serum cytokine levels were measured in patients and healthy controls between July 2018 and March 2020. A total of 41 patients with histologically proven IGM were found. Serum interleukin (IL)-6 level was significantly higher in patients with IGM (n = 11) than healthy controls (n = 7). Serum IL-6 and C-reactive protein (CRP) levels were significantly higher in patients with severe disease than mild and moderate disease. Serum IL-6 (Spearman’s ρ = 0.855; p < 0.001) and CRP (Spearman’s ρ = 0.838; p = 0.001) levels were associated with time to resolution. A higher serum CRP level was associated with a longer time to resolution (B = 0.322; p < 0.001) in multiple linear regression analysis. Serum IL-6 and CRP levels can be used as biomarkers for the evaluation of disease severity in IGM. IL-6 may play a crucial role in the immunopathology of IGM.

scholarly journals Systemic Inflammation (C-Reactive Protein) in Older Chinese Adults Is Associated with Long-Term Exposure to Ambient Air Pollution

2021 ◽  
Vol 18 (6) ◽  
pp. 3258
Author(s):  
Mona Elbarbary ◽  
Artem Oganesyan ◽  
Trenton Honda ◽  
Geoffrey Morgan ◽  
Yuming Guo ◽  
...  
Keyword(s):  
Air Pollution ◽  
Systemic Inflammation ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
Chinese Adults ◽  
Reactive Protein ◽  
Hs Crp ◽  
Older Chinese ◽  
Older Chinese Adults

There is an established association between air pollution and cardiovascular disease (CVD), which is likely to be mediated by systemic inflammation. The present study evaluated links between long-term exposure to ambient air pollution and high-sensitivity C reactive protein (hs-CRP) in an older Chinese adult cohort (n = 7915) enrolled in the World Health Organization (WHO) study on global aging and adult health (SAGE) China Wave 1 in 2008–2010. Multilevel linear and logistic regression models were used to assess the associations of particulate matter (PM) and nitrogen dioxide (NO2) on log-transformed hs-CRP levels and odds ratios of CVD risk derived from CRP levels adjusted for confounders. A satellite-based spatial statistical model was applied to estimate the average community exposure to outdoor air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM10), 2.5 μm or less (PM2.5), and 1 μm or less (PM1) and NO2) for each participant of the study. hs-CRP levels were drawn from dried blood spots of each participant. Each 10 μg/m3 increment in PM10, PM2.5, PM1, and NO2 was associated with 12.8% (95% confidence interval; (CI): 9.1, 16.6), 15.7% (95% CI: 10.9, 20.8), 10.2% (95% CI: 7.3, 13.2), and 11.8% (95% CI: 7.9, 15.8) higher serum levels of hs-CRP, respectively. Our findings suggest that air pollution may be an important factor in increasing systemic inflammation in older Chinese adults.

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