scholarly journals 488. Comparison of Demographics and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children and Kawasaki Disease

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S344-S345
Author(s):  
Rana Talj ◽  
Ahmad Yanis ◽  
Danielle A Rankin ◽  
Joseph R Starnes ◽  
Lauren S Starnes ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Categorical Variables ◽  
Unknown Etiology ◽  
Hospitalized Children ◽  
Research Support ◽  
Material Support ◽  
Laboratory Values ◽  
Inflammatory Syndrome

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) is an illness associated with recent SARS-CoV-2 infection or exposure. Kawasaki disease (KD), a vasculitis with an unknown etiology, has overlapping clinical presentation with MIS-C, making it difficult to clinicians for distinguish between them. Therefore, we aimed to compare demographic, laboratory, and clinical characteristics between MIS-C and KD in hospitalized children in Nashville, TN. Methods We conducted a single-center retrospective chart review for hospitalized children under 18 years who met American Heart Association criteria for KD and were treated with intravenous immunoglobulin from May 2000 to December 2019, and children meeting the CDC criteria for MIS-C from July 2020 to May 2021. Data abstraction for patients’ demographics, clinical presentation, laboratory values and imaging results was performed. Pearson’s chi-squared test for categorical variables and Wilcoxon rank sum test for continuous variables, with alpha=5%, were used to compare groups. Results A total of 603 KD and 52 MIS-C hospitalized patients were included. Children with MIS-C were older than those with KD. A higher frequency of male sex was noted in both groups, with no significant differences in race and ethnicity (Table). MIS-C children frequently presented with symptoms similar to KD (63.5% rash, 55.8% conjunctivitis, 28.9% mucous membrane changes); however, only one MIS-C patient met criteria for complete KD (Figure). Both MIS-C and KD children presented with elevated CRP and ESR, but the median value of CRP in MIS-C children was significantly higher (Table). In addition, white cell count was lower in MIS-C children, which is primarily driven by the lower absolute lymphocyte count in this group (0.9 vs 2.7, p< 0.001), and echocardiography was more likely to be abnormal at presentation compared to KD (Table). Table. Comparison of Sociodemographic, Clinical, and Laboratory Characteristics among Children with Kawasaki Disease and Multisystem Inflammatory Syndrome in Nashville Figure. Comparison of Kawasaki Criteria Between Children with Multisystem Inflammatory Syndrome and Kawasaki Disease Conclusion MIS-C and KD present similarly in children; however, age, laboratory and echocardiography findings can help differentiate between them. Different laboratory values suggest different pathophysiology and inflammatory mediators behind these two illnesses, warranting further research. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support

scholarly journals Clinical Characteristics and Organ System Involvement of the University of Minnesota Sarcoidosis Cohort

2019 ◽  
Author(s):  
Hok Sreng ◽  
David M Perlman ◽  
Chetan Shenoy ◽  
Daniel J Steinberger ◽  
Rebecca J Cogswell ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Pulmonary Function Tests ◽  
Interleukin 2 ◽  
High Variability ◽  
Categorical Variables ◽  
Unknown Etiology ◽  
University Of Minnesota ◽  
Multisystem Disease ◽  
Tertiary Center ◽  
The University

Abstract Background: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Clinical cohort studies of different populations are important to understand the high variability in clinical presentation and disease course of sarcoidosis. The aim of the study is to evaluate clinical characteristics, including organ involvement, pulmonary function tests, and laboratory parameters, in a sarcoidosis cohort at the University of Minnesota. Methods: We conducted a retrospective data collection and analysis of 187 subjects with biopsy-proven sarcoidosis seen at a tertiary center. Chi-square test or Fischer’s exact test was conducted for categorical variables, while Student’s t-test or analysis of variance was conducted for continuous variables, with p < 0.05 considered statistically significant. Results: Mean subject age at diagnosis was 45.8 ± 12.4, with a higher proportion of males (55.1%), and a higher proportion of blacks (17.1%) compared to the racial distribution of Minnesota residents (5.95%). The majority (71.1%) of subjects required anti-inflammatory therapy for at least 1 month. Compared to the A Case Control Etiologic Study of Sarcoidosis cohort, there was a higher frequency of extra-thoracic lymph node (34.2% vs. 15.2%), eye (20.9% vs. 11.8%), liver (17.6% vs. 11.5%), spleen (20.9% vs. 6.7%), musculoskeletal (9.6% vs. 0.5%), and cardiac (10.7% vs. 2.3%) involvement in our cohort. A multisystem disease with at least five different organs involved was identified in 13.4% of subjects. A restrictive physiological pattern was observed in 21.6% of subjects, followed by an obstructive pattern in 17.3% and mixed pattern in 2.2%. Almost half (49.2%) were Scadding stages II/III. Commonly employed disease activity markers, including soluble interleukin-2 receptor, angiotensin-converting enzymes, and C-reactive protein, did not differ between treated and untreated groups. Conclusions: This cohort features a relatively high frequency of high-risk sarcoidosis phenotypes including cardiac and multiorgan disease. Commonly-utilized serum biomarkers do not identify subpopulations that require or do better with treatment. Findings from this study present further the high-variability nature of sarcoidosis and the need for a more reliable biomarker to predict and measure disease severity and outcomes for better clinical management for sarcoidosis patients.

scholarly journals 181. Demographic and Geographic Epidemiology of Staphylococcus aureus Bacteremia using Geographic Information Systems Mapping and Spatial Statistics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S199-S199
Author(s):  
Julia Marshall ◽  
Vance G Fowler ◽  
Felicia Ruffin ◽  
Paul Lantos ◽  
Christopher Timmins
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Information Systems ◽  
Geographic Information Systems ◽  
Spatial Statistics ◽  
Clinical Characteristics ◽  
Geographic Information ◽  
Research Support ◽  
Material Support ◽  
Staphylococcus Aureus Bacteremia

Abstract Background Risk factors for community-associated Staphylococcus aureus bacteremia (SAB) are incompletely understood. We used Geographic Information Systems (GIS) and spatial statistics to analyze demographic and geographic epidemiology of SAB in the community. Methods We used the S. aureus Bacteremia Group Prospective Cohort Study (SABG-PCS) at Duke University Medical Center to obtain demographic and clinical data. We used the American Community Survey and U.S. Census to supply neighborhood variables. Secular trends in demographic and clinical characteristics of SAB patients prospectively enrolled between 1995 and 2015 (n = 2478) were determined using linear regressions. To characterize spatial patterns in Methicillin-resistant S. aureus (MRSA) bacteremia compared to Methicillin-susceptible S. aureus (MSSA) bacteremia, we used GIS mapping and selected a subgroup of patients (n = 667) living in and around Durham County, North Carolina. We then created generalized additive models (GAMs) using this subgroup to detect geographic heterogeneities in probabilities of MRSA infections compared to MSSA infections. Results We found evidence of changing demographic and clinical characteristics of SAB patients over the 21-year period. The proportion of infections acquired in the community increased significantly (p &lt; 0.0001). However, we did not detect spatial heterogeneities of MRSA infections in Durham County. Patient location of residence was not significantly associated with antimicrobial-resistant infections. Patient age and year of hospital admission were the only statistically significant covariates in our spatial models. Conclusion We utilized a novel method to analyze SAB in the community using GIS and spatial statistics. Future research should prioritize community transmission of S. aureus to identify robust risk factors for infection. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Grant/Research Support)Affinium (Consultant)Akagera (Consultant)Allergan (Grant/Research Support)Amphliphi Biosciences (Consultant)Aridis (Consultant)Armata (Consultant)Basilea (Consultant, Grant/Research Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Other Financial or Material Support, Educational fees)Contrafect (Consultant, Grant/Research Support)Debiopharm (Consultant, Other Financial or Material Support, Educational fees)Destiny (Consultant)Durata (Consultant, Other Financial or Material Support, educational fees)Genentech (Consultant, Grant/Research Support)Green Cross (Other Financial or Material Support, Educational fees)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)MedImmune (Consultant, Grant/Research Support)Merck (Grant/Research Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Grant/Research Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Grant/Research Support)sepsis diagnostics (Other Financial or Material Support, Pending patent for host gene expression signature diagnostic for sepsis.)Tetraphase (Consultant)Theravance (Consultant, Grant/Research Support, Other Financial or Material Support, Educational fees)Trius (Consultant)UpToDate (Other Financial or Material Support, Royalties)Valanbio (Consultant, Other Financial or Material Support, Stock options)xBiotech (Consultant)

scholarly journals Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisa Fernández-Cooke ◽  
Carlos D. Grasa ◽  
Sara Domínguez-Rodríguez ◽  
Ana Barrios Tascón ◽  
Judith Sánchez-Manubens ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Characteristics ◽  
Myocardial Dysfunction ◽  
Clinical Signs ◽  
Pediatric Intensive Care ◽  
Terminal Segment ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Aneurysm Development ◽  
Inflammatory Syndrome

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain.Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV).Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period.Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

scholarly journals 484. Identification of Early Features to Differentiate Hospitalized Children Admitted for Suspected MIS-C from Alternative Diagnoses

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S343-S344
Author(s):  
Matthew T Clark ◽  
Danielle A Rankin ◽  
Anna E Patrick ◽  
Alisa Gotte ◽  
Alison Herndon ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Panel Member ◽  
Laboratory Evaluation ◽  
Categorical Variables ◽  
Research Support ◽  
Review Panel ◽  
Material Support ◽  
Unequal Variances ◽  
Chi Squared ◽  
Early Features

Abstract Background Multi-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology. Methods We performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children’s Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson’s chi-squared test for categorical variables, alpha set at &lt; 0.05. Results There were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. Conclusion We identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support James A. Connelly, MD, Horizon Therapeutics (Advisor or Review Panel member)X4 Pharmaceuticals (Advisor or Review Panel member)

scholarly journals Characteristics of Children With Kawasaki Disease-Like Signs in COVID-19 Pandemic: A Systematic Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Parham Mardi ◽  
Marzieh Esmaeili ◽  
Parisa Iravani ◽  
Mohammad Esmail Abdar ◽  
Kumars Pourrostami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kawasaki Disease ◽  
Clinical Characteristics ◽  
Case Reports ◽  
Case Series ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Comprehensive Search ◽  
Respiratory Outcomes ◽  
Inflammatory Syndrome

Recent studies have shown that several children diagnosed with COVID-19 have developed Kawasaki Disease (KD)-like symptoms. This systematic review aims to assess the demographic, laboratory, and clinical characteristics of children with KD-like syndrome during the COVID-19 pandemic and evaluate efficacy of treatments and patients' outcome. A comprehensive search was carried out systematically through PubMed, Scopus, and Web of Science (WoS), medRxiv, and bioRxiv by two reviewers independently for all studies or preprints data on the demographic, laboratory, and clinical characteristics of children with K.D-like signs during the COVID-19 outbreak. Overall, 378 studies were identified by the systematic search, of which 25 studies were included in the study. The included studies involved 599 patients in total. Thirteen studies (52%) were case reports or case series, and the rest (48%) were cohort studies. In 19 studies, patients were diagnosed with Multisystem inflammatory syndrome in children (MIS-C). In 16 studies COVID-19 was diagnosed in all patients based on their polymerase chain reaction result, serological findings, and computed tomography results. Higher C-reactive protein and erythrocyte sedimentation rate level were the most prevalent laboratory findings. In most studies, patients had leucopenia with marked lymphopenia, hypoalbuminemia, and increased ferritin, as well as hyponatremia. Abnormal echocardiography and respiratory outcomes were the most common clinical outcomes. In 11 studies, all patients required intensive care unit admission. Findings of the present systematic review show that the incidence of KD-like syndrome in the COVID-19 pandemic increased significantly. Moreover, this study offers new insights in the KD-like syndrome pathogenesis and clinical spectrum during COVID-19 pandemic.

scholarly journals The Challenging Diagnosis of Pediatric Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 Infection—Two Case Reports and Literature Review

2021 ◽  
Vol 11 (4) ◽  
pp. 318
Author(s):  
Marcela Daniela Ionescu ◽  
Roxana Taras ◽  
Bianca Dombici ◽  
Mihaela Balgradean ◽  
Elena Camelia Berghea ◽  
...  
Keyword(s):  
High Risk ◽  
Kawasaki Disease ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Reports ◽  
Cardiovascular Complications ◽  
Novel Coronavirus ◽  
Short Time ◽  
Respiratory Coronavirus ◽  
Inflammatory Syndrome

Severe acute respiratory coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in 2019 that caused the coronavirus disease 2019 (COVID19). During the last year, over 70 million people were infected and more than 1.5 million people died. Despite the tremendous number of people infected, children were less affected and presented milder forms of the disease. A short time after the pandemic was declared, a new hyperinflammatory syndrome resembling Kawasaki disease (KD) was described in children with confirmed or suspected SARS-CoV-2 infection named multisystem inflammatory syndrome in children (MIS-C). The incidence of MIS-C is low and it has a polymorphous clinical presentation, making the diagnosis difficult. Although the incidence is reduced, there is a high risk of cardiovascular complications. In order to raise awareness, we present the cases of two pediatric patients diagnosed with MIS-C in our clinic.

scholarly journals 58. Clinical Characteristics of SARS-CoV-2 Among Confirmed and Suspected Cases in Tennessee

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S160-S161
Author(s):  
Rana Talj ◽  
Danielle A Rankin ◽  
Janet Nicotera ◽  
Leigh Howard ◽  
Natasha B Halasa
Keyword(s):  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Medical Condition ◽  
Severe Disease ◽  
Ambulatory Setting ◽  
Research Support ◽  
Disease Spectrum ◽  
Adult Participants ◽  
Support Research ◽  
Research Grant

Abstract Background On March 11, 2020, a pandemic due to SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), was declared. The disease spectrum varies from asymptomatic detection to severe disease. Data on community versus hospitalized cases are limited. We aim to evaluate and compare the epidemiological and clinical characteristics associated with SARS-CoV-2 infection among suspected and confirmed COVID-19 cases primarily diagnosed in the ambulatory setting and compare their illness presentation. Methods We are prospectively enrolling a longitudinal cohort of laboratory-confirmed or suspected COVID-19 subjects and their close contacts. Suspect cases are defined as anyone who developed fever and/or Covid-19 like-symptoms in the post-Covid-19 era without proven SARS-CoV-2 detection. We consented and interviewed subjects over the phone to capture detailed sociodemographic data, medical and social histories, and clinical characteristics of the illness. Results From March 20 to June 16, 2020, 463 subjects were enrolled (Figure 1). Of those, 178 were SARS-CoV-2 positive [164 adults and 13 pediatric (&lt; 18 years) cases] and 192 were COVID-19 suspected (111 adults and 78 pediatric cases). Adult confirmed cases were more likely to be Hispanic and have an underlying medical condition but less likely to be white compared to suspected cases (Table 1). Pediatric confirmed cases were more likely to be Hispanic and have smoke exposure, but less likely to have a travel history compared to suspected cases (Table 1). Both adult and pediatric confirmed subjects had fatigue, headache and cough as the most common symptoms reported. Cough, muscle aches and chest tightness were more likely to be reported in pediatric confirmed than suspected cases; whereas loss of taste, smell and appetite, diarrhea and fever ≥ 100.4 were documented more often in adult confirmed than suspected cases (Figure 2). Figure 1. Cumulative enrollment of subjects by day Table 1. Sociodemographic characteristics among confirmed and suspected COVID-19 cases Figure 2. Adults and pediatrics, confirmed and suspected cases, by clinical presentation Conclusion We observed differences of clinical presentation between confirmed and suspected cases among both pediatric and adult participants. Further research is needed to determine whether these differences are due to disease severity or absence of proven COVID-19. We are collecting serial nasal swabs, blood and stool specimens, on which future testing will confirm SARS-CoV-2 infection in suspected subjects. Disclosures Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)

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