scholarly journals Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during the COVID-19 Pandemic

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Reza Shahriarirad ◽  
Anahita Sanaei Dashti ◽  
Shabnam Hajiani Ghotbabadi
Keyword(s):  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Organ Damage ◽  
Laboratory Evaluation ◽  
Number Of Children ◽  
Reactive Protein ◽  
Public Crisis ◽  
Exact Etiology ◽  
Novel Coronavirus ◽  
Inflammatory Syndrome

Background. Although Kawasaki disease (KD) is the most common self-limited systemic vasculitis in pediatrics, the exact etiology of the disease, its association with other diseases, and pathogens is still unknown. In order to achieve a better understanding and management of the disease, documentation and reporting of atypical cases is justified, particularly with the growing number of children with inflammatory syndrome with clinical features simulating KD during the COVID-19 pandemic. Here, we present a case of an atypical case of KD presenting as multisystem inflammatory syndrome (MIS) during the COVID-19 pandemic. Case Presentation. The patient is a 7-year-old girl who developed fever (39°C) and erythematous multiform rash on the abdomen and along with erythema and edema on the extremities. Laboratory evaluation revealed neutrophilia and lymphopenia along with elevated C-reactive protein, erythrocyte sedimentation rate, troponin, lactate dehydrogenase, ferritin, and D-dimer. Although the patient did not fulfill the KD criteria, based on approved guidelines and approaches regarding atypical KD and multisystem inflammatory syndrome in children (MIS-C) during the COVID-19 pandemic, intravenous immunoglobulin along with aspirin was administered for the patients. The patient’s symptoms resolved with an uneventful postdischarge course. Conclusion. Early diagnosis and treatment of patients meeting full or partial criteria for KD are critical to preventing end-organ damage and other long-term complications, especially during times of public crisis and global health emergencies, such as the novel coronavirus pandemic.

scholarly journals COVID-19 Pandemic in the Disguise of Multi System Inflammatory Syndrome in Children: A Case Series

2021 ◽  
Author(s):  
Anahita Sanaei Dashti ◽  
Kamyar Ebrahimi ◽  
Reza Shahriarirad ◽  
Shabnam Hajiani Ghotbabadi ◽  
Shiva Aminnia
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Organ Damage ◽  
The Novel ◽  
Number Of Children ◽  
Public Crisis ◽  
Novel Coronavirus ◽  
Atypical Presentations ◽  
Inflammatory Syndrome

Abstract Although nearly a year has passed since the emerge of the SARS-CoV-2 virus, with it, a serious and novel pediatric condition called children's multisystem inflammatory syndrome (MIS-C) has subsequently emerged. In order to achieve a better understanding and management of the disease, documentation and reporting of atypical cases is justified, particularly with the growing number of children with inflammatory syndrome with clinical features simulating MIS during the ongoing COVID-19 pandemic. Based on similar reports from numerous countries with temporal relation to COVID-19 infection in the community, it is essential for general pediatricians to be on alert for such atypical presentations and early referral to tertiary care should be considered as appropriate. Here we four cases of Multisystem Inflammatory Syndrome (MIS) during the COVID-19 pandemic. Early diagnosis and treatment of patients meeting full or partial criteria for MIS are critical to preventing end-organ damage and other long-term complications, especially during times of public crisis and global health emergencies, such as the novel coronavirus pandemic.

Role of antioxidant therapy in patients with moderate and severe COVID-19

2021 ◽  
Vol 19 (1) ◽  
pp. 159-164
Author(s):  
E.K. Shavarova ◽  
◽  
E.R. Cazakhmedov ◽  
M.V. Alekseeva ◽  
L.G. Ezhova ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Intervention Group ◽  
Clinical Manifestations ◽  
Organ Damage ◽  
Control Group ◽  
Reactive Protein ◽  
Virus Rna ◽  
Active Intervention Group ◽  
Group 2 ◽  
Novel Coronavirus

The coronavirus disease COVID-19 is characterized by high mortality and the lack of effective etiotropic therapy. Activation of oxidative stress may be one of the links in the pathogenesis of organ damage of this infection. Objective. To assess the ability of Mexidol® to influence the rate of clinical improvement in pneumonia caused by the SARSCoV-2 virus in hospitalized patients with the novel coronavirus disease COVID-19 and concomitant discirculatory encephalopathy. 62 patients over the age of 18 years with confirmed new coronavirus disease COVID-19 according to computed tomography (CT) of the lungs (stages CT1, CT2, CT3) and PCR of a swab from the nasopharynx and oropharynx for SARS-CoV-2 virus RNA were included. After randomization patients of group 1 received an infusion of Mexidol® at a dose of 1000 mg/day, patients of group 2 – an infusion of isotonic sodium chloride solution for 7 days. Compared with the control group, the patients receiving Mexidol® therapy showed a significantly more pronounced decrease in body temperature, a tendency towards a decrease in the severity of shortness of breath. In the Mexidol® group, the concentration of superoxidedismutase did not change, while in the control group there was a tendency to its decrease, C-reactive protein decreased 2.2 times more than in the control group (p = 0.09). There was a tendency for a more rapid decrease in ferritin in the active intervention group. Mexidol® therapy can have a positive effect on the clinical manifestations and severity of laboratory-inflammatory syndrome in patients with the new coronavirus disease COVID-19. Key words: coronavirus disease COVID-19, oxidative stress, Mexidol

scholarly journals Comparison laboratory data between children with Kawasaki Disease and COVID-19

2021 ◽  
Author(s):  
Xiaoping Liu ◽  
Ying-Hsien Huang ◽  
Yuh-Chyn Tsai ◽  
Shih-Feng Liu ◽  
Ho-Chang Kuo
Keyword(s):  
New York ◽  
Kawasaki Disease ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Reactive Protein ◽  
First Case ◽  
Neutrophil Percentage ◽  
Adults And Children ◽  
Novel Coronavirus

Abstract Background: The 2019 coronavirus disease (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years old. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6-10 times increase when compared with previous years. We conducted this article to compare characters and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 COVID-19 children from the literature review and 234 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD had higher levels of white blood cell (WBC), platelet, neutrophil percentage, C-reactive protein (CRP), procalcitonin, Aspartate Aminotransferase (AST), and body temperature, while patients with COVID-19 had higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBC, platelet, procalcitonin, and AST provide identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide precision treatment with intravenous immunoglobulin (IVIG) for KD or multisystem inflammatory syndrome in children (MIS-C).

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.

scholarly journals Is COVID-19 multisystem inflammatory syndrome a new variant of Kawasaki Disease?

2021 ◽  
Author(s):  
Khawla Abu Hammour ◽  
Rana Abu Farha ◽  
Qusai Manaseer ◽  
Tasnim Dawoud ◽  
Walid Abu Hammour
Keyword(s):  
Kawasaki Disease ◽  
Clinical Signs ◽  
Myocardial Damage ◽  
Original Data ◽  
Causal Link ◽  
Temporal Association ◽  
New Variant ◽  
Novel Coronavirus ◽  
Almost All ◽  
Inflammatory Syndrome

Objectives: In this systematic review, we aimed to evaluate the clinical features, therapeutic options, and outcomes of children with multisystem inflammatory syndrome in children (MIS-C) and to investigate whether MIS-C is a new variant of Kawasaki disease. Materials and methods: Adhering to PRISMA principles, we searched for eligible studies between December 2019 and June 2020 through the following databases: PubMed, ISI Web of Science, SCOPUS, and Science Direct. Studies including original data of patients aged <21 years with MIS-C and descriptions of clinical signs, laboratory or radiological investigations were selected. Results: A total of 84 studies were identified, for which 48 were eligible for full screening and only 13 studies (n=657) met our inclusion criteria. More than 70% of patients with MIS-C tested positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The most common symptoms were gastrointestinal (80 to 100%) and most patients presented with fever for >4 days. Mucocutaneous manifestations are similar to Kawasaki disease presented in up to 64% in some studies. Almost all patients had significant elevations in inflammatory markers, and up to 50 to 100% had elevated troponin suggesting myocardial damage. Intravenous immunoglobulin (IVIG) was administered to 60% of patients in 12 studies and 80 to 100% in five studies. Steroids were administered to 10 to 95% of patients. The overall mortality rate was 0.9%. Conclusion: The temporal association between novel coronavirus disease 2019 (COVID-19) onset and Kawasaki-like disease and MIS-C suggests a causal link. Both syndromes have similar cascades of symptoms and hyperinflammation, which likely explain their response to the same immunomodulatory agents. However, it is unclear yet why some children appear more susceptible to develop MIS-C.

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 Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis—A Critical Review of Its Pathogenesis and Treatment

2020 ◽  
Vol 8 ◽  
Author(s):  
Jeremy C. McMurray ◽  
Joseph W. May ◽  
Madeleine W. Cunningham ◽  
Olcay Y. Jones
Keyword(s):  
Kawasaki Disease ◽  
Critical Review ◽  
Acute Rheumatic Fever ◽  
Systemic Vasculitis ◽  
Viral Myocarditis ◽  
Current Treatment ◽  
Clinical Perspective ◽  
Treatment Regimens ◽  
Inflammatory Syndrome ◽  
Post Infectious

MIS-C is a newly defined post-viral myocarditis and inflammatory vasculopathy of children following COVID-19 infection. This review summarizes the literature on diagnosis, parameters of disease severity, and current treatment regimens. The clinical perspective was analyzed in light of potential immunopathogenesis and compared to other post-infectious and inflammatory illnesses of children affecting the heart. In this paradigm, the evidence supports the importance of endothelial injury and activation of the IL-1 pathway as a common determinant among MIS-C, Kawasaki disease, and Acute Rheumatic fever.

scholarly journals Affinché non MIS-Cappi il caso: la sindrome infiammatoria multisistemica SARS-CoV-2-correlata

2021 ◽  
Vol 24 (10) ◽  
pp. 289-297
Author(s):  
Salvatore Giordano ◽  
Ilaria Pirrone ◽  
Giulia Angela Restivo ◽  
Filippo Collura ◽  
Giovanni Francesco Saia ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Rare Condition ◽  
Good Prognosis ◽  
Left Ventricular ◽  
Case Definition ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reactive Protein ◽  
Atypical Kawasaki Disease ◽  
Inflammatory Syndrome

Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes incidence as well as clinical, laboratoristic and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

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 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with 2019 Novel Coronavirus (SARS-CoV-2) Infection

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Helen Kest ◽  
Ashlesha Kaushik ◽  
William DeBruin ◽  
Mario Colletti ◽  
David Goldberg
Keyword(s):  
Critically Ill ◽  
Care Center ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Reactive Protein ◽  
Clinical Presentations ◽  
Gastrointestinal Complaints ◽  
Novel Coronavirus ◽  
Inflammatory Syndrome ◽  
Csf Findings

We report three critically ill pediatric patients (aged 6–10 years), presenting with features of multisystem inflammatory syndrome in children (MIS-C) from April 4 to May 10, 2020, to a tertiary-care center in New Jersey, United States. All patients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were previously healthy. Clinical presentations were similar with fever, abdominal pain, gastrointestinal complaints, and/or rash. One patient had altered mental status with cerebrospinal fluid (CSF) findings consistent with aseptic meningitis. Laboratory values were remarkable for high levels of C-reactive protein, D-dimers, B-type natriuretic peptide (BNP), and troponin in all patients. All had low albumin levels. Evaluation for other infectious etiologies was negative. All of the patients were critically ill, requiring admission to the intensive care unit. All had circulatory shock and needed inotropes. Two patients had respiratory failure requiring advanced respiratory support and one had cardiac dysfunction. All patients received steroids, and two received intravenous immunoglobulin (IVIG). One patient received tocilizumab. None of the children died. MIS-C is a recently recognized pediatric illness spectrum in association with SARS-CoV-2 infection, and clinical characterization is essential for understanding disease mechanisms to inform clinical practice.

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