scholarly journals Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children

Circulation ◽  
2021 ◽  
Vol 143 (1) ◽  
pp. 78-88
Author(s):  
Tarek Alsaied ◽  
Adriana H. Tremoulet ◽  
Jane C. Burns ◽  
Arwa Saidi ◽  
Audrey Dionne ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Infection ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Published Data ◽  
Control And Prevention ◽  
Cardiac Evaluation ◽  
Inflammatory Syndrome

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with substantial cardiovascular implications. Although infection with SARS-CoV-2 is usually mild in children, some children later develop a severe inflammatory disease that can have manifestations similar to toxic shock syndrome or Kawasaki disease. This syndrome has been defined by the US Centers for Disease Control and Prevention as multisystem inflammatory syndrome in children. Although the prevalence is unknown, >600 cases have been reported in the literature. Multisystem inflammatory syndrome in children appears to be more common in Black and Hispanic children in the United States. Multisystem inflammatory syndrome in children typically occurs a few weeks after acute infection and the putative etiology is a dysregulated inflammatory response to SARS-CoV-2 infection. Persistent fever and gastrointestinal symptoms are the most common symptoms. Cardiac manifestations are common, including ventricular dysfunction, coronary artery dilation and aneurysms, arrhythmia, and conduction abnormalities. Severe cases can present as vasodilatory or cardiogenic shock requiring fluid resuscitation, inotropic support, and in the most severe cases, mechanical ventilation and extracorporeal membrane oxygenation. Empirical treatments have aimed at reversing the inflammatory response using immunomodulatory medications. Intravenous immunoglobulin, steroids, and other immunomodulatory agents have been used frequently. Most patients recover within days to a couple of weeks and mortality is rare, although the medium- and long-term sequelae, particularly cardiovascular complications, are not yet known. This review describes the published data on multisystem inflammatory syndrome in children, focusing on cardiac complications, and provides clinical considerations for cardiac evaluation and follow-up.

Liver Transplantation in Patients With Cardiac Disease

2017 ◽  
Vol 22 (2) ◽  
pp. 111-121 ◽  
Author(s):  
Christopher L. Wray
Keyword(s):  
Cardiovascular Disease ◽  
Liver Transplantation ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Adverse Outcomes ◽  
Treatment Modalities ◽  
Cardiac Complications ◽  
Major Step ◽  
Cardiac Evaluation ◽  
The Impact

Liver transplantation (LT) is a unique surgical procedure that has major hemodynamic and cardiovascular implications. Recently, there has been significant interest focused on cardiovascular issues that affect LT patients in all phases of the perioperative period. The preoperative cardiac evaluation is a major step in the selection of LT candidates. LT candidates are aging in concordance with the general population; cardiovascular disease and their risk factors are highly associated with older age. Underlying cardiovascular disease has the potential to affect outcomes in LT patients and has a major impact on candidate selection. The prolonged hemodynamic and metabolic instability during LT may contribute to adverse outcomes, especially in patients with underlying cardiovascular disease. Cardiovascular events are not unusual during LT; transplant anesthesiologists must be prepared for these events. Advanced cardiovascular monitoring techniques and treatment modalities are now routinely used during LT. Postoperative cardiovascular complications are common in both the early and late posttransplant periods. The impact of cardiac complications on posttransplant mortality is well recognized. Emerging knowledge regarding cardiovascular disease in LT patients and its impact on posttransplant outcomes will have an important role in guiding the future perioperative management of LT patients.

scholarly journals COVID-19 and Treatment and Immunization of Children—The Time to Redefine Pediatric Age Groups is Here

2021 ◽  
Vol 12 (2) ◽  
pp. e0010
Author(s):  
Klaus Rose ◽  
◽  
Jane M. Grant-Kels ◽  
Earl B. Ettienne ◽  
Oishi Tanjinatus ◽  
...  
Keyword(s):  
United States ◽  
Age Groups ◽  
Drug Approval ◽  
The United States ◽  
The Body ◽  
Kawasaki Syndrome ◽  
Pediatric Age ◽  
Prevention And Treatment ◽  
Control And Prevention ◽  
Inflammatory Syndrome

Children are infected with coronavirus disease 2019 (COVID-19) as often as adults, but with fewer symptoms. During the first wave of the COVID-19 pandemic, multisystem inflammatory syndrome (MIS) in children (MIS-C), with symptoms similar to Kawasaki syndrome, was described in young minors testing positive for COVID-19. The United States (US) Centers for Disease Control and Prevention (CDC) defined MIS-C as occurring in <21-year-olds, triggering hundreds of PubMed-listed papers. However, postpubertal adolescents are no longer children biologically; the term MIS-C is misleading. Furthermore, MIS also occurs in adults, termed MIS-A by the CDC. Acute and delayed inflammations can be triggered by COVID-19. The 18th birthday is an administrative not a biological age limit, whereas the body matures slowly during puberty. This blur in defining children leads to confusion regarding MIS-C/MIS-A. United States and European Union (EU) drug approval is handled separately for children, defined as <18-year-olds, ascribing non-existent physical characteristics up to the 18th birthday. This blur between the administrative and the physiological meanings for the term child is causing flawed demands for pediatric studies in all drugs and vaccines, including those against COVID-19. Effective treatment of all conditions, including COVID-19, should be based on actual physiological need. Now, the flawed definition for children in the development of drugs and vaccines and their approval is negatively impacting prevention and treatment of COVID-19 in minors. This review reveals the necessity for redefining pediatric age groups to rapidly establish recommendations for optimal prevention and treatment in minors.

scholarly journals A multisystem inflammatory syndrome in children associated with COVID-19 in a 11-years-old girl

2021 ◽  
pp. 78-78
Author(s):  
Milena Bjelica ◽  
Gordana Vilotijevic-Dautovic ◽  
Andrea Djuretic ◽  
Slobodan Spasojevic
Keyword(s):  
Gastrointestinal Symptoms ◽  
World Health ◽  
Nasopharyngeal Swab ◽  
First Case ◽  
Control And Prevention ◽  
Inflammatory State ◽  
Life Threatening ◽  
History Of ◽  
Health Organization ◽  
Inflammatory Syndrome

Introduction. Multisystem inflammatory syndrome in children (MIS-C) is a post-viral, life-threatening, inflammatory state with multisystem involvement that typically manifests 3-4 weeks after SARS-CoV-2 infection. In this article, we present the first case of MIS-C in the Institute for Child and Youth Health Care of Vojvodina at the beginning of the COVID-19 pandemic. Case outline. A previously 11-years-old healthy girl got sick two days before admission to the hospital with a fever, headache, vomiting, abdominal pain, and fatigue. She was tested positive for COVID-19 by nasopharyngeal swab PCR with positive IgM and IgG antibodies. In the further course the illness presented with prolonged fever, laboratory evidence of inflammation, multiorgan involvement such as respiratory, gastrointestinal, cardiovascular, and dermatologic. Based on Centers for Disease Control and Prevention and World Health Organization criteria the diagnosis of MIS-C was made and IVIG and methylprednisolone were introduced with favorable clinical course. Conclusion. Every prolonged and unusual febrile state, especially if it is accompanied by gastrointestinal symptoms, in a school-age child, should be investigated in the direction of recent COVID-19 infection or exposure. In a case of a positive COVID-19 history or history of exposure, the MIS-C diagnosis should be considered.

scholarly journals COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Ashkan Baradaran ◽  
Abdolreza Malek ◽  
Nasrin Moazzen ◽  
Zahra Abbasi Shaye
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Multiple Organ ◽  
Current Evidence ◽  
Cardiac Complications ◽  
Clinical Presentations ◽  
Atypical Kawasaki Disease ◽  
Novel Coronavirus ◽  
Inflammatory Syndrome

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: (“novel coronavirus” Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.  

KAWASAKI DISEASE AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN WITH COVID-19 INFECTION

2020 ◽  
Vol 99 (6) ◽  
pp. 209-219
Author(s):  
L.V. Bregel ◽  
◽  
M.M. Kostik ◽  
L.Z. Fell ◽  
O.S. Efremova ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Hemophagocytic Syndrome ◽  
Early Recognition ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Interleukin 10 ◽  
Left Ventricular ◽  
Urgent Care ◽  
High Dose ◽  
Inflammatory Syndrome

During the COVD-19 pandemic, some pediatric patients in many countries around the world experienced a syndrome resembling a severe Kawasaki disease (KD), often accompanied by shock. Due to the incomplete signs of the classic KD in the era before the present pandemic, in many publications from European countries and the United States, this condition was called «multisystem inflammatory syndrome in children – MIS-C» or «hyperinflammatory shock» or «Kawasaki-like syndrome». This syndrome with a new coronavirus infection is characterized by refractory fever, frequent gastrointestinal symptoms, heart damage (including coronary dilation in some patients, and acute left ventricular failure in the majority), increased ESR and CRP levels, neutrophilia, extremely high troponin levels, increased ferritin, AST, ALT, lactate dehydrogenase, creatine phosphate kinase, interleukin-6 and interleukin-10, coagulopathy with an increase in D-dimer and fibrinogen, thrombocytopenia, sometimes procalcitonin increase. The manifestations of a cytokine storm may meet the criteria for secondary hemophagocytic syndrome. The mechanism of myocardial damage remains unclear. Treatment with high-dose intravenous immunoglobulin is effective, and in the presence of signs of hemophagocytic syndrome, dexamethasone or methylprednisolone. Further research is needed to understand the pathogenesis, resemblance and differences of this syndrome with classic KD, understanding of heart injuiry and early recognition for the need of urgent care.

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

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.

scholarly journals Mortality Trends and Causes of Death in Persons with Sickle Cell Disease in the United States, 1979-2014

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 865-865
Author(s):  
Amanda B. Payne ◽  
Jason M. Mehal ◽  
Christina Chapman ◽  
Dana L. Haberling ◽  
Lisa C. Richardson ◽  
...  
Keyword(s):  
Acute Infection ◽  
Age Groups ◽  
The United States ◽  
Cardiac Complications ◽  
Mortality Trends ◽  
Clinical Interventions ◽  
Cerebrovascular Complications ◽  
Time Period ◽  
Icd 10 ◽  
Related Mortality

Abstract Background: Sickle cell disease (SCD)-related mortality is a significant cause of mortality among Blacks in the United States. Several clinical interventions, such as penicillin prophylaxis, vaccination, and hydroxyurea, have decreased SCD-related mortality over time. This report investigates changes in the causes of death (COD) associated with SCD-related mortality over time and among age groups and compares SCD-related deaths to non-SCD-related deaths to identify changes in the burden of specific COD in order to inform future public health improvement efforts. Methods: SCD-related deaths were examined using the 1979-2014 US multiple COD mortality data. SCD-related deaths were identified as deaths for which an International Classification of Disease 9th revision (ICD-9) or ICD-10 code for SCD (282.6 for ICD-9; D57.0, D57.1, D57.2, D57.8 for ICD-10) was listed anywhere on the death record. Age-specific annual and average annual SCD-related death rates were calculated as the number of deaths per 100,000 corresponding population, with the bridged-race intercensal estimates of the US resident population as the denominator. Because death from SCD is a rare event in races other than Black, the analysis focused on decedents of Black race. Underlying and contributing COD codes were categorized according to their ICD-9 or ICD-10 codes into 20 groups relevant to SCD outcomes, including acute infection complications, cerebrovascular complications, splenic complications, and renal complications. To compare SCD-related deaths to non-SCD deaths, death records not listing an ICD-9 or ICD-10 code for SCD were randomly selected in a 1:1 ratio; non-SCD deaths were matched to SCD deaths by race, sex, age group, year of death, and region of residence. Results: From 1979-2014 there were 23,226 SCD-related deaths reported in the US. The median age at death increased from 28 years in 1979 to 43 years in 2014. The SCD-related average annual death rate trends shifted by time period across various age groups. The average annual SCD-related death rate among children &lt;5 years of age declined from 2.05/100,000 in 1979-1989 to 0.35/100,000 in 2011-2014 (p&lt;.0001). Conversely, the rate among adults ≥60 years of age increased from 1.20/100,000 in 1979-1989 to 1.69/100,000 in 2000-2014 (p&lt;0.0001). Changes in the frequency of various underlying and contributing COD among SCD-related deaths reflects the success of clinical interventions. During the first time period (1979-1989) acute cardiac and infection complications were the most common underlying and contributing COD. In contrast, chronic cardiac complications was most commonly listed as the underlying or contributing COD during the last time period (2010-2014) (Figure 1). The underlying and contributing COD listed among SCD-related deaths also differed by age group (Figure 2). The most common COD among deaths occurring at &lt;5 years of age was acute infection. The most common COD among deaths occurring at ≥60 years of age was cardiac complications. While clinical interventions have shown effect, compared to non-SCD-related deaths, SCD-related deaths remained more likely to be related to COD, such as acute infections, cerebrovascular complications, and renal complications (Figure 3). Conclusions: While utilizing death certificate data alone may misclassify some deaths, the utilization of national data allows the assessment of trends in mortality over several decades and provides information regarding SCD-related mortality trends nationwide. The data presented indicate interventions to prevent acute complications of SCD appear effective during the study period. More research regarding prevention and treatment of chronic complications of SCD is necessary, as persons with SCD are living longer and are more likely to die of chronic complications of their disease. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Trilogy of SARS-CoV-2 in Pediatrics (Part 2): Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 26 (4) ◽  
pp. 318-338
Author(s):  
Van L. Tran ◽  
Sarah Parsons ◽  
Andrew Nuibe
Keyword(s):  
Kawasaki Disease ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Febrile Illness ◽  
Current Treatment ◽  
Published Data ◽  
Treatment Considerations ◽  
Cardiac Manifestations ◽  
Effectiveness Studies ◽  
Inflammatory Syndrome

Multisystem Inflammatory Syndrome in Children (MIS-C) was first recognized as a novel illness in 2020 with manifestations similar to other hyperinflammatory syndromes, such as Kawasaki disease or macrophage activation syndrome. Severity varies from a self-limited febrile illness to shock requiring inotropes and mechanical ventilation. Gastrointestinal symptoms and persistent fevers are the most common clinical symptoms, with the addition of cardiac manifestations inclusive of ventricular dysfunction and coronary artery aneurysms. With no controlled trials or comparative effectiveness studies evaluating treatment of MIS-C to date, current treatment with immunomodulatory agents has mainly been derived from previous experience treating Kawasaki disease. This article provides a comprehensive review summarizing published data for the evaluation and management of MIS-C, with a focus on pharmacotherapy treatment considerations.

A Survey on Cardiac Complications of COVID-19 in Infants

2021 ◽  
Author(s):  
Reza Bahrami ◽  
Sedigheh Ekraminasab ◽  
Fatemeh Asadian
Keyword(s):  
Cardiac Involvement ◽  
Scientific Evidence ◽  
Fatal Outcome ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Limited Data ◽  
Predisposing Factor ◽  
Young Subjects ◽  
Inflammatory Syndrome ◽  
Underlying Pathophysiology

Congenital heart disease (CHD) may have serious effects on the course of COVID-19. Limited data were available on CHD in neonates with COVID-19. This study aimed to review the cardiac complications in neonates infected with COVID-19. Some studies showed that myocardial injury in adult patients is often correlated with a fatal outcome. But, scientific evidence in infants is rare, although several reports were published with the description of cardiac involvement in COVID-19 pediatric patients. In these young subjects, a background of surgically treated CHD seems to be a predisposing factor. Numerous studies showed Multisystem inflammatory syndrome in children (MIS-c) is a deadly demonstration of COVID-19 with cardiac involvement. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of the myocardium, systemic inflammatory response, coagulation abnormalities and thrombosis and hypoxia have been suggested as possible mechanisms of cardiac complications. It seems COVID-19 can affect different parts of the heart; however, the myocardium is more involved. The mechanisms of pathogenesis of cardiovascular implications in adults and infants are similar but CHD and MIS-c in infants are more important. Further studies on the effects of COVID-19 on the neonatal cardiovascular system are needed.

scholarly journals Evaluation of the Indirect Hemagglutination Assay for Diagnosis of Acute Leptospirosis in Hawaii

2000 ◽  
Vol 38 (3) ◽  
pp. 1081-1084 ◽  
Author(s):  
Paul V. Effler ◽  
Harry Y. Domen ◽  
Sandra L. Bragg ◽  
Tin Aye ◽  
David M. Sasaki
Keyword(s):  
Acute Infection ◽  
Positive Culture ◽  
Field Evaluation ◽  
The United States ◽  
Screening Tests ◽  
Hemagglutination Assay ◽  
Course Of Illness ◽  
Indirect Hemagglutination ◽  
Control And Prevention ◽  
Favorable Clinical Outcome

Timely diagnosis of leptospirosis is important to ensure a favorable clinical outcome. The definitive serologic assay, the microscopic agglutination test (MAT), requires paired sera and is not useful for guiding early clinical management. The only screening test approved for use in the United States, the indirect hemagglutination assay (IHA), has not undergone extensive field evaluation. To assess the performance of the leptospirosis IHA in Hawaii, serum from patients evaluated for leptospirosis between 1992 and 1997 were tested with the IHA at the Hawaii State Laboratories Division and with the MAT at the Centers for Disease Control and Prevention. Leptospirosis was considered confirmed by a fourfold rise in MAT titer and/or a positive culture. A total of 92 (41%) of 226 specimens from 114 persons with confirmed leptospirosis were found positive by IHA. Only 18 (15%) of 119 specimens obtained within 14 days of onset were IHA positive, compared to 74 (69%) of 107 specimens collected more than 14 days after onset (P <0.001). Repeat testing ultimately resulted in 78 (68%) of the confirmed cases having at least one specimen found positive by IHA. Thirteen different presumptive infecting serogroups were identified among 251 specimens with an MAT titer of ≥200 and obtained from persons with confirmed or probable leptospirosis. Fifty (68%) of 73 specimens with Icterohaemorrhagiae as the presumptive infecting serogroup were found positive by IHA, compared to 44 (47%) of 93 specimens with Australis as the presumptive infecting serogroup (P, 0.01). The IHA test was positive for 3 (1%) of 236 specimens from 154 persons without leptospirosis. The sensitivity of the leptospirosis IHA in Hawaii was substantially below figures reported previously, particularly early in the course of illness, limiting its usefulness for diagnosing acute infection. Since the presumptive infecting serogroup affected IHA results and the prevalence of serovars varies with geography, the performance of the IHA should be assessed locally. More sensitive leptospirosis screening tests are needed in Hawaii.

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