scholarly journals Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253625
Author(s):  
Shazia S. Mohsin ◽  
Qalab Abbas ◽  
Devyani Chowdhary ◽  
Farah Khalid ◽  
Abdul Sattar Sheikh ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Viral Myocarditis ◽  
Intravenous Immunoglobulins ◽  
Left Ventricular ◽  
World Health ◽  
Fulminant Myocarditis ◽  
Severe Left Ventricular Dysfunction ◽  
Inflammatory Syndrome

Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes.

scholarly journals Severe Multi-inflammatory syndrome in children amidst tropical fevers– an overlapping spectrum, its clinical and laboratory attributes from a tertiary care centre in India.

2021 ◽  
Author(s):  
Arpita Chattopadhyay ◽  
Karnika Saigal Kalra ◽  
Diganta Saikia ◽  
Varshanjali Yadav ◽  
Juhi Chouksey ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Case Series ◽  
World Health ◽  
Fulminant Myocarditis ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Prospective Case Series ◽  
Inflammatory Syndrome

Abstract Objective: We aim to describe our experience in terms of clinical and laboratory attributes in children with Multi – inflammatory syndrome in children temporally related to COVID-19 (MISC) presenting amidst other prevalent tropical infections.Design: Prospective case series.Setting: A tertiary care hospital pediatric intensive care unit (PICU).Patients: Seventeen children with severe MIS-C managed in PICU.Methods: We did a prospective case series of children (aged ≤ 12 years), admitted to PICU betweenMay 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analysed routinely collected demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors.Results: 17 critically ill children with no previous comorbidities fulfilled the WHO/CDC classification of MIS-C. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammation markers were highly raised - median C- reactive protein (mg/L) showed serial reduction in levels - from (median/IQR) 210 (132.6, 246.9) at admission to PICU to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n=12) was 690 (203, 1324), serum LDH (IU/L) (n=12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n=7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Although neutrophilia was seen in 16 patients [Mean (SD) - 14,952.9/μl (7175.2)], lymphopenia was uncommon and seen in only 4/17, median (IQR) [3000/μl (2245, 4508)]. 12 patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six patients expired.Conclusions: With our case series we wish to highlight the pattern of clinical and laboratory features in a cohort of severe MISC who were positive for SARSCOV2 antibody. We suggest refining the spectra of phenotypes of MIS-C for tropical countries keeping other exanthematous infections that present with fulminant myocarditis and refractory shock in perspective.

scholarly journals Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient

2021 ◽  
Author(s):  
Mohammad Yousef Mohammad Yousef ◽  
Basel Abdelazeem ◽  
Atefeh Kalantary ◽  
Rebecca Pratiti
Keyword(s):  
Ventricular Dysfunction ◽  
Medical Literature ◽  
Acute Myocarditis ◽  
Late Complication ◽  
Viral Myocarditis ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
Clinical Challenge ◽  
History Of ◽  
Tomography Scan

Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19. A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge. Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis.

scholarly journals Paediatric inflammatory multisystem syndrome temporally associated with COVID-19: a new virus and a new case presentation

2020 ◽  
Vol 13 (12) ◽  
pp. e238531
Author(s):  
Phoebe Makiello ◽  
Sima Svirpliene ◽  
Lisa Finlay ◽  
Jean McKnight
Keyword(s):  
Clinical Symptoms ◽  
Late Phase ◽  
Upper Airway ◽  
Intravenous Immunoglobulins ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Case Presentation ◽  
Full Resolution ◽  
Inflammatory Syndrome

An 11-year-old boy presented with features resembling those described in health alerts on Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), including persistent fever, haemodynamic instability and abdominal pain. Laboratory tests, including raised inflammatory markers, D-dimer, troponin and a coagulopathy, were consistent with PIMS-TS. Our patient required transfer to the paediatric intensive care unit; an echocardiography revealed left ventricular dysfunction. He was treated with intravenous immunoglobulins (Igs), corticosteroids and aspirin, with full resolution of clinical symptoms. A follow-up echocardiogram 1 month after discharge was unremarkable.Three SARS-CoV-2 PCRs on respiratory samples, taken over the initial 4-day period, were negative, as was a SARS-CoV-2 PCR on faeces 1 month after presentation; titres of IgG were clearly elevated. The negative PCRs in the presence of elevated titres of IgG suggest that the inflammatory syndrome might have developed in a late phase of COVID-19 infection when the virus was no longer detectable in the upper airway.

scholarly journals Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children: One Year after the Onset of the Pandemic in a High-Incidence Area

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2022
Author(s):  
Marianna Fabi ◽  
Emanuele Filice ◽  
Carlotta Biagi ◽  
Laura Andreozzi ◽  
Daniela Palleri ◽  
...  
Keyword(s):  
Median Time ◽  
Ventricular Dysfunction ◽  
Clinical Laboratory ◽  
Heart Function ◽  
Immunological Response ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Inotropic Support ◽  
Cross Sectional ◽  
Inflammatory Syndrome

SARS-CoV-2 infection in children can trigger cardiovascular manifestations potentially requiring an intensive treatment and defining a new entity named Multisystem Inflammatory Syndrome in Children (MIS-C), whose features partially overlap with Kawasaki Disease (KD). A cross-sectional study including all diagnoses of MIS-C and KD from April 2020 to May 2021 in our metropolitan area was conducted evaluating clinical, laboratory (including immunological response, cytokines, and markers of myocardial damage), and cardiac (coronary and non-coronary) features at onset of the diseases. Evolution of ventricular dysfunction, valve regurgitations, and coronary lesions was documented. The severity of the disease was also considered based on the need for inotropic support and ICU admission. Twenty-four MIS-C were diagnosed (14 boys, median age 82 months): 13/24 cases (54.17%) presented left ventricular dysfunction, 12/24 (50%) required inotropic support, and 10/24 (41.67%) developed coronary anomalies (CALs). All patients received steroids and IVIG at a median time of 5 days (IQR1:4, IQR3:6.5) from onset of fever and heart function normalized 6 days (IQR1: 5, IQR3: 7) after therapy, while CALs persisted in one. One patient (12.5%) required infliximab because of refractory disease and still presented CALs 18 days after therapy. During the same study period, 15 KD were diagnosed: none had ventricular dysfunction, while 7/15 (46.67%) developed CALs. Three out of 15 patients (20%) still presented CALs 46 days from onset. Compared to KD, MIS-C pts have significantly higher IL8 and similar lymphocytes subpopulations. Despite a more severe presentation and initial cardiac findings compared to KD, the myocardial injury in MIS-C has a rapid response to immunomodulatory treatment (median time 6 days), in terms of ventricular function, valve regurgitations, and troponin. Incidence of CALs is similar at onset, but it tends to regress in most of the cases of MIS-C differently than in KD where CALs persist in up to 40% in the subacute stage after treatment.

scholarly journals Fulminant myocarditis: COVID or not COVID? Reinfection or co-infection?

2021 ◽  
Author(s):  
Ramya Yeleti ◽  
Maya Guglin ◽  
Kashif Saleem ◽  
Sasikanth V Adigopula ◽  
Anjan Sinha ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Diagnostic Testing ◽  
Viral Myocarditis ◽  
Left Ventricular ◽  
Fulminant Myocarditis ◽  
Molecular Diagnostic ◽  
Unique Case ◽  
Va Ecmo ◽  
Time Of Presentation ◽  
Cardiotropic Viruses

We describe a unique case of fulminant myocarditis in a patient with presumed SARS-CoV-2 reinfection. Patient had initial infection 4 months backand had COVID-19 antibody at the time of presentation. Endomyocardial biopsy showed lymphocytic myocarditis, that is usually seen in viral myocarditis. The molecular diagnostic testing of the endomyocardial biopsy for cardiotropic viruses was positive for Parvovirus and negative for SARS-CoV-2. Authors highly suspect co-infection of SARS-CoV-2 and Parvovirus, that possibly triggered the immune cascade resulting in fulminant myocarditis. Patient was hemodynamically unstable with ventricular tachycardia and was supported on VA ECMO and Impella CP. There was impressive recovery of left ventricular function within 48 hours, leading to decannulation of VA ECMO in 72 h. This unique case was written by the survivor herself.

scholarly journals 474. Unique Treatment Challenges with Multisystem Inflammatory Syndrome in Children (MIS-C) compared to Kawasaki Disease Shock Syndrome

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S338-S339
Author(s):  
Rachel Downey Quick ◽  
Keren Hasbani ◽  
Donald Murphey ◽  
Mariosl Fernandez ◽  
Kenneth Shaffer ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Ivig Treatment ◽  
Medical Treatments ◽  
Cardiac Recovery ◽  
Prompt Treatment ◽  
Hospital Comparison ◽  
Inflammatory Syndrome ◽  
Ivig Administration

Abstract Background Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 present similarly with mucocutaneous symptoms and fever. Both syndromes can progress to shock. Successful treatments for MIS-C are largely based on proven KD management. As more patients with MIS-C are treated, protocols are adjusted. Infectious Diseases (ID) specialists are often early consultants in these cases. Understanding differences in how body systems are affected in MIS-C versus KD is essential for management. Figure 1. Cardiac changes among patients with Kawasaki Disease shock syndrome (KDSS) and Muti-system Inflammatory Syndrome (MIS-C) Methods This is a single hospital comparison of 25 cases of MIS-C with mucocutaneous presentation and symptoms of shock and 25 consecutive cases of KD Shock Syndrome (KDSS). Cases were compared for demographics, symptoms, cardiac abnormalities, medical treatments, and cardiac recovery. Results Patients with MIS-C develop symptoms of shock including sustained hypotension and tachycardia at 3 times the rate of patients with KD (45% vs 13%; p&lt; 0.001). On echocardiogram, left ventricular myocardial dysfunction, assessed by ejection fraction, is more commonly noted in cases of MIS-C than KDSS (fig 1). About half of patients with MIS-C show left ventricular myocardial dysfunction initially with normalization by 6 months post-presentation in the majority (96%). Conclusion Cardiac changes and shock events related to KD and MIS-C are thought to be caused by differing inflammatory mediators. By comparing these two syndromes, we can determine ways to manage each optimally. MIS-C often results in left ventricular myocardial dysfunction, which is rarer in KD cases. Fluid resuscitation with multiple fluid boluses followed by inotropes to treat hypotension in cases of in MIS-C puts increased strain on the already weakened myocardium. Early intravenous immunoglobulin (IVIG) administration, even in the presence of mild hypotension, can simultaneously provide the patient with additional fluid and decrease the underlying inflammatory process. This prompt treatment might reduce the need for pressor support while protecting the myocardium from further damage. As early consultants in MIS-C, ID providers should be educated regarding the unique cardiac challenges of MIS-C and avoid delay in IVIG treatment and cardiologist and intensivist consultation. Disclosures All Authors: No reported disclosures

scholarly journals FULMINATING MYOCARDITIS IN PATIENT AFFECTED BY COVID-19

2020 ◽  
pp. 1-3
Author(s):  
María Belén Paucar Valdivieso ◽  
Joselyn Jennifer Castillo Jaramillo ◽  
Manuel Antonio Álvarez Pichazaca ◽  
David Andrés Suasnavas Amagua
Keyword(s):  
Clinical Laboratory ◽  
Severe Pneumonia ◽  
Medical Personnel ◽  
World Health ◽  
Medical Community ◽  
Fulminant Myocarditis ◽  
Imaging Characteristics ◽  
Rapid Spread ◽  
Health Organization ◽  
The 19Th Century

The coronavirus disease (Covid19) caused by “severe acute respiratory syndrome coronavirus 2” (SARS-CoV2), began in Wuhan, China, but its rapid spread internationally has led the World Health Organization to declare it a pandemic on March 11 last. It is essential that cardiology specialists and the medical community in general know its impact at the cardiovascular level. We must know that the information to date comes, mostly from China, from retrospective and single-center analyzes, or from reported cases. Therefore, the statistical data is probably not the real one, but it is what is available to date; and surely some of them have modifications as time goes by.1 Covid-19 infection directly impacts cardiovascular disease. Patients with heart problems are predisposed to infection by the new coronavirus, and also have a higher risk of adverse events. Thus, the infection itself is associated with complications at the heart level.2 When speaking of myocarditis, it imposes great importance on us, because it is a serious clinical entity with permanent evolution from its initial definitions at the beginning of the 19th century to the present, and it is associated with Covid-19 infection.3 Reason for which we present the case of an octogenarian patient, with multiple comorbidities; who develops fulminant myocarditis in the context of Covid-19 infection, and subsequently presented complications; among them superinfection due to severe pneumonia and acute respiratory distress syndrome that led to his death. Objective Describe how myocarditis associated with Covid-19 infection causes sudden damage. Methodology This is a systematic review of fulminant myocarditis in the context of Covid-19 infection and its subsequent complications; emphasizing its clinical, laboratory and imaging characteristics. The information and images obtained belong to the medical personnel in charge of the case, whose reinforcements are provided by the Excel, Word and JPG statistical package.

scholarly journals Sinus bradycardia as the initial manifestation of multisystem inflammatory syndrome in children

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Gonzalez ◽  
I Mendoza Britto ◽  
M Mateu ◽  
E Marcano ◽  
J De Izaguirre ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Sinus Bradycardia ◽  
Case Series ◽  
Intravenous Immunoglobulins ◽  
Cardiovascular Complications ◽  
Laboratory Evaluation ◽  
Initial Manifestation ◽  
Funding Sources ◽  
Coronary Abnormalities ◽  
Inflammatory Syndrome

Abstract Background While cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C. Methods We included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan. Results Of the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted. Treatment All patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins. Conclusion Sinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation. FUNDunding Acknowledgement Type of funding sources: None. Kid, MIS-C. Bradycardia/Atrial Rhythm

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.

Multisystem Inflammatory Syndrome in Children Associated with COVID-19: An Interim Review

2021 ◽  
Author(s):  
Jyoti R. Behera ◽  
Mukesh K. Jain ◽  
Sanjay K. Sahu ◽  
Sibabratta Patnaik
Keyword(s):  
Toxic Shock Syndrome ◽  
Inflammatory Markers ◽  
Myocardial Dysfunction ◽  
Treatment Plan ◽  
Left Ventricular ◽  
World Health ◽  
Left Ventricular Ejection ◽  
Toxic Shock ◽  
Ventricular Ejection Fraction ◽  
Inflammatory Syndrome

AbstractThe pediatric population is relatively less affected by novel coronavirus disease 2019 (COVID-19) compared with adults, both in numbers and severity. However, evolution of a new entity, named multisystem inflammatory syndrome in children (MIS-C), has led to significant number of children being admitted to hospital, especially to intensive care units. Case definitions of MIS-C have been defined by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) separately. Autoantibodies and antibody-dependent enhancement (ADE) are the key factors proposed in pathogenesis, leading to immune dysregulation, and cytokine storm. Three distinct clinical types are observed as follows: (1) fever and elevated inflammatory markers with no end-organ damage; (2) shock with severe myocardial dysfunction similar to toxic shock syndrome (TSS); and (3) with mucocutaneous features like Kawasaki's disease (KD). Cardiovascular and gastrointestinal symptoms are the predominant presentations. Inflammatory markers like C-reactive protein (CRP), ferritin, and interleukin (IL)-6 are raised along with high D-dimer and lactate dehydrogenase (LDH). Echocardiography may demonstrate low left ventricular ejection fraction (<50%) and/or coronary aneurysms. Reverse-transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is usually negative, with most having antibodies against the virus. KD, KD shock syndrome (KDSS), and toxic shock syndrome (TSS) are the important differential diagnoses to be considered. Immunomodulatory therapy is the cornerstone of the management. Intravenous immunoglobulin (IVIg) is preferred, the next option being steroids. Supportive care, antiplatelet, and anticoagulation medications, when indicated, are also vital aspects of treatment plan. The prognosis is favorable with low mortality but meticulous cardiac monitoring and follow-up by a multidisciplinary team is very important. Being an evolving disease, future research may reveal different manifestations, newer diagnostic modalities, and better treatment options.

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