Unique presentations of the post COVID-19 infection, multisystem inflammatory syndrome in children.

2021 ◽  
Author(s):  
Amit Nahum ◽  
Keren Rochwerger-Biham
Keyword(s):  
Inflammatory Responses ◽  
Wall Thickening ◽  
Systemic Involvement ◽  
Prolonged Fever ◽  
Immune Mediated ◽  
Mild Reduction ◽  
Myocardial Involvement ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome ◽  
Post Infectious

Introduction: The epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing COVID-19, continuous to affect most of the world's population. In children, the respiratory and systemic involvement appears to have a much more benign course in comparison to adults, with almost no fatalities reported. However, we are encountering a post-infectious immune mediated condition, termed, multisystem inflammatory syndrome in children (MIS-C). In most cases the main features are prolonged fever and elevation of inflammatory markers, many of the patients present with abdominal pain and varying degree of myocardial involvement from mild reduction in cardiac output to the most alarming manifestation of cardiovascular shock. Results: We present two patients with unusual manifestations of MIS-C, related to post COVID-19 infection, an infant born to a mother who was severely ill at the very end of pregnancy, presenting with prolonged fever, rash, pericardial effusion, and evidence of coronary arteries wall thickening as a result of inflammation, and, a teenage girl with severe cardiac tamponade without the more common cardiac manifestations of myocardial involvement. Discussion: Post COVID-19 MIS-C can present in a wide variety of manifestations. The pathophysiologic mechanism underlying these inflammatory responses in infants are yet to be elucidated. Physicians should be aware of such presentations since rapid diagnosis and treatment are key for favorable outcome.

scholarly journals Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 572
Author(s):  
Ravindra Pawar ◽  
Vijay Gavade ◽  
Nivedita Patil ◽  
Vijay Mali ◽  
Amol Girwalkar ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Case Series ◽  
Feeding Intolerance ◽  
Av Block ◽  
Igm Antibodies ◽  
Immune Mediated ◽  
History Of ◽  
Exposure During Pregnancy ◽  
Inflammatory Syndrome ◽  
Post Infectious

Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed.

scholarly journals Post-infectious inflammatory syndrome associated with SARS-CoV-2 in a paediatric patient with Down syndrome

2021 ◽  
Vol 14 (4) ◽  
pp. e240490
Author(s):  
Mellad Khoshnood ◽  
Roshan Mahabir ◽  
Nick M Shillingford ◽  
Jonathan D Santoro
Keyword(s):  
Down Syndrome ◽  
Paediatric Patient ◽  
Cerebrovascular Accident ◽  
Neurological Complications ◽  
Infectious Period ◽  
Unique Case ◽  
Cardiac Lesion ◽  
Immune Mediated ◽  
Inflammatory Syndrome ◽  
Post Infectious

Neurological complications of SARS-CoV-2 continue to be recognised. In children, neurological phenomenon has been reported generally in the acute infectious period. It is possible that SARS-CoV-2 could trigger an immune-mediated post-infectious phenomenon. Here, we present a unique case of post-infectious marantic cardiac lesion causing cerebrovascular accident in a patient with Down syndrome.

COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

2021 ◽  
pp. 1-3
Author(s):  
Lesya G. Tomlinson ◽  
Mitchell I. Cohen ◽  
Rebecca E. Levorson ◽  
Megan B. Tzeng
Keyword(s):  
Inflammatory Process ◽  
Myocardial Dysfunction ◽  
Sinus Node ◽  
Qtc Prolongation ◽  
Mild Disease ◽  
Abnormal Immune Response ◽  
Idioventricular Rhythm ◽  
Inflammatory Syndrome ◽  
Electrocardiographic Abnormalities ◽  
Post Infectious

Abstract SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.

scholarly journals COVID-19 related multisystem inflammatory syndrome in children (MIS-C): Role of 18F-FDG PET/CT to assess myocardial involvement

2021 ◽  
Author(s):  
Swayamjeet Satapathy ◽  
Rajender Kumar ◽  
Anwin Joseph Kavanal ◽  
Venkata Subramanian Krishnaraju ◽  
Arivan Ramachandran ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Pet Ct ◽  
Myocardial Involvement ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Inflammatory Syndrome

scholarly journals Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199661
Author(s):  
Anuja R. Shikhare ◽  
Rimsha M. Iqbal ◽  
Rabail Tariq ◽  
Daniel R. Turner ◽  
Bassam M. Gebara ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Asymptomatic Infection ◽  
Cardiac Monitoring ◽  
Delayed Presentation ◽  
Terminal Ileitis ◽  
Serologic Evidence ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

scholarly journals Adjuvant corticosteroid therapy in hepatosplenic candidiasis-related IRIS

2012 ◽  
Vol 4 (1) ◽  
pp. e2012018 ◽  
Author(s):  
Cengiz Bayram ◽  
Ali Fettah ◽  
Nese Yarali ◽  
Abdurrahman Kara ◽  
Fatih Mehmet Azik ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Immune Reconstitution ◽  
Inflammatory Responses ◽  
Clinical Symptoms ◽  
Lymphoblastic Leukemia ◽  
Laboratory Findings ◽  
Hepatosplenic Candidiasis ◽  
Cell Acute Lymphoblastic Leukemia ◽  
Inflammatory Syndrome ◽  
Standard Risk

Hepatosplenic candidiasis (HSC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy and requires protracted antifungal therapy. Immune reconstitution inflammatory syndrome (IRIS) is best characterized as a dysregulated inflammatory responses triggered by rapid resolution of immunosuppression.We present a child diagnosed with standard-risk precursor B cell-acute lymphoblastic leukemia who developed HSC and Candida-related IRIS during recovery of neutropenia associated with induction chemotherapy. Addition of corticosteroid therapy to antifungal treatment is associated with the resolution of the clinical symptoms and laboratory findings

Chia oil prevents chemical and immune-mediated inflammatory responses in mice: Evidence for the underlying mechanisms

2021 ◽  
Vol 149 ◽  
pp. 110703
Author(s):  
Juliana Cavalli ◽  
Mariana A. Freitas ◽  
Elaine C.D. Gonçalves ◽  
Guilherme P. Fadanni ◽  
Adara A. Santos ◽  
...  
Keyword(s):  
Inflammatory Responses ◽  
Immune Mediated ◽  
Underlying Mechanisms ◽  
Chia Oil

scholarly journals DNA damage independent inhibition of NF-κB transcription by anthracyclines

2020 ◽  
Author(s):  
Angelo Chora ◽  
Dora Pedroso ◽  
Nadja Pejanovic ◽  
Eleni Kyriakou ◽  
Henrique Colaço ◽  
...  
Keyword(s):  
Dna Damage ◽  
Transcription Factors ◽  
Binding Sites ◽  
Inflammatory Responses ◽  
Inflammatory Diseases ◽  
Anticancer Properties ◽  
Dna Binding Sites ◽  
Immune Mediated ◽  
Life Threatening ◽  
Molecular Patterns

AbstractTranscriptional programs leading to induction of a large number of genes can be rapidly initiated by the activation of only few selected transcription factors. Upon stimulation of macrophages with microbial-associated molecular patterns (MAMPs), the activation of the nuclear factor kappa B (NF-κB) family of transcription factors triggers inflammatory responses that, left uncontrolled, can lead to excessive inflammation with life-threatening consequences for the host. Here we identify and characterize a novel effect of Anthracyclines, a class of drugs currently used as potent anticancer drugs, in the regulation of NF-κB transcriptional activity in BMDMs, in addition to the previously reported DNA damage and histone eviction. Anthracyclines, including Doxorubicin, Daunorubicin and Epirubicin, disturb the complexes formed between the NF-κB subunit RelA and its DNA binding sites, to limit NF-κB-dependent gene transcription during inflammatory responses, including of pivotal pro-inflammatory mediators such as TNF. We observed that suppression of inflammation can also be mediated by Aclarubicin, Doxorubicinone and the newly developed Dimethyl-doxorubicin, which share anticancer properties with the other Anthracyclines, but do not induce DNA damage in the tested concentrations. This novel mechanism of action of Anthracyclines, contributing to the reduction of inflammation, is thus independent of the activation of DNA damage responses and may be relevant for the development of novel strategies targeting immune-mediated inflammatory diseases.

scholarly journals Effects of PARP-1 Deficiency on Th1 and Th2 Cell Differentiation

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
M. Sambucci ◽  
F. Laudisi ◽  
F. Novelli ◽  
E. Bennici ◽  
M. M. Rosado ◽  
...  
Keyword(s):  
Cell Differentiation ◽  
Inflammatory Responses ◽  
Inhibitory Effect ◽  
Th2 Cells ◽  
Cell Functions ◽  
Th2 Cell ◽  
Gene Ablation ◽  
Immune Mediated ◽  
Parp 1 ◽  
Th1 And Th2

T cell differentiation to effector Th cells such as Th1 and Th2 requires the integration of multiple synergic and antagonist signals. Poly(ADP-ribosy)lation is a posttranslational modification of proteins catalyzed by Poly(ADP-ribose) polymerases (PARPs). Recently, many reports showed that PARP-1, the prototypical member of the PARP family, plays a role in immune/inflammatory responses. Consistently, its enzymatic inhibition confers protection in several models of immune-mediated diseases, mainly through an inhibitory effect on NF-κB (and NFAT) activation. PARP-1 regulates cell functions in many types of immune cells, including dendritic cells, macrophages, and T and B lymphocytes. Our results show that PARP-1KO cells displayed a reduced ability to differentiate in Th2 cells. Under both nonskewing and Th2-polarizing conditions, naïve CD4 cells from PARP-1KO mice generated a reduced frequency of IL-4+cells, produced less IL-5, and expressed GATA-3 at lower levels compared with cells from wild type mice. Conversely, PARP-1 deficiency did not substantially affect differentiation to Th1 cells. Indeed, the frequency of IFN-γ+cells as well as IFN-γproduction, in nonskewing and Th1-polarizing conditions, was not affected by PARP-1 gene ablation. These findings demonstrate that PARP-1 plays a relevant role in Th2 cell differentiation and it might be a target to be exploited for the modulation of Th2-dependent immune-mediated diseases.

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