COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart

2021 ◽  
Vol 48 ◽  
Author(s):  
LORAINE ENTRINGER FALQUETO ◽  
CAROLINA MARTINS VISSOCI ◽  
ISABELLA CRISTINA BONETTO FERREIRA ◽  
AMANDA GINANI ANTUNES ◽  
FERNANDO ANTÔNIO BERSANI AMADO ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Initial Phase ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Pediatric Hospital ◽  
Inflammatory Syndrome

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.

scholarly journals Multisystem inflammatory syndrome in children associated with COVID-19: nursing care

2021 ◽  
Vol 11 (2) ◽  
pp. 10-17
Author(s):  
Sofia Panato Ribeiro ◽  
Simone Boettcher
Keyword(s):  
Nursing Care ◽  
Pediatric Patients ◽  
Quality Care ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Viral Disease ◽  
Provide Quality Care ◽  
Generalized Lymphadenopathy ◽  
Inflammatory Syndrome

In 2019, a new viral disease, known as SARS-Cov-2 infection, was identified. Scientists believed that it was a disease with low morbidity for pediatric patients; however, a small percentage of children infected with the new coronavirus developed a multisystem inflammatory response, which aroused the interest of many researchers and health professionals. The objective of the study is to describe the main characteristics related to the Pediatric Multisystemic Inflammatory Syndrome Associated with Covid-19 (MIS-C), its complications and nursing care. The main clinical manifestations of MIS-C are hyperthermia, gastrointestinal symptoms, skin manifestations, generalized lymphadenopathy, cardiac and neurological disorders. The main nursing care was listed according to the signs and symptoms, such as monitoring of neurological and hydroelectrolytic changes. The nurse professional must add knowledge about MIS-C so that he is able to qualify his care and improve his skills to provide quality care to pediatric patients.

Acute abdomen: syndromes and causes of surgeries in a hospital of taubaté − sp

2008 ◽  
Vol 2 (2) ◽  
pp. 165
Author(s):  
Ana Lucia De Faria ◽  
Silvana Novaes ◽  
Monica Silva Gonçalves ◽  
Regina Celia C Peres
Keyword(s):  
Septic Shock ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Signs And Symptoms ◽  
Age Group ◽  
Inflammatory Syndrome ◽  
Hospital General

ABSTRACTAcute abdomen refers to a not traumatic disorder located in the bowels of the abdominal cavity and classifies itself in five syndromes named, inflammatory perforating, obstructive, hemorrhagic and vascular. The signs and symptoms are: abdominal pain that is installed of quick and sudden form, vomiting, fever, interruption of the elimination of gases and evacuation. The aim was identify the syndromes and the causes of surgeries resulting on acute abdomen in patients interned and submitted to a surgical intervention in a General Hospital of the Taubaté - SP. The research was the type retrospective, documentary, descriptive and quantitative, in the period 2004 to 2006. The results showed that the 91 (100%) cases studied prevailing male in the 55 (60,44%); the surgery occurred more in the age group of 40-49 years in 16 (17,58%); among the signs and symptoms abdominal pain was present in (100%) and vomiting in 41 (29,50%); due to the higher incidence of surgery was acute appendicitis with 45 (49,45%); the predominant syndrome was the inflammatory in 49 (53,85%), but perforating appeared in 23 (25,27%) to be obstructive in 18 (19,78%), vascular in 1 (1,10%) of the cases; the most frequent cause of death was septic shock in 10 (38,46%); the mortality prevailed in the age group between 80 to 89 years old with 5 (45,46%), with perforating syndrome in 6 (54,55%). It is concluded that the inflammatory syndrome and the cause appendicitis were the most frequent. Descriptors: acute abdomen; surgery; mortality.RESUMOAbdome agudo refere-se a uma afecção não traumática, localizada nas vísceras da cavidade abdominal, e classifica-se em cinco síndromes, nomeadas de: inflamatória, perfurativa, obstrutiva, hemorrágica e vascular. Os sinais e sintomas são: dor abdominal que se instala de forma súbita e rápida, vômito, febre, interrupção da eliminação de gases e fezes. O objetivo da pesquisa foi identificar as síndromes e as causas de cirurgias decorrentes do quadro de abdome agudo em pacientes internados e submetidos a uma intervenção cirúrgica em um Hospital Geral de Taubaté - SP. A pesquisa foi do tipo retrospectiva, documental, descritiva e quantitativa, no período de 2004 a 2006. Os resultados mostraram que, dos 91 (100%) casos estudados, o sexo masculino predominou em 55 (60,44%); as cirurgias ocorreram mais na faixa etária de 40-49 anos de idade, em 16 (17,58%); dentre os sinais e sintomas, a dor abdominal esteve presente em 100%, e o vômito, em 41 (29,50%); a causa cirúrgica de maior incidência foi a apendicite aguda, em 45 (49,45%); a síndrome predominante foi a inflamatória, em 49 (53,85%), a perfurativa apareceu em 23 (25.27%), a obstrutiva em 18 (19,78%),e a vascular, em 1 (1,10 %) dos casos; a causa de morte mais frequente foi o choque séptico, em 10 (38,46%); a mortalidade prevaleceu na faixa etária entre 80 e 89 anos de idade, em 5 (45,46%), com síndrome perfurativa em 6 (54,55%). Concluiu-se que a síndrome inflamatória foi predominante e que a apendicite foi a causa mais freqüente de cirurgia. Descritores: abdome agudo; cirurgia; mortalidade.RESUMENAbdomen agudo se refiere a un trastorno no traumático que se  encuentra en las vísceras de la cavidad abdominal y se clasifica en cinco síndromes nombrados de inflamatorio, perforativa, obstructiva, hemorrágica y vasculares. Las señales y síntomas son: dolor abdominal que se instalan de forma repentina y rápida, vómitos, fiebre, interrupción en la eliminación de gases y heces. El objetivo era determinar los síndromes y las causas de cirugías derivadas del cuadro de abdomen agudo en pacientes hospitalizados y sometidos a un procedimiento quirúrgico en el Hospital General del Taubate - SP. La investigación es del tipo retrospectivo, documental, descriptivo y cuantitativo, en el período de 2004 a 2006. Los resultados mostraron que de los 91 (100%) casos estudiados predominó el sexo masculino en 55 (60,44%); La cirugía ocurrieron en más frecuencia en el grupo de edad de 40 -49 años en 16 (17,58%); entre las señales y síntomas el dolor  abdominal estuvo presente en el (100%) y los vómitos en 41 (29,50%) la causa de cirugía de mayor incidencia fue apendicitis aguda con 45 (49,45%); El síndrome predominante  fue la inflamatoria en 49 (53, 85% ), Pero  perforativa apareció en 23 (25,27%), la obstructiva en 18 (19,78%), vasculares en 1 (1,10%) de los casos; la causa más frecuente de muerte fue el  choque séptico, 10 (38,46%); Prevaleció la mortalidad en el grupo de edad entre 80 a 89 años con 5 (45,46%), con síndrome  perforativa en 6 (54,55%). Se concluye que la síndrome inflamatoria y la causa apendicitis fueron las más frecuentes. Descriptores: abdomen agudo; cirurgía; mortalidad. 

scholarly journals Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru

Medwave ◽  
2021 ◽  
Vol 21 (01) ◽  
pp. e8107-e8107
Author(s):  
Jesús Domínguez Rojas ◽  
Matilde Estupiñan Vigil ◽  
Raquel Garcés-Ghilardi ◽  
Giancarlo Alvarado-Gamarra ◽  
Olguita del Águila ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Abdomen ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Inflammatory Syndrome

Introduction Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.

scholarly journals SARS-CoV-2 identification in an acute appendicitis case: Acute abdomen as manifestation of Multisystem Inflammatory Syndrome in a child with COVID-19

2021 ◽  
pp. 101651
Author(s):  
Amanda Munhoz Serra ◽  
Andréa Maria Cordeiro Ventura ◽  
Lucas Freitas Xavier ◽  
Angélica Braz Simões ◽  
Amaro Nunes Duarte-Neto
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Inflammatory Syndrome

scholarly journals Gastrointestinal manifestations as the initial presentation of COVID 19 in pediatrics

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Ana Leticia Souza ◽  
Flavia Matos ◽  
Rosana Flintz ◽  
Roberta Marliere ◽  
Mariana Presti ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Positive Serology ◽  
Hospital Unit ◽  
Gastrointestinal Conditions ◽  
Clinical Presentations ◽  
Starting Point ◽  
Initial Symptoms

Initial research on SARS-COV 2 (Severe Acute Respiratory Syndrome Coronavirus 2) appeared to demonstrate that children infected with the virus remained asymptomatic or had only mild to moderate conditions. The most common symptoms were fever and cough. However, in a later phase of the pandemic, numerous other aspects of clinical presentation in the pediatric public were observed, especially gastrointestinal conditions. In the present study, patients monitored at the Pediatric Intensive Care Unit of the Hospital Estadual Adão Pereira Nunes from April 17, 2020 until June 17, 2020, who had detectable PCR-RT (Polymerase Chain Reaction -Trasncriptase) or positive serology for COVID 19 (Coronavirus disease 19). This is a hospital unit that is not a reference for COVID 19, and its target audience is trauma victims.The initial symptoms of most hospitalized patients with clinical suspicion were fever and gastrointestinal symptoms, with significant abdominal pain standing out, mimicking acute abdomen. Signs and symptoms that differ from adults, who have respiratory manifestations as a starting point. Based on the recognition of the different clinical presentations of SARS-COV 2 in the pediatric population, an early diagnosis is possible, with better conduction and outcome.

scholarly journals A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

PRILOZI ◽  
2021 ◽  
Vol 42 (2) ◽  
pp. 95-101
Author(s):  
Lidija Kareva ◽  
Katarina Stavrik ◽  
Kristina Mironska ◽  
Arjeta Hasani ◽  
Sonja Bojadzieva ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Close Contact ◽  
Multiorgan Failure ◽  
Gastrointestinal Symptoms ◽  
Gastrointestinal Diseases ◽  
Serological Testing ◽  
Inflammatory Syndrome ◽  
Pcr Test

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

scholarly journals Post-Discharge Telephonic Follow-Up of Pediatric Patients Affected by SARS-CoV2 Infection: A Safe and Feasible Way to Monitor Children After Hospitalization. The Experience of a Single Italian Pediatric COVID Center.

2021 ◽  
Author(s):  
Vitangelo Clemente ◽  
Costanza Tripiciano ◽  
Patrizio Moras ◽  
Daniele Deriu ◽  
Martina Di Giuseppe ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Social Issues ◽  
Pediatric Hospital ◽  
Post Discharge ◽  
Pharyngeal Swab ◽  
Viral Shedding ◽  
Discharge From Hospital ◽  
Inflammatory Syndrome

Abstract BackgroundSARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring.Materials and Methods65 children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs.ResultsDuring the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. 1 patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days.ConclusionOur experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

scholarly journals Case Report: Pediatric Patient with COVID-19 and Multisystem Inflammatory Syndrome in Children

2020 ◽  
Vol 4 (4) ◽  
pp. 513-516
Author(s):  
MacKenzie Burger ◽  
Marcus Moore ◽  
John Wilburn
Keyword(s):  
Case Report ◽  
Risk Stratification ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Pediatric Patient ◽  
Pediatric Patients ◽  
Signs And Symptoms ◽  
Unique Case ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Inflammatory Syndrome

Introduction: Coronavirus disease 2019 (COVID-19) rarely manifests with severe complications in pediatric patients. An association between COVID-19 and a Kawasaki-like inflammatory syndrome has recently presented in pediatric patients. Case Report: We report a unique case of multisystem inflammatory syndrome in children presenting with characteristic findings in a child who later developed cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. Conclusion: Recognition of these early signs and symptoms facilitates screening and risk stratification of pediatric COVID-19 cases associated with increased morbidity.

Collagen Cross-linking for the Treatment of Keratoconus in Pediatric Patients

2015 ◽  
Vol 4 (3) ◽  
pp. 94-99
Author(s):  
Jamyl Habib Castillo ◽  
Beatrice Tiosano ◽  
Rana Hanna ◽  
Eran Berkwitz
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Corneal Transplantation ◽  
Signs And Symptoms ◽  
Cross Linking ◽  
Pediatric Age Group ◽  
Uva Light ◽  
Corneal Rigidity ◽  
New Treatment ◽  
Collagen Cross Linking

ABSTRACT Keratoconus (KC) is a bilateral noninflammatory, ectatic corneal disorder. It is the most common primary ectasia affecting approximately 1 in 2,000 in the general population. Classically, the disease starts in puberty and progresses throughout the 3rd or 4th decades of life. Ocular signs and symptoms vary depending on disease severity. As the disease progresses, approximately 20% of KC eyes require penetrating keratoplasty. Collagen cross-linking (CXL) with ultraviolet-A (UVA) light and riboflavin is a new treatment that has emerged in the recent years. It is reported to slow the progression of the disease in its early stages, by increasing corneal rigidity and biomechanical stability. As the number of adult KC patients treated using this procedure grew, proving its safety and high efficacy, the pediatric KC patients population has started to receive special attention. In the pediatric KC patients’ eyes, corneas have been shown to be significantly steeper at the time of diagnosis compared to adults, and the severity of KC seems inversely correlated with age. Since treating KC in earlier age may be beneficiary, before developing an advanced disease that may require corneal transplantation, CXL in the pediatric age group has been advocated by many practitioners. The aim of this review is to collect and consolidate all known data regarding the efficacy and safety of CXL in the pediatric population. How to cite this article Hanna R, Berkwitz E, Castillo JH, Tiosano B. Collagen Cross-linking for the Treatment of Keratoconus in Pediatric Patients. Int J Kerat Ect Cor Dis 2015;4(3):94-99.

scholarly journals Post-discharge telephonic follow-up of pediatric patients affected by SARS-CoV2 infection in a single Italianpediatric COVID center: a safe and feasible way to monitor children after hospitalization

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Vitangelo Clemente ◽  
Costanza Tripiciano ◽  
Patrizio Moras ◽  
Daniele Deriu ◽  
Martina Di Giuseppe ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Social Issues ◽  
Pediatric Hospital ◽  
Post Discharge ◽  
Pharyngeal Swab ◽  
Viral Shedding ◽  
Discharge From Hospital ◽  
Inflammatory Syndrome

Abstract Background SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. Materials and methods Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. Results During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. Conclusion Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

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