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 Multisystem Inflammatory Syndrome in Children and Adolescents Associated with COVID-19: Review

2020 ◽  
Vol 07 (04) ◽  
pp. 13-15 ◽  
Author(s):  
BS Mahapatra ◽  
Keyword(s):  
Early Recognition ◽  
Artery Aneurysm ◽  
Multidisciplinary Care ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Immune Mediated ◽  
Life Threatening ◽  
Adolescent And Young Adults ◽  
Inflammatory Syndrome

Multisystem Inflammatory Syndrome in Children (MIS-C) is a newly recognized multiorgan disease seen in children, adolescent and young adults presumed to be a delayed immune mediated complication of Corona virus 2 (SARS-CoV-2) infection leading to severe acute respiratory syndrome. MIS-C can be associated with life threatening organ dysfunction requiring complex multidisciplinary care. Early recognition is important in order to prevent complication and serious sequalae. Because it is a post infective complication, in most of the cases RT-PCR comes negative though antibodies to COVID-19 are positive. Although SARS-CoV-2 in children are generally mild and nonfatal, there is increasing evidence of MIS-C. Clinical and laboratory features of MIS-C are similar to those of Kawasaki disease like syndrome and Toxic Shock Syndrome. Pathophysiology of MIS-C is still unclear and mainly due to formation of autoantibody and immune complex which activates inflammation. Most of the MIS-C associated with COVID-19, need treatment with ionotropic agents and anticoagulants. The long-term outcome of MIS-C like coronary artery aneurysm formation remain unknown and needs close follow up.

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.

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 Myocardial involvement in children with post-COVID multisystem inflammatory syndrome: a cardiovascular magnetic resonance based multicenter international study—the CARDOVID registry

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Florence A. Aeschlimann ◽  
Nilanjana Misra ◽  
Tarique Hussein ◽  
Elena Panaioli ◽  
Jonathan H. Soslow ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular Systolic Dysfunction ◽  
Acute Myocarditis ◽  
Systolic Dysfunction ◽  
Disease Onset ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
World Health ◽  
Inflammatory Syndrome

Abstract Background Recent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort. Methods and results Hundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0–13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19–47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87–23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18–21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction. Conclusion No CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage. Clinical trial registration: The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.

scholarly journals Inflammation and Endothelial Injury Profiling in COVID-19 Pediatric Multi-system Inflammatory Syndrome

2020 ◽  
Author(s):  
Douglas Fraser ◽  
Eric Patterson ◽  
Mark Daley ◽  
Gedaminas Cepinskas
Keyword(s):  
Clinical Signs ◽  
Gastrointestinal Symptoms ◽  
Endothelial Injury ◽  
Clinical Severity ◽  
Blood Draw ◽  
Case Presentation ◽  
Cardiac Inflammation ◽  
Markers Of Inflammation ◽  
Inflammatory Syndrome ◽  
Plasma Measurements

Abstract Background COVID-19 is associated with a novel multi-system inflammatory syndrome that shares some characteristics with Kawasaki’s Disease. The syndrome manifestation is delayed relative to COVID-19 onset, with a spectrum of clinical severity. Clinical signs may include persistent fever, gastrointestinal symptoms, cardiac inflammation and/or shock. Case Presentation: We measured 59 inflammatory and endothelial injury plasma analytes in an adolescent girl that presented with malaise, fever, cough, strawberry tongue and jaundice. Her COVID-19 status was positive with detection of 2 SARS-CoV-2 viral genes using polymerase chain reaction. She was treated with intravenous immunoglobulin prior to blood draw, but our plasma measurements suggested a unique analyte expression pattern associated with inflammation, endothelial injury and microvascular glycocalyx degradation. Conclusions COVID-19 is associated with a multi-system inflammatory syndrome and a unique inflammatory and endothelial injury signature. Analyte markers of inflammation and endothelium injury might serve as putative biomarkers and/or be investigated further as potential therapeutic targets.

scholarly journals Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Satoshi Takasago ◽  
Aiko Sakai ◽  
Masaya Sugiyama ◽  
Masashi Mizokami ◽  
Hiromichi Hamada ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Acute Myocarditis ◽  
Severe Disease ◽  
Gastrointestinal Symptoms ◽  
Disease Status ◽  
Classical Trajectory ◽  
Course Of Disease ◽  
Old Japanese ◽  
Cervical Swelling ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in children (MIS-C) is a severe disease that is reportedly linked to coronavirus disease 2019. Affected patients present with gastrointestinal symptoms and cardiovascular dysfunction, in addition to Kawasaki disease-like features, suggesting the potential for overlapping disease mechanisms. Kawasaki disease has been reported among individuals of East Asian ethnicities, whereas there is minimal clinical literature regarding the occurrence of MIS-C among individuals of Asian ethnicities. A few reports thus far have described changes in cytokine kinetics during the course of disease in patients with MIS-C. We followed the temporal cytokine kinetics in a 9-year-old Japanese girl who exhibited a classical trajectory of MIS-C. The patient exhibited right cervical swelling and pain, abdominal pain, vomiting, and lip reddening, which developed 31 days after she was diagnosed with severe acute respiratory syndrome coronavirus-2 infection. The patient was diagnosed with Kawasaki disease on her fifth day of illness; because she fulfilled the criteria for MIS-C, she was also diagnosed with this disease on her fifth day of illness. Her fever rapidly resolved upon administration of intravenous immunoglobulin, aspirin, and prednisolone. On the patient's sixth day of illness, she developed acute myocarditis, which was treated with two diuretics and one vasodilator; the myocarditis ameliorated within a few days. Analyses of temporal kinetics for 71 serum cytokines revealed several patterns of cytokine changes that were consistent with the patient's clinical course of disease. Importantly, there was a clear distinction between cytokines that did and did not decrease rapidly following post-treatment fever resolution. These findings may be useful for the assessment of disease status and selection of therapy in patients with similar symptoms; they may also provide insights for basic and clinical research regarding MIS-C.

scholarly journals The “Golden Hours” Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C)

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199033
Author(s):  
Sanaa Mahmoud ◽  
Eman M Fouda ◽  
Alyaa Kotby ◽  
Hanan M Ibrahim ◽  
Mervat Gamal ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Risk Groups ◽  
Intravenous Immunoglobulins ◽  
High Risk Group ◽  
Circulatory Support ◽  
Clinical Approach ◽  
Number Of Children ◽  
Isolation Ward ◽  
Inflammatory Syndrome

The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.

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.

scholarly journals Case Report: Inflammation and Endothelial Injury Profiling of COVID-19 Pediatric Multisystem Inflammatory Syndrome (MIS-C)

2021 ◽  
Vol 9 ◽  
Author(s):  
Douglas D. Fraser ◽  
Eric K. Patterson ◽  
Mark Daley ◽  
Gediminas Cepinskas
Keyword(s):  
Cell Injury ◽  
Clinical Signs ◽  
Gastrointestinal Symptoms ◽  
Endothelial Injury ◽  
Clinical Severity ◽  
Blood Draw ◽  
Cardiac Inflammation ◽  
Markers Of Inflammation ◽  
Inflammatory Syndrome ◽  
Plasma Measurements

Introduction: COVID-19 is associated with a novel multi-system inflammatory syndrome that shares some characteristics with Kawasaki's Disease. The syndrome manifestation is delayed relative to COVID-19 onset, with a spectrum of clinical severity. Clinical signs may include persistent fever, gastrointestinal symptoms, cardiac inflammation and/or shock.Case Presentation: We measured 59 inflammatory and endothelial injury plasma analytes in an adolescent girl that presented with malaise, fever, cough, strawberry tongue and jaundice. Her COVID-19 status was positive with detection of 2 SARS-CoV-2 viral genes using polymerase chain reaction. She was treated with intravenous immunoglobulin prior to blood draw, but our plasma measurements suggested a unique analyte expression pattern associated with inflammation, endothelial injury and microvascular glycocalyx degradation.Conclusions: COVID-19 is associated with a multi-system inflammatory syndrome and a unique inflammatory and endothelial injury signature.Summary: Analyte markers of inflammation and endothelial cell injury might serve as putative biomarkers and/or be investigated further as potential therapeutic targets.

scholarly journals An Arab Adolescent with Multisystem Inflammatory Syndrome Associated with COVID-19: A Report from Syria

2021 ◽  
Author(s):  
Jaafer Zaino ◽  
Abdullah Bakri ◽  
Amani Al Sayed Ahmad ◽  
Ghadeer Hadba
Keyword(s):  
Inflammatory Markers ◽  
Gastrointestinal Symptoms ◽  
Epidemiological Data ◽  
Intravenous Immunoglobulins ◽  
Arab Countries ◽  
Rt Pcr ◽  
High Grade Fever ◽  
Multiorgan Dysfunction ◽  
Laboratory Profile ◽  
Inflammatory Syndrome

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a rare and critical condition that affects children following exposure to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, leading to multiorgan dysfunction and shock. MIS-C has been reported from different parts of the world but rarely from Arab countries. In this report, we describe a 15-year-old Arab boy who was admitted to the ICU during the surge of Coronavirus transmission in Syria with a clinical picture consistent with MIS-C, including high-grade fever, gastrointestinal symptoms, rash, multiorgan dysfunction, and shock. Laboratory profile showed significant elevation of inflammatory markers, negative SARS-CoV-2 RT-PCR testing but positive serologic testing for SARS-CoV-2. The patient received intravenous immunoglobulins (IVIG) and glucocorticoids with remarkable cardiac improvement and significant alleviation in inflammatory markers. To our knowledge, this is the first reported case of MIS-C from Syria, which adds to the epidemiological data about this new syndrome.

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