CLINICAL, LABORATORY-INSTRUMENTAL CHARACTERISTICS, COURSE AND THERAPY OF PEDIATRIC MULTISYSTEM INFLAMMATORY SYNDROME ASSOCIATED WITH COVID-19

2020 ◽  
Vol 99 (6) ◽  
pp. 73-83
Author(s):  
Yu.Yu. Novikova ◽  
◽  
D.Yu. Ovsyannikov ◽  
A.A. Glazyrina ◽  
O.I. Zhdanova ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Intensive Therapy ◽  
Gastrointestinal Symptoms ◽  
Arterial Hypotension ◽  
Therapy Outcomes ◽  
Clinical Hospital ◽  
Severe Manifestation ◽  
Symptom Complex ◽  
Coronavirus Infection ◽  
Inflammatory Syndrome

The most severe manifestation of the new coronavirus infection COVID-19 in children is the multisystem inflammatory syndrome in children (MIS-C). A systematic review of foreign publications as of July 25, 2020 contains an analysis of the disease course in 662 children with this syndrome and is used for comparison with the data obtained. Objective of the research: to characterize clinical manifestation, results of laboratory and instrumental studies, therapy, outcomes and consequences of the COVID-19- associated MIS-C, based on the observation of patients hospitalized to Morozov Children's City Clinical Hospital and Children’s clinical hospital of infectious diseases № 6 from May 1 to September 15, 2020. Materials and methods: the pilot study included 32 children aged 9 months – 15 years with COVID-19-associated MIS-C, verified based on WHO criteria (2020), including symptoms of Kawasaki disease (KD), arterial hypotension/shock, laboratory and instrumental signs of heart damage, signs of coagulopathy, gastrointestinal symptoms, increased inflammation markers, COVID-19 markers. Results: the median age of patients was 6 years, boys predominated among the patients (66%), all patients had antibodies to SARS-CoV-2 (31 children of the IgG class); MIS-C manifested itself as a combination of KD symptom complex (75% of patients) with arterial hypotension/shock (28%), neurological (50%), respiratory (41%), gastrointestinal (59%) symptoms; macrophage activation syndrome (MAS) was verified in 16% of patients. Therapy included intravenous immunoglobulin (75%), systemic glucocorticosteroids (88%), anticoagulants (91%), vasoactive/vasopressor support (31%). In 38% of cases treatment was performed in intensive care unit; one child died. According to echocardiography, 16% of patients had coronariitis, ectasia, and coronary arteries aneurysms. Conclusion: COVID-19-associated MIS-C is characterized by a severe course, cross-features with KD, shock syndrome with KD, MAS which requires intensive therapy and can cause acquired pathology of the cardiovascular system in children.

MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ASSOCIATED WITH COVID-19: RESULTS OF A MULTICENTER STUDY

2021 ◽  
Vol 100 (6) ◽  
pp. 23-31
Author(s):  
Yu.Yu. Novikova ◽  
◽  
D.Yu. Ovsyannikov ◽  
A.A. Glazyrina ◽  
N.N. Zvereva ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Intensive Therapy ◽  
Late Complication ◽  
Clinical Signs ◽  
Open Label ◽  
Atypical Form ◽  
Symptom Complex ◽  
Inflammatory Syndrome ◽  
Symptoms And Signs

Coronavirus disease 2019 (COVID-19) in children in most cases is asymptomatic or mild, and its most severe late complication is multisystem inflammatory syndrome in children (MIS-C). The aim of the study is to find clinical, laboratory and instrumental characteristics, description of therapeutic tactics, including determination of the profile of patients requiring Tocilizumab prescription and the outcomes of MIS-C associated with COVID-19. Materials and methods of research: 245 children aged 3 months – 17 years old were included in the pilot prospective multicenter open-label comparative study with MIS-C associated with COVID-19, verified based on CDC criteria (2020). Results: the median age of patients was 8 [5; 10] years, boys predominated among the patients (57.1%); MIS-C manifested itself as a combination of the symptom complex of Kawasaki disease (KD, 53.1% of patients), more often of atypical form, cardiovascular (66.1%), gastrointestinal (61.2%), neurological (27.3%) symptoms and signs of detection of the urinary (29.4%) and respiratory (19.6%) systems; macrophage activation syndrome (MAS) was diagnosed in 19.5% of patients. Therapy included glucocorticosteroids (97.6%), antibiotics (95.5%), anticoagulants (93.9%), intravenous immunoglobulin (34.7%), vasoactive/vasopressor support (31.8%), Tocilizumab (15.1%), mechanical ventilation (2.4%), extracorporeal membrane oxygenation (0.4%). Patients receiving Tocilizumab, statistically significantly more often compared with patients without this therapy, were in the intensive care unit (ICU, 86.5% versus 40.9%, p<0.001), more often required vasopressor therapy (70.3% versus 25%, p<0.001), had statistically significantly higher markers of laboratory inflammatory activity. Treatment in 47.8% of cases was carried out in an ICU; one child has died. In 4.1%, according to echocardiography, coronaritis, ectasia of the coronary arteries without the formation of persistent aneurysms were detected. Conclusion: MIS-C associated with COVID-19 has clinical signs of KD, often of the incomplete form, accompanied by arterial hypotension/shock, MAS, which requires intensive therapy, and the prescription of Tocilizumab.

scholarly journals Characteristics of CoVID-19 in children: the first experience in the hospital of st. Petersburg

2020 ◽  
Vol 12 (3) ◽  
pp. 56-63 ◽  
Author(s):  
E. A. Dondurey ◽  
L. N. Isankina ◽  
O. I. Afanasyeva ◽  
A. V. Titeva ◽  
T. V. Vishnevskaya ◽  
...  
Keyword(s):  
Blood Test ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Intensive Therapy ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Total Mortality ◽  
Upper Respiratory Tract ◽  
Epidemiological Features ◽  
Upper Respiratory

Objective: to identify the clinical, laboratory and epidemiological features of the new coronavirus (CV) infection in the provision of specialized medical care to children in the megalopolis of the Russian Federation. Methods: 674 cases of hospitalization of patients from birth to 17 years old inclusive with confirmed COVID-19 in the period from March 26 to June 26, 2020 in a children’s multidisciplinary hospital in St. Petersburg. Diagnostics of SARS-COV-2 in upper respiratory tract (URT) smears was carried out by PCR (a set of reagents for detecting RNA of coronavirus 2019-nCoV by PCR with hybridization-fluorescence detection “Vector-PCRRV-2019-nCoV-RG”). Patients underwent 4 (3; 5) repeated examinations depending on the diagnosis of the referral, as well as the duration of the convalescent virus carriage. The analysis of the severity of the course of the disease, the main clinical manifestations and their relationship with the development of pneumonia, as well as the epidemiological features of COVID-19 in children. The duration of inpatient treatment, outcomes and the need for intensive care are described. Changes in a number of laboratory parameters on analyzers made in the USA were assessed: a clinical blood test on a hematological one - Coulter UniCel (Beckman Coulter), a biochemical blood test on a biochemical one - Uni Cel DxC (Beckman Coulter), a coagulogram on a hemostasis analyzer (Instrumentation Laboratory). Results: Overall, there was a favorable course of COVID-19 in children. Intensive therapy was required only in 3.6% of cases with a total mortality rate of 0.15%, Kawasakilike syndrome was recorded in 0.3% of cases. In 1/3 of patients, prolonged viral shedding from the upper respiratory tract was detected. In children, intrafamilial infection from adults was in the lead; schoolchildren accounted for half of all hospitalizations. A distinctive feature of the new infection was mild clinical symptoms with fever and catarrhal symptoms up to 4/5 of cases, gastrointestinal symptoms - in every third patient. There were no significant differences in the severity of the disease by age. Pneumonia, diagnosed in ¾ cases by computed tomography, complicated the course in 13.1% of cases. The defeat of the lungs was accompanied by fever and dry cough, and in a more severe course: desaturation, chest pains, a feeling of insufficiency of inspiration. The age peaks of the incidence of pneumonia were revealed: at 4, 9, 12 years old and at the age of 17 years, the maximum (in 1/3 of cases). Laboratory changes were insignificant and quickly reversible. Conclusion: the course of COVID-19 in children in the megalopolis of Russia is comparable with foreign information. However, taking into account the experience of “Spanish ‘flu”, it is possible that in pediatric practice the number of severe forms and unfavorable outcomes may change in the near future, especially due to the difficulty of diagnosing Kawasaki-like syndrome and the need for a multidisciplinary approach to the treatment of such patients. Currently, the most vulnerable to the new CV are children with severe oncological, neurological and cardiovascular pathology, who have a rapid decompensation of the underlying disease against the background of COVID-19.

scholarly journals Dermatological Manifestations of COVID-19 in Children

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Vivek Athwani ◽  
Sunil Gothwal
Keyword(s):  
Toxic Shock Syndrome ◽  
Gastrointestinal Symptoms ◽  
Skin Lesions ◽  
Skin Involvement ◽  
Toxic Shock ◽  
Cutaneous Manifestations ◽  
Systemic Involvement ◽  
Atypical Kawasaki Disease ◽  
Coronavirus Infection ◽  
Inflammatory Syndrome

: Coronavirus infection 2019 (COVID-19) primarily has a respiratory system and multi-systemic involvement. Respiratory and gastrointestinal symptoms are predominantly seen in children. In adults, few COVID-19 cases are reported with cutaneous manifestations. Although children are less severely affected by COVID-19, there is increasing evidence for skin involvement, which is in the form of chilblain (e.g., lesions, vesicular, and maculopapular) and erythema multiforme (e.g., rash). Also, few COVID-19 cases are presented with a clinical picture of atypical Kawasaki disease and toxic shock syndrome, later defined as pediatric multisystem inflammatory syndrome (PMIS). The present study aims to summarize various skin lesions with COVID-19.

scholarly journals Current, effectiveness of therapy and outcomes of new coronavirus infection: preliminary analysis

2020 ◽  
Vol 12 (2) ◽  
pp. 27-38
Author(s):  
Sergey A. Sayganov ◽  
Vadim I. Mazurov ◽  
Igor G. Bakulin ◽  
Elguja L. Lataria ◽  
S A Artyushkin ◽  
...  
Keyword(s):  
Preliminary Analysis ◽  
Clinical Laboratory ◽  
Treatment Options ◽  
Fatal Outcome ◽  
Age Groups ◽  
Statistical Processing ◽  
Complex Therapy ◽  
Symptom Complex ◽  
Coronavirus Infection ◽  
D Dimer

Relevance. Verification of a new coronavirus infection (COVID-19) requires clear algorithms for the diagnosis and treatment of patients, depending on clinical, laboratory and instrumental dates. Timely and informed decisions on optimizing management tactics and prescribing proactive anti-inflammatory therapy before development of a complete symptom complex life threatening conditions are needed in some cases. Aim of the study. To analyze the course and outcomes of a new coronavirus infection, depending on the initial characteristics of the patients and treatment options. Materials and methods. A preliminary analysis of the case histories of 129 people hospitalized in the center for treating patients with a new coronavirus infection at North-Western State Medical University n.a. I.I. Mechnikov was made by random sampling. Among the hospitalized patients there were 67 men (51.9%), the average age was 57.9 16.4 years, 62 women (48.1%), and the average age was 60.2 13.6 years. During hospitalization, all patients underwent standard clinical laboratory and instrumental examination, as well as determination of saturation (SpO2), markers of the cytokine storm (CRP, ferritin, AST, D-dimer, fibrinogen, lymphocytes), compute tomography (CT) of the lungs. The effectiveness and safety of therapy was evaluated by the outcome (recovery, death), as well as by the presence of adverse events in the background of the therapy. Statistical processing of the research results was carried out using the Statistica 12 for Windows application software package, the significance of differences between the two relative values was evaluated using the Student t-test (t 2, p 0.05). Results. Fatal outcomes were significantly more frequently recorded among patients of older age groups and males. The presence of concomitant diseases such as obesity, diabetes mellitus, pathology of the cardiovascular system was accompanied by more frequent fatal outcomes. That allows considering comorbidity as a risk factor for severe course and poor prognosis of COVID-19. However, in general, in the presence of the indicated forms of concomitant diseases, it was not possible to establish significant differences with the outcomes of COVID-19, which may be due to an insufficient amount of patients. Predictors of fatal outcome was low values of saturation, the presence of respiratory failure, a significant amount of lung tissue damage (CT-3-4), as well as high values of CRP, ferritin, AST, D-dimer, neutrophilia, lymphopenia, thrombocytopenia. The use of anticytokine drugs (ACD) in complex therapy can be considered a favorable predictor of outcome, which indicates the advisability of wider use. The materials of the study allow not only a preliminary assessment of the course and effectiveness of complex therapy using anticytokine drugs with COVID-19 in patients with comorbid diseases, but also to develop therapeutic and diagnostic algorithms in patients of this category.

NEW CORONAVIRUS INFECTION AS TRIGGER FACTOR FOR MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: LITERATURE REVIEW AND ANALYSIS OF ORIGINAL DATA

2020 ◽  
Vol 99 (6) ◽  
pp. 127-134
Author(s):  
S.R. Rodionovskaya ◽  
◽  
L.N. Mazankova ◽  
I.M. Osmanov ◽  
E.R. Samitova ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Epidemiological Data ◽  
Original Data ◽  
Trigger Factor ◽  
Laboratory Markers ◽  
Systemic Glucocorticoids ◽  
Coronavirus Infection ◽  
Characteristic Features ◽  
Inflammatory Syndrome

The article presents data on the epidemiology, pathogenesis, features of clinical manifestations and diagnosis of multisystem inflammatory syndrome in children (MIS-C) associated with a new coronavirus infection. Objective of the research: to identify clinical manifestations and results of laboratory and instrumental examination of pediatric patients with confirmed MIS-C caused by a new coronavirus infection, the most characteristic features of this pathology and to analyze the amount of therapy based on the assessment of epidemiological data. Results: median age – 8 years (6; 9,5), median duration of the disease at the time of hospitalization – 6 days (3; 6). A positive result of SARS-CoV-2 analysis in rhinopharyngeal swabs by PCR was in 3 patients, antibodies to SARS-CoV-2 by ELISA were detected in 10. Clinical manifestations included prolonged febrile fever in 11 patients, gastrointestinal symptoms of varying severity – in 10, polymorphic rash was noted in 7 cases, conjunctivitis/scleritis – in 7, edema of the eyelids, face, extremities – in 4. CNS lesion manifested itself with general cerebral and meningeal symptoms. All patients had an increase in the level of inflammation laboratory markers. In 2 children chest MSCT revealed characteristic changes for SARS-CoV-2, interpreted as CT 3–4. Therapy included intravenous immunoglobulin infusions, systemic glucocorticoids, antiviral and antibacterial drugs, anticoagulants; two patients received tocilizumab infusions.

scholarly journals Clinical case of multisystem inflammatory syndrome development in a child with new coronavirus infection

2021 ◽  
Vol 20 (2) ◽  
pp. 60-63
Author(s):  
Yu. B. Belan ◽  
E. A. Gashina ◽  
E. F. Lobova ◽  
E. P. Shefer
Keyword(s):  
Infectious Diseases ◽  
Clinical Case ◽  
Maculopapular Rash ◽  
Present Patient ◽  
Clinical Hospital ◽  
Nasal Swabs ◽  
Coronavirus Infection ◽  
Inflammatory Syndrome

Objective: The article deals with a clinical case of new coronavirus infection in a 1 5-year-old child who was receiving treatment in an infectious diseases hospital of City Children's Clinical Hospital №3 during the period from 1 0 October to 1 December 2020.Materials and methods. The diagnosis was confirmed through nasal swabs examination for the presence of SARS-CoV-2 RNA using PCR and SARS-CoV-2 IgM detection through ELISA.Results. The main feature of the infection course in the present patient was multisystem inflammatory syndrome development with long-term fever, maculopapular rash and multisystemic lesions including bilateral pneumonia, acute carditis and polyserositis.

scholarly journals Pediatric multisystem inflammatory syndrome associated with a new coronavirus infection: unresolved issues

2021 ◽  
Vol 13 (1) ◽  
pp. 13-20
Author(s):  
Yu. V. Lobzin ◽  
A. A. Vilnits ◽  
M. M. Kostik ◽  
M. K. Bekhtereva ◽  
A. N. Uskov ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Number Of Children ◽  
Treatment Regimens ◽  
Almost Everywhere ◽  
Laboratory Confirmation ◽  
High Incidence ◽  
Life Threatening ◽  
Symptom Complex ◽  
Coronavirus Infection ◽  
Inflammatory Syndrome

Since March 2020, the first reports have appeared about the increasing, almost everywhere, number of children who have undergone a new coronovirus infection caused by SARS-Cov-2 with a symptom complex resembling the manifestations of Kawasaki disease. A special feature of the clinical manifestations of this syndrome, which is called “Pediatric multisystem inflammatory syndrome associated with COVID-19”, is the high incidence of life-threatening conditions caused by the sharp development of arterial hypotension against the background of cardiogenic or vasogenic shock.In St. Petersburg, since the end of November 2020, there has been a sharp surge in admissions of children to the ICU of various hospitals with the clinic of Pediatric multisystem inflammatory syndrome, who have laboratory confirmation of the transferred COVID-19.The purpose of this article is to attract the attention of doctors of various profiles, to combine efforts to study this pathology, to determine the criteria for verifying the diagnosis, optimal treatment regimens and dispensary monitoring of patients who have been ill.

MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ASSOCIATED WITH NEW CORONAVIRUS INFECTION (COVID-19): CLINICAL AND MORPHOLOGICAL COMPARISONS

2020 ◽  
Vol 99 (6) ◽  
pp. 119-126
Author(s):  
D.Yu. Ovsyannikov ◽  
◽  
Yu.Yu. Novikova ◽  
D.S. Abramov ◽  
A.E. Angel ◽  
...  
Keyword(s):  
Toxic Shock Syndrome ◽  
Pediatric Patients ◽  
Clinical Observation ◽  
Systemic Vasculitis ◽  
Toxic Shock ◽  
Lethal Outcome ◽  
Severe Manifestation ◽  
Coronavirus Infection ◽  
Inflammatory Infiltrates ◽  
Inflammatory Syndrome

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with new coronavirus infection (COVID-19), with signs of Kawasaki disease (KD) and toxic shock syndrome, well-defined diagnostic criteria, is the most severe manifestation of COVID-19 in pediatric patients. MIS-C is analogous to the cytokine storm in children with COVID-19. The article presents a clinical observation of a child with MIS-C with a lethal outcome. Clinical and anamnestic data, the results of laboratory and instrumental research allowed to diagnose MIS-C in a 2-year-old girl with full KD form. Autopsy results, detailed microscopic examination, which revealed systemic vasculitis of small and mediumsized vessels, inflammatory infiltrates in different organs, are presented, clinical and morphological comparisons are made.

scholarly journals Clinical Characteristics of Rheumatic Diseases and Children Multisystem Inflammatory Syndrome Associated With COVID-19

2021 ◽  
Vol 7 (11) ◽  
pp. 170-183
Keyword(s):  
Connective Tissue ◽  
Clinical Manifestations ◽  
Pathological Process ◽  
Favorable Effect ◽  
Systemic Diseases ◽  
Clinical Observations ◽  
Symptom Complex ◽  
Coronavirus Infection ◽  
Almost All ◽  
Inflammatory Syndrome

With a new coronavirus infection, almost all organism systems are involved in the pathological process, which leads to development during the disease or post-COVID period of both new diseases and complications of existing chronic diseases requiring treatment or rehabilitation. The remaining after the suffered disease symptom complex complaints and clinical manifestations can be disturbed without conducting therapy and rehabilitation over many months. Purpose of the study. Present on their own observations of the laws of the clinical picture and therapies of the treatment of children’s multisystem inflammatory syndrome and systemic diseases of the connective tissue associated with COVID-19. Research results. Presented in Kyrgyzstan series of own clinical observations of 31 patients with children’s multisystem inflammatory syndrome and 23 patients with systemic diseases of the connective tissue associated with COVID-19, and 29 — with exacerbation of the systemic diseases of the connective tissue due to the transferred coronavirus infection, demonstrates the etiological and pathogenic significance SARS COV2 in the emergence of a severe system of inflammatory response. Timely anti-inflammatory treatment of children’s multisystem inflammatory syndrome is crucial and must be adapted for each patient in order to achieve the most favorable effect. Patients of the systemic diseases of the connective tissue account for a risk group with regard to the disease COVID-19 and the unfavorable disease.

scholarly journals Clinical, laboratory characteristics of a new Сoronavirus Infection in children in the Stavropol Territory

2021 ◽  
Vol 20 (4) ◽  
pp. 18-21
Author(s):  
S. M. Bezrodnova ◽  
N. A. Yatsenko ◽  
G. M. Sirazhov
Keyword(s):  
Retrospective Study ◽  
Infectious Diseases ◽  
Clinical Picture ◽  
Medical Records ◽  
Clinical Laboratory ◽  
Gastrointestinal Symptoms ◽  
Hospitalized Patients ◽  
Clinical Recovery ◽  
The World ◽  
Coronavirus Infection

A new coronavirus infection in children is more often asymptomatic or in mild forms, however, more and more severe cases of the disease have been recorded recently, and single deaths in children have been recorded in the world.The aim of the study was a clinical and laboratory analysis of the features of the course of a new coronavirus infection in children in the Stavropol Territory.Based on a retrospective study, 86 medical records of inpatient children who were treated at the Regional Specialized Clinical Infectious Diseases Hospital of the Stavropol Territory were analyzed with a diagnosis of U07.1 New coronavirus infection for the period from April 2020 to April 2021.The majority of hospitalized patients suffered from COVID-19 in a moderate form 59.3%. Children are more likely to become infected in family foci of infection – 51.2%. In 60% of cases, children are hospitalized 4—7 days from the onset of the disease. In the clinical picture, the leading symptoms were: fever (76.7%), cough (55.8%), weakness (38.4%), rhinitis (20.9%), gastrointestinal symptoms (12.8%). Pneumonia was detected in 37.2% of children. All patients were discharged with clinical recovery.

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