scholarly journals MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: DIAGNOSTIC MARKERS AND FEATURES OF PHARMACOTHERAPY

2021 ◽  
Vol 17 (1) ◽  
pp. 24-28
Author(s):  
M.V. Кhaitovych ◽  
L.M. Voroniuk ◽  
G.Yu. Borisova ◽  
N.V. Diudenko ◽  
N.M. Miagka

Relevance. In 2020, children were hospitalized with fever and multisystem inflammation throughout the world during the COVID-19 pandemic. In the United States, this condition is called MIS-C (Multisystem Inflammatory Syndrome in Children). This syndrome is thought to be similar to the severe course of COVID-19 in adults (cytokine storm). The objective of the work is to evaluate the features of the course and pharmacotherapy of multisystem inflammatory syndrome in children. Materials and methods. The study included 17 children (10 boys and 7 girls) aged 3-16 years (on average – 9.5±3.4 years). Diagnosis of coronavirus infection was performed by polymerase chain reaction with real-time detection, determined the level of immunoglobulins M and G before coronavirus infection. Results. The duration of fever in patients was 5-21 days (average 8.1±4.0 days), the duration of inpatient treatment – 7-35 days (average 15.7±7.0 days). Blood albumin levels were reduced in 53.8% of children; the level of fibrinogen was increased in 88.2% of children, the level of C-reactive protein, ferritin, and D-dimer – in all patients. 15 (88.2%) children had pathology of the digestive system, 13 (76.5%) – cardiovascular system (7 children were diagnosed with carditis, 2 – dilation of coronary arteries, 7 – cardiac arrhythmia). Acute respiratory distress -syndrome was found in a 13-year-old girl, shock - in an 11-year-old boy, 11 children (64.7%) were diagnosed with the pathology of the respiratory system (pleurisy, pneumonia), skin and mucous membranes, and 4 children (23.5%) there were manifestations of central nervous system disorders (meningism, decreased reflexes, ataxia), in 2 (11.8%) – renal failure. On average, each patient had lesions of 3.9 ±1.2 systems. Conclusions. MIS-C was manifested by prolonged fever, high levels of laboratory markers of inflammation, hypoalbuminemia, hypercoagulation, often – pathological manifestations of the cardiovascular, digestive, respiratory systems, skin, and mucous membranes. The treatment included intravenous immunoglobulin, steroids, anticoagulant, and antibacterial therapy and was effective.

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1399.1-1399
Author(s):  
M. Gilio ◽  
S. B. Morella ◽  
F. Picaro ◽  
C. Acierno ◽  
D. Palazzo ◽  
...  

Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology.Objectives:We report a case of multisystem inflammatory syndrome in children (MIS-C) in patient with SARS-CoV-2 infection and Enteropathogenic Escherichia coli (EPEC) sepsis due to acute enteritis, observed at end of December 2020 to a tertiary-care center (San Carlo Hospital), in Basilicata region (Italy).Methods:This healthy 12-year- old male patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Clinical presentations was characterized by fever, abdominal pain, gastrointestinal complaints and evanescent rash. Laboratory values were remarkable for high levels of procalcitonin, C-reactive protein (CRP), D-dimers, B-type natriuretic peptide (BNP), and troponin. He also had low albumin levels. Autoantibodies tests were negative. Chest tomography showed ground-glass opacities in less than 25% of the lungs, small bilateral pleural effusion and increased cardiac area; abdominal tomography showed enlargement of the lymphnodes and ascites. Evaluation for other infectious etiologies showed molecular test positivity on fecal samples for EPEC E. coli. He received broad spectrum intravenous antibiotics (macrolids and quinolones and then carbapenems). On the seventh day the enteritis resolved and procalcitonin normalized, however he continued to have lymphopenia, thrombocytopenia, hypoalbuminemia, elevated levels of CRP, D-dimers, ferritin, troponin, and increased BNP. On the ninth day he was feverish again and developed severe cardiac and respiratory failure requiring advanced respiratory support and admission to the intensive care unit. He received IVIG (intravenous immunoglobulin at 2 g/Kg, glucocorticoids (Methylprednisolone 1mg/kg) and enoxaparin.Results:The patient was discharged asymptomatic at home after 28 days of hospital stay.Conclusion:We observed multisystem inflammatory syndrome in children (MIS-C) in a previously healthy patient with SARS-CoV-2 infection and E.coli sepsis, who became critically ill with multisystem involvement. In this case viral and bacterial infections could be considered as a double hit for the etiopathogenesis of MIS-C. The trend of procalcitonin was better than C-reactive protein for differentiating bacterial from non-bacterial phase of systemic inflammatory response syndrome (SIRS) in this critically ill child. Although the accuracy of both tests is moderate. Diagnostic accuracy could be enhanced by combining these tests with bedside clinical judgment.References:[1]Consiglio CR, Cotugno N, Sardh et al. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell. 2020 Nov 12;183(4):968-981.e7. doi: 10.1016/j.cell.2020.09.016. Epub 2020 Sep 6. PMID: 32966765; PMCID: PMC7474869.[2]Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children (Basel). 2020 Jul 1;7(7):69. doi: 10.3390/children7070069. PMID: 32630212; PMCID: PMC7401880.[3]Simon L, Saint-Louis P, Amre DK, Lacroix J, Gauvin F. Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome. Pediatr Crit Care Med. 2008 Jul;9(4):407-13. PMID: 18496408.Disclosure of Interests:None declared


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nandana Rao ◽  
Rozenn Lemaitre ◽  
Colleen Sitlani ◽  
Jason G Umans ◽  
Lyle G BEST ◽  
...  

Background: Both experimental animal and human observational studies have suggested that magnesium (Mg) deficiency influences systemic inflammation. Whether this association is modified by genes associated with Mg metabolism and transport is unknown. Objective: To examine associations of reported Mg intake, and the interaction of reported Mg intake with a single nucleotide polymorphisms (SNP) related to Mg metabolism and transport, on serum markers of inflammation (i.e., C-reactive protein (CRP) and interleukin 6 (IL-6)). Methods: This cross-sectional study included 1,924 participants from the Strong Heart Family Study—a study of risk factors for cardiovascular diseases among American Indians (AIs) from 12 communities in the United States. Intake of Mg from foods and dietary supplements was ascertained using a 119-item Block food frequency questionnaire. Serum hsCRP and IL-6 were measured from blood collected after a 12-hour fast, and candidate SNP (rs3740393) was genotyped using MetaboChip. Generalized estimating equations, with clusters defined by family membership, were used to examine associations of Mg intake, and the interaction of rs3740393 with estimated dietary Mg, on CRP and IL-6. Results: FFQ-estimated Mg intake was not associated with CRP or IL-6. We observed no interaction of reported Mg intake with rs3740393 on CRP (p-interaction=0.70). However, we observed an interaction (p-interaction=0.018) of reported Mg intake with rs3740393 on IL-6. (Table). Conclusion: Reported Mg intake is inversely associated with serum IL-6 among carriers of the C allele at rs3740393. Future research is necessary to replicate this finding, and to examine other Mg-related genes that may influence associations of Mg intake or sufficiency with inflammation.


2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Jeffrey E Stokes

Abstract Background and Objectives This cross-sectional study examines associations of social integration and daily discrimination with 4 biological markers of inflammation and cardiovascular health and tests whether self-esteem may mediate any of these effects. Research Design and Methods Data came from 746 participants of the National Survey of Midlife Development in the United States (MIDUS) Refresher (2011–2014) and MIDUS Refresher Biomarker Project (2012–2016). Structural equation modeling estimated direct and indirect associations of social integration and daily discrimination with glycosylated hemoglobin (HbA1c), high-density lipoprotein (HDL), C-reactive protein, and interleukin-6. Results Social integration and daily discrimination were both significantly associated with self-esteem, which was in turn associated with HbA1c, HDL, and interleukin-6 levels. Social integration was indirectly associated with HbA1c, HDL, and interleukin-6 via self-esteem. Daily discrimination was directly associated with HbA1c, C-reactive protein, and interleukin-6 and was indirectly associated with HDL and interleukin-6 via self-esteem. Discussion and Implications Findings identify social correlates of inflammation and cardiovascular risk and suggest that self-esteem may serve as a pathway for effects. Overall, results were somewhat mixed: Daily discrimination was directly associated with both self-esteem and 3 of the 4 biological markers of health; however, although social integration was strongly associated with self-esteem, it was only weakly and indirectly associated with biological health markers. Moreover, the indirect effects of daily discrimination on the biomarker outcomes—while significant—were notably smaller than its direct effects. Implications for theory, practice, and future research are discussed, including the need for further study of self-esteem and physical health across mid- and later life.


2018 ◽  
Vol 6 ◽  
pp. 205031211877499 ◽  
Author(s):  
Eileen K Graham ◽  
Emily D Bastarache ◽  
Elizabeth Milad ◽  
Nicholas A Turiano ◽  
Kelly A Cotter ◽  
...  

Objectives: The current study investigated whether personality traits and facets were associated with interleukin-6, C-reactive protein, and fibrinogen, and whether physical activity mediated the relationship between personality and biomarkers of inflammation. Methods: Personality was assessed in the Midlife Development in the United States study using the Multi-Dimensional Personality Questionnaire and Midlife Development Inventory personality scale. Data were included from 960 participants (mean age = 57.86 years, standard deviation = 11.46). Personality was assessed from 2004 to 2009. Serum levels of interleukin-6, fibrinogen, and C-reactive protein were assessed in 2005–2009 as part of the Midlife Development in the United States biomarkers subproject. Results: Lower neuroticism was associated with elevated interleukin-6, and achievement was associated with lower fibrinogen. Higher physical activity was associated with lower interleukin-6 and C-reactive protein. Mediation models suggested that physical activity mediated the associations between achievement and both interleukin-6 and C-reactive protein. Discussion: Physical activity is an important factor in the Health Behavior Model of personality and explains some of the associations between personality and inflammation. These findings contribute to the fields of aging and health by linking individual difference factors to markers of inflammation, and showing that these processes may function partially through specific behaviors, in this case physical activity.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Lifang Chen ◽  
Yingbao Huang ◽  
Huajun Yu ◽  
Kehua Pan ◽  
Zhao Zhang ◽  
...  

AbstractBackgroundHypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers.MethodsLaboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP.ResultsSeventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (allP < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L,P = 0.004, OR = 3.362, 95%CI = 1.492–8.823) and apolipoprotein A-I (< 1.1 g/L,P < 0.001, OR = 5.126, 95%CI = 2.348–11.195), as well as high C-reactive protein (> 90 mg/L,P = 0.005, OR = 3.061, 95%CI = 1.407–6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070–4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (allP < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (allP < 0.05).ConclusionsLow serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.


2011 ◽  
Vol 10 (2) ◽  
pp. 207
Author(s):  
Hemelrijck M.J.J. Van ◽  
I. Jugner ◽  
G. Walldius ◽  
H. Garmo ◽  
E. Binda ◽  
...  

2021 ◽  
Vol 21 (3) ◽  
pp. 159-164
Author(s):  
Tamara N. Shvedova ◽  
Olga S. Kopteva ◽  
Polina A. Kudar ◽  
Anna A. Lerner ◽  
Yuliya A. Desheva

BACKGROUND: Despite the continuing global spread of the coronavirus infection COVID-19 caused by the SARS-CoV-2 coronavirus, the mechanisms of the pathogenesis of severe infections remain poorly understood. The role of comorbidity with other seasonal viral infections, including influenza, in the pathogenesis of the severe course of COVID-19 remains unclear. MATERIALS AND METHODS: The present study used sera left over from ongoing laboratory studies of patients with varying degrees of severity of COVID-19. The study was approved by the Local Ethics Committee of the Federal State Budgetary Scientific Institution IEM (protocol 3/20 from 06/05/2020). We studied 28 paired samples obtained upon admission of patients to the hospital and after 57 days of hospital stay. Paired sera of patients with COVID-19 were tested for antibodies to influenza A and B viruses. The presence of IgG antibodies specific to the SARS-CoV-2 spike (S) protein was studied using an enzyme-linked immunosorbent assay (ELISA). The serum concentration of C-reactive protein and the neutrophil-lymphocyte ratio on the day of hospitalization were also assessed. RESULTS: At least a 4-fold increase in serum IgG antibodies to SARS-CoV-2 S protein was found both in patients with PCR-confirmed SARS-CoV-2 infection and without PCR confirmation. It was shown that out of 18 patients with moderate and severe forms of COVID-19 infection, six of them showed at least a 4-fold increase in antibodies to influenza A/H1N1, in one to influenza A/H3N2 and in two cases to the influenza B. Laboratory data in these two groups were characterized by significant increases in serum C-reactive protein and neutrophil-lymphocyte ratio concentrations compared with the moderate COVID-19 group. CONCLUSIONS: Serological diagnostics can additionally detect cases of coronavirus infection when the virus was not detected by PCR. In moderate and severe cases of COVID-19, coinfections with influenza A and B viruses have been identified. The results obtained confirm the need for anti-influenza immunization during the SARS-CoV-2 pandemic. Influenza virus screening can significantly improve patient management because recommended antiviral drugs (neuraminidase inhibitors) are available.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Makrouhi Sonikian ◽  
Aggeliki Barbatsi ◽  
Eugenia Karakou ◽  
Theodoros Chiras ◽  
Jacob Skarakis ◽  
...  

Abstract Introduction C-reactive protein (CRP) and procalcitonin (PCT) are widely used as markers of inflammation and infection in general population and in chronic hemodialysis (HD) as well. However, in dialysis (D) patients, serum CRP and PCT levels may be elevated even in the absence of inflammatory or infectious disease and diagnostic process is a challenge in such cases. We studied HD patients' laboratory profile concerning CRP and PCT. Subjects and Methods We studied 25 stable HD patients, M/F=22/3, aged 68(44-89) years, dialyzed thrice weekly for 55(6-274) months with a dialysate flow rate of 700 ml/min, with a residual daily diuresis less than 200 ml, Kt/V values of 1,44±0,3 and no signs of infection. Patients were classified in two groups. Group A included 10 patients on pre-dilution online hemodiafiltration (HDF). Group B consisted of 15 patients on conventional HD with low-flux polysulfone membrane. Twenty healthy subjects formed a control group C. Serum CRP and PCT levels were measured in duplicate in A and B groups before and at the end of mid-week dialysis sessions and also in C group. Results Pre-D serum CRP values in the total of patients were higher than those in healthy controls (10,89±19,29 vs 2,54±1,28 mg/L-p=0,004). Compared with group C, pre-D CRP values were higher only in B group (15,98±24,54 mg/L-p=0,001) but not in A group (4,09±3,33 mg/L-p=NS). There was a significant difference in pre-D serum CRP values between A and B groups (p=0,028). At the end of D session serum CRP values showed a tendency to increase in both groups A (5,16±4,81 mg/L) and B (17,00±27,00 mg/L) but differences were not significant. Pre-D serum PCT values in the total of patients were higher than those in healthy controls (0,82±0,9 vs 0,29±0,55 ng/ml-p&lt;0,001). Compared with group C, pre-D PCT values were higher in both A group (0,52±0,15 ng/ml-p&lt;0,001) and B group (1,01±1,13 ng/ml-p=0,006). There was no significant difference in pre-D serum PCT values between A and B groups (p=0,261). At the end of D session serum PCT values decreased in A group (0,32±0,11 ng/ml-p&lt;0,001) and increased in B group (1,12±1,21 ng/ml-p=0,014). Conclusions In patients on both conventional low-flux HD and online HDF pre-D serum CRP and PCT levels were higher than those in healthy subjects. Dialysis modality and membrane flux did not affect post-D serum CRP values, but post-PCT values decreased in online HDF. PCT usefulness might be limited in dialysis with high-flux membranes. Cut-off values have to be established for both markers to eliminate confusion in diagnosis of inflammatory and infectious diseases in hemodialyzed patients.


2020 ◽  
Vol 87 (3-4) ◽  
pp. 14-17
Author(s):  
O. V. Rotar ◽  
I. V. Khomiak ◽  
V. I. Rotar ◽  
A. I. Khomiak ◽  
S. I. Railianu

Objective. To conduct comparative estimation of efficacy of C-reactive protein and procalcitonin as laboratory markers for stratification of the patients severity state suffering an acute necrotic pancreatitis. Materials and methods. Prospective cohort investigation, including 151 patients with an acute necrotic pancreatitis, was conducted. Clinical, laboratory and bacteriological investigations were accomplished. The levels of C-reactive protein and procalcitonin were determined in the blood plasm. Results. The necrotic accumulations infectioning was diagnosed in 89 (58.9%) patients: local purulent complications - in 27, sepsis - in 33,septic shock - in 29. In 62 patients with sterile pancreonecrosis a C-reactive protein concentration have raised from (5.6 ± 0.89) to (206 ± 29) mg/l (p˂0.001). Development of purulent-septic complications was accompanied by significant and trustworthy (p<0.01) elevation of procalcitonin concentration: in the patients with sepsis - up to (5.05 ± 0.92) ng/ml, in the patients with septic shock - up to (7.25 ± 2.15) ng/ml. Conclusion. Simultaneous measurement of levels of C-reactive protein and procalcitonin in the blood plasm in patients, suffering acute necrotic pancreatitis, gives permission to determine the inflammatory process character and stratify the disease severity in its early terms.


Author(s):  
M Petrushin ◽  
V Leontyeva ◽  
A Malygin ◽  
M Demidova

The objective of the study was the evaluation of the effectiveness of tocilizumab in patients with coronavirus infection COVID-19 who were treated in the intensive care unit of an infectious diseases hospital. Material and methods. There was carried out a retrospective analysis of the case histories of 40 patients with confirmed severe and extremely severe coronavirus infection COVID-19. The average age of the patients was 58.3 ± 1.8 years, the total lung lesion volume was 83.2 ± 2.0%. Results: The survival rate of patients who received immunosuppressive therapy with tocilizumab in combination with pulse therapy of glucocorticosteroids was 55%, and 44% of patients with 100% lung involvement. The use of tocilizumab (4-8 mg / kg) led to a statistically significant decrease in the level of C-reactive protein in the blood, which was an indicator of adequate pharmacotherapy of the "cytokine storm" in the ICU.


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