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 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 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; an Emerging Global Threat - A Review

2021 ◽  
Vol 8 (7) ◽  
pp. 481-485
Author(s):  
AR Shabaraya ◽  
Archana KU
Keyword(s):  
Kawasaki Disease ◽  
Gastrointestinal Symptoms ◽  
High Grade Fever ◽  
Management Options ◽  
Methyl Prednisolone ◽  
Markers Of Inflammation ◽  
Clinical Presentations ◽  
Global Threat ◽  
Available Information ◽  
Inflammatory Syndrome

MIS C (Multisystem Inflammatory Syndrome in Children) is a disease related to post COVID-19 sequelae. Differential diagnosis includes Kawasaki disease, Bacterial sepsis, toxic shock syndrome, Appendicitis, Macrophage activation syndrome. Clinical Presentations include high grade fever, rashes, Gastrointestinal symptoms like (abdominal pain, vomiting, diarrhea), hypotension and shock. The pathogenesis of MIS-C is unknown, and a postinfective etiology has been hypothetical but unproven. Antibodies to SARS-CoV-2 appear in the second week following infection, although their existence does not suggest infection resolution. Laboratory markers of inflammation, such as CRP, are elevated. IVIG, Glucocorticoids such as methyl prednisolone, Antibiotics, thromboprophylaxis with Light Molecular Weight Heparin are the management options. Since the available information doesn't allow to formulate well-established guidelines or recommendations for MIS-C treatment, and therefore the long-term sequelae of the illness aren't yet known. Keywords: MIS C, IVIG, Kawasaki disease.

scholarly journals P078 Multi-system inflammatory syndrome associated with SARS-CoV-2 in children: clinical and therapeutic characteristics

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Nacera Masmi
Keyword(s):  
United Kingdom ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Artery Aneurysm ◽  
Cardiac Insufficiency ◽  
Markers Of Inflammation ◽  
Wide Range ◽  
Inflammatory Syndrome

Abstract Background The COVID-19 pandemic was associated with the emergence of a new disease resembling the Kawasaki disease (kDa). That was primarily reported in children of western countries strongly affected by SARS-CoV-2. This syndrome was called Pediatric Multi-System Inflammatory Syndrome (PIMS or MIS-C), and has affected thousands of children, adolescents and young adults throughout the world since the alert launched by the National Health Service of the United Kingdom at the end of April 2020. This work is a literature review of data focusing on the clinical and prognostic characteristics of the MIS-C, the links between Covid-19 and MIS-C, and current therapeutic recommendations. Material and methods We carried out research of the studies recently published in the electronic bibliographic databases (Google Scholar, PubMed, Science direct, EmConsults, Research Gate, Medline, Cochrane, Trip). Results 25 studies were selected, involving 3015 MIS-C patients from different countries (France, United Kingdom, Italy, Germany, Spain, Brazil, Mexico, Chile, United States, India, Pakistan, Iran). Fever and gastrointestinal disorders were the most frequent clinical manifestations, followed by cardiovascular and respiratory symptom. Biological markers of inflammation and SARS-CoV-2 serology were assessed in all studies. Characteristics similar to Kawasaki disease, and toxic shock syndrome were reported in all studies. Complications such as coronary artery aneurysm; cardiac insufficiency, renal insufficiency, respiratory distress were noted as well as a significant rate of admission to intensive care units. Finally, the mortality rate was low in the majority of studies. The treatment adopted in the majority of the studies was an association of intravenous immunoglobulins and corticosteroids. Conclusion Although the fact that the exact pathogenesis of MIS-C remains unknown, post-infectious immune deregulation induced by the SARS-CoV-2 virus appears to be the trigger of MIS-C. MIS- C has been described as a new and serious disease entity with multi-organ involvement and a wide range of signs ranging from fever and gastrointestinal symptoms to myocardial damage, shock, and the development of coronary artery aneurysms. Keywords COVID-19, Multi-System Inflammatory Syndrome (MIS-C), Kawasaki Disease (kDa), Child

Machine-learning algorithm as a prognostic tool in non-obstructive acute-on-chronic kidney disease in the cat

2021 ◽  
pp. 1098612X2110012
Author(s):  
Jade Renard ◽  
Mathieu R Faucher ◽  
Anaïs Combes ◽  
Didier Concordet ◽  
Brice S Reynolds
Keyword(s):  
Machine Learning ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Decision Tree ◽  
Diagnostic Performance ◽  
Clinical Signs ◽  
Learning System ◽  
Clinical Severity ◽  
Medium Term ◽  
Term Survival

Objectives The aim of this study was to develop an algorithm capable of predicting short- and medium-term survival in cases of intrinsic acute-on-chronic kidney disease (ACKD) in cats. Methods The medical record database was searched to identify cats hospitalised for acute clinical signs and azotaemia of at least 48 h duration and diagnosed to have underlying chronic kidney disease based on ultrasonographic renal abnormalities or previously documented azotaemia. Cases with postrenal azotaemia, exposure to nephrotoxicants, feline infectious peritonitis or neoplasia were excluded. Clinical variables were combined in a clinical severity score (CSS). Clinicopathological and ultrasonographic variables were also collected. The following variables were tested as inputs in a machine learning system: age, body weight (BW), CSS, identification of small kidneys or nephroliths by ultrasonography, serum creatinine at 48 h (Crea48), spontaneous feeding at 48 h (SpF48) and aetiology. Outputs were outcomes at 7, 30, 90 and 180 days. The machine-learning system was trained to develop decision tree algorithms capable of predicting outputs from inputs. Finally, the diagnostic performance of the algorithms was calculated. Results Crea48 was the best predictor of survival at 7 days (threshold 1043 µmol/l, sensitivity 0.96, specificity 0.53), 30 days (threshold 566 µmol/l, sensitivity 0.70, specificity 0.89) and 90 days (threshold 566 µmol/l, sensitivity 0.76, specificity 0.80), with fewer cats still alive when their Crea48 was above these thresholds. A short decision tree, including age and Crea48, predicted the 180-day outcome best. When Crea48 was excluded from the analysis, the generated decision trees included CSS, age, BW, SpF48 and identification of small kidneys with an overall diagnostic performance similar to that using Crea48. Conclusions and relevance Crea48 helps predict short- and medium-term survival in cats with ACKD. Secondary variables that helped predict outcomes were age, CSS, BW, SpF48 and identification of small kidneys.

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 Validating clinical characteristic of primary failure of eruption (PFE) associated with PTH1R variants

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cristina Grippaudo ◽  
Isabella D’Apolito ◽  
Concetta Cafiero ◽  
Agnese Re ◽  
Pietro Chiurazzi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Mutational Analysis ◽  
Clinical Signs ◽  
Open Bite ◽  
Clinical Severity ◽  
Mixed Dentition ◽  
Phenotype Correlation ◽  
Posterior Teeth ◽  
Primary Failure Of Eruption ◽  
Genotype Phenotype Correlation

Abstract Background Primary failure of eruption (PFE) is a hereditary condition, and linkage with variants in the PTH1R gene has been demonstrated in many cases. The clinical severity and expression of PFE is variable, and the genotype–phenotype correlation remains elusive. Further, the similarity between some eruption disorders that are not associated with PTH1R alterations is striking. To better understand the genotype–phenotype correlation, we examined the relationship between the eruption phenotype and PTH1R genotype in 44 patients with suspected PFE and 27 unaffected relatives. Sanger sequencing was employed to analyze carefully selected PFE patients. Potential pathogenicity of variants was evaluated against multiple genetic databases for function prediction and frequency information. Results Mutational analysis of the PTH1R coding sequence revealed 14 different variants in 38 individuals (30 patients and 8 first-degree relatives), 9 exonic and 5 intronic. Their pathogenicity has been reported and compared with the number and severity of clinical signs. In 72.7% of patients with pathogenic variants, five clinical and radiographic criteria have been found: involvement of posterior teeth, involvement of the distal teeth to the most mesial affected, supracrestal presentation, altered vertical growth of the alveolar process and posterior open-bite. In cases with mixed dentition (3), the deciduous molars of the affected quadrant were infraoccluded. Discussion The probability of an affected patient having a PTH1R variant is greater when five specific clinical characteristics are present. The likelihood of an eruption defect in the absence of specific clinical characteristics is rarely associated with a PTH1R mutation. Conclusions We report here that systematic clinical and radiographic observation using a diagnostic rubric is highly valuable in confirming PFE and offers a reliable alternative for accurate diagnosis.

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
Keyword(s):  
Distress Syndrome ◽  
The United States ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Laboratory Markers ◽  
Mucous Membranes ◽  
Coronavirus Infection ◽  
Polymerase Chain ◽  
Inflammatory Syndrome

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.

ARTERIAL BLOOD GAS AND ACID-BASE DISORDERS IN INFANTS AND CHILDREN WITH STATUS ASTHMATICUS

PEDIATRICS ◽  
1968 ◽  
Vol 42 (2) ◽  
pp. 238-249
Author(s):  
John J. Downes ◽  
David W. Wood ◽  
Theodore W. Striker ◽  
Joffie C. Pittman
Keyword(s):  
Status Asthmaticus ◽  
Clinical Signs ◽  
Arterial Oxygen Tension ◽  
Base Deficit ◽  
Infants And Children ◽  
Clinical Severity ◽  
Arterial Oxygen ◽  
Acid Base ◽  
Arterial Blood ◽  
Arterial Ph

The course of arterial oxygen tension (Pao2), pH, carbon dioxide tension (Paco2) and base deficit (negative base excess) was studied in 45 episodes of status asthmaticus occurring in 32 infants and children. The data indicate that arterial hypoxemia occurs in these patients due to alveolar hypoventilation and pulmonary arterial-venous shunts. Three fourths of the patients tested demonstrated a base deficit which was related in part to ketonemia. The Paco2 varied from below normal to 168 mm Hg, and arterial pH varied from 6.89 to 7.41 at the time of peak clinical severity. Clinical signs of respiratory failure associated with a Paco2 above 65 mm Hg occurred in 13 patients (18 episodes), all of whom were successfully managed by mechanical ventilation. These studies indicate the variability in alveolar ventilation and acid-base balance during an asthmatic episode and the need for repeated assessment of arterial pH and blood gases if one is to provide optimal management.

scholarly journals Impact of a 3-Month Anti-inflammatory Dietary Intervention Focusing on Watermelon on Body Habitus, Inflammation, and Metabolic Markers: A Pilot Study

2020 ◽  
Vol 13 ◽  
pp. 117863881989939 ◽  
Author(s):  
Michael D Wirth ◽  
Nitin Shivappa ◽  
Samira Khan ◽  
Shraddha Vyas ◽  
Lynae Beresford ◽  
...  
Keyword(s):  
Pilot Study ◽  
Online Education ◽  
Dietary Intervention ◽  
Blood Draw ◽  
Metabolic Markers ◽  
Body Habitus ◽  
Management Intervention ◽  
Inflammatory Index ◽  
Markers Of Inflammation ◽  
Anti Inflammatory

An anti-inflammatory dietary intervention called the Inflammation Management Intervention (IMAGINE) was adapted to emphasize watermelon due to its anti-inflammatory properties. This pilot study (n = 23) tested the effect of a watermelon-enhanced IMAGINE intervention (n = 15) on body habitus and markers of inflammation and metabolism. This 3-month self-selection trial, consisting of weekly in-person classes and online education for 12 weeks, focused on incorporating watermelon into an already anti-inflammatory diet. Controls (n = 8) received basic health education via email and blogs. Measurements, including diet, anthropometrics, actigraphy, and a blood draw, were made at baseline and immediately postintervention. Linear regression analyses were conducted using intervention status as the main exposure. Post hoc analyses then ignored intervention assignment and grouped participants based on their change in their energy-adjusted Dietary Inflammatory Index (E-DIITM) score. There were no group-by-time interactions for any of the studied outcomes. However, some intervention participants’ diets became more proinflammatory, and several control participants’ diets became more anti-inflammatory. Those participants below the median of E-DII change (ie, more anti-inflammatory changes) showed reductions in body fat percent (–1.27% vs +0.90%, respectively, P = .01), body mass index (–0.66 vs +0.38 kg/m2, respectively, P = .06) and body weight (–0.99 vs +0.54 kg, respectively, P = .08) compared to those above the median of E-DII change. This study demonstrates that individuals who adopt a more anti-inflammatory diet containing watermelon will have improvements in body anthropometrics. Future studies should focus on increasing adherence and compliance to intervention prescriptions, exploring options to extend interventions to evaluate long-term changes, and further examining changes in inflammatory biomarkers. Clinical Trials Registration: NCT03158740

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