COVID-19 Disease in Infants Less Than 90 Days: Case Series

The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤ 90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤ 90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

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Ocular and Systemic Manifestations in Paediatric Multisystem Inflammatory Syndrome Associated with COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10132953 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2953

Author(s):

Tzu-Chen Lo ◽

Yu-Yen Chen

Keyword(s):

Serum Antibody ◽

Case Series ◽

Pooled Analysis ◽

Rt Pcr ◽

Laboratory Findings ◽

Systemic Manifestations ◽

Polymerase Chain ◽

Exposure History ◽

Systemic Symptoms ◽

Inflammatory Syndrome

This study aimed to achieve a better understanding of the epidemiological and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). We searched PubMed and Embase between December 2019 and March 2021 and included only peer-reviewed clinical studies or case series. The proportions of patients who had conjunctivitis, systemic symptoms/signs (s/s), Kawasaki disease (KD), and exposure history to suspected/confirmed COVID-19 cases were obtained. Moreover, positive rates of the nasopharyngeal real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serum antibody for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recorded. Overall, 32 studies with 1458 patients were included in the pooled analysis. Around half of the patients had conjunctivitis. The five most common systemic manifestations were fever (96.4%), gastrointestinal s/s (76.7%), shock (61.5%), rash (57.1%), and neurological s/s (36.8%). Almost one-third presented complete KD and about half had exposure history to COVID-19 cases. The positivity of the serology (82.2%) was higher than that of the nasopharyngeal RT-PCR (37.0%). MIS-C associated with COVID-19 leads to several features similar to KD. Epidemiological and laboratory findings suggest that post-infective immune dysregulation may play a predominant role. Further studies are crucial to elucidate the underlying pathogenesis.

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Case Report: Case Series of Children With Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Switzerland

Frontiers in Pediatrics ◽

10.3389/fped.2020.594127 ◽

2021 ◽

Vol 8 ◽

Author(s):

Athina Fouriki ◽

Yves Fougère ◽

Caroline De Camaret ◽

Géraldine Blanchard Rohner ◽

Serge Grazioli ◽

...

Keyword(s):

Clinical Features ◽

Toxic Shock Syndrome ◽

Case Series ◽

Serum Levels ◽

Intravenous Immunoglobulins ◽

Toxic Shock ◽

Laboratory Findings ◽

First Line Therapy ◽

Ivig Resistance ◽

Inflammatory Syndrome

Since the beginning of the severe SARS-CoV-2 pandemic, an increasing number of countries reported cases of a systemic hyperinflammatory condition defined as multi-system inflammatory syndrome in children (MIS-C). The clinical features of MIS-C can be an overlap of Kawasaki Disease (KD), Toxic Shock Syndrome (TSS), Macrophage Activation Syndrome (MAS), or have often an acute abdominal presentation. Intravenous immunoglobulin (IVIG) is recommended as first line therapy in KD. Recent evidence suggests intravenous immunoglobulins (IVIG) resistance in some cases of SARS-CoV-2 related MIS-C, thereby questioning the benefit of immunomodulators such as IL-1 or IL-6 blocking agents. We report on a cohort of 6 Swiss children with SARS-CoV2 related MIS-C presenting with clinical features compatible with Incomplete KD and Toxic Shock Syndrome associated to a cytokine storm. Serum cytokine profile investigations showed increased IL1RA levels (8 to 22-fold) in 5 of the 6 patients (one patient had not been tested), whereas, IL-6 serum levels were increased only in the 3 patients of the 6 who were tested. With exception of one patient who had only benefited by Anakinra, all patients received at least one dose of IVIG. One patient has only received Anakinra with favorable evolution, and three patients had also a steroid treatment. In addition to all this anti-inflammatory medication two patients have also received one dose of anti-IL6. In conclusion, our case series reports on clinical and laboratory findings of most of Swiss cases with MIS-C and suggests the use of Anakinra as an alternative to steroids in these children, most of whom presented with high IL-1RA levels.

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COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

10.21203/rs.3.rs-124953/v1 ◽

2021 ◽

Author(s):

Mohammad Hasan ◽

Khaled Al Zubaidi ◽

Karim Diab ◽

Yahia Hejazi ◽

Sharon Bout-Tabaku ◽

...

Keyword(s):

Clinical Features ◽

Early Recognition ◽

Tertiary Care ◽

Case Series ◽

Case Definition ◽

Cardiac Biomarkers ◽

Medical Attention ◽

Laboratory Findings ◽

First Case ◽

Inflammatory Syndrome

Abstract Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar. Methods: Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed.Results: The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70%-100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors.Conclusions: Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.

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Examining Multisystem Inflammatory Syndrome in Children (MIS-C) Amidst the SARS-CoV-2 Pandemic

Proceedings of IMPRS ◽

10.18060/24625 ◽

2020 ◽

Vol 3 ◽

Author(s):

Matthew Harris ◽

Dibyadyuti Datta ◽

Katrina Co ◽

Samina Bhumbra ◽

Chandy John

Keyword(s):

Gastrointestinal Symptoms ◽

Care Patient ◽

Common Finding ◽

Laboratory Findings ◽

Patient Reports ◽

Reactive Protein ◽

Presenting Symptoms ◽

Literature Searches ◽

Clinical Presentations ◽

Inflammatory Syndrome

Background/Objective: Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel and rare pediatric post-infectious complication associated with SARS-CoV-2 infection. First described in April 2020, our scope of understanding is limited but rapidly growing. Our objective was to construct a literature repository containing MIS-C patient data from available publications to serve as a curated collection of literature on the topic. This collection facilitates direct comparison of data from various sources, allowing for informed discussions of MIS-C. Methods: A database search strategy was developed for locating primary literature on MIS-C available on PubMed, medRxiv, and bioRxiv databases. Literature searches were conducted from June 26, 2020 to July 10, 2020. Search results were tested against several criteria before inclusion in the repository. Intrinsic limitations for each publication were identified during quality review. Data from each source was organized in a standardized format for analysis. Results: 26 publications met inclusion criteria, 9 (35%) in pre-print status. 742 cases of probable or confirmed MIS-C were reported. Individuals ranged from 7 months to 20 years old and 58% were male. By SARS-CoV-2 PCR testing, 257/707 (36%) were positive while 485/597 (81%) were positive by SARS-CoV-2 serology testing. Common presenting symptoms included fever, one or more gastrointestinal symptoms, and rash. Laboratory testing varied, but elevated C-Reactive Protein was the most common finding (411/689, 60%), followed by elevated D-Dimer (214/470, 46%). Echocardiogram findings included coronary artery dilation in 38/414 (9%) and decreased ejection fraction in 177/330 (54%). Treatments offered included intravenous immunoglobulin (486/742, 65%), followed by steroids (376/742, 51%). 450/577 (78%) required ICU care. Patient outcomes were generally favorable, with 11 (1%) fatalities at the time of publication. Conclusion/Impact: Our repository of MIS-C literature compiled patient reports to identify common clinical presentations and laboratory findings. Future literature reviews are necessary to elucidate mechanisms associated with MIS-C and establish diagnostic criteria.

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Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

Epidemiology and Infection ◽

10.1017/s095026882000196x ◽

2020 ◽

Vol 148 ◽

Cited By ~ 6

Author(s):

Setareh Mamishi ◽

Zahra Movahedi ◽

Mohsen Mohammadi ◽

Vahid Ziaee ◽

Mahmoud Khodabandeh ◽

...

Keyword(s):

Wide Spectrum ◽

Case Series ◽

Signs And Symptoms ◽

Case Definition ◽

Laboratory Findings ◽

Duration Of Symptoms ◽

Presenting Symptoms ◽

Hands And Feet ◽

Inflammatory Syndrome ◽

D Dimer

Abstract During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has a similar clinical presentation to Kawasaki disease, toxic shock syndrome and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the three paediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom and Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between 7 March and 23 June 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) with median duration of symptoms prior to presentation of 5 (interquartile range (IQR) 3, 7) days. Fifty-three percent of children showed lymphopaenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (>500 ng/ml) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dl, D-dimer was 3909 (IQR 848, 4528) ng/ml and troponin was 0.6 (IQR 0.1, 26) ng/ml, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatraemia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis and pericardial effusions were found in 18%, 11%, 4% and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalised children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin and albumin; and multi-organ involvement.

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Characteristics of Children With Kawasaki Disease-Like Signs in COVID-19 Pandemic: A Systematic Review

Frontiers in Pediatrics ◽

10.3389/fped.2021.625377 ◽

2021 ◽

Vol 9 ◽

Author(s):

Parham Mardi ◽

Marzieh Esmaeili ◽

Parisa Iravani ◽

Mohammad Esmail Abdar ◽

Kumars Pourrostami ◽

...

Keyword(s):

Systematic Review ◽

Kawasaki Disease ◽

Clinical Characteristics ◽

Case Reports ◽

Case Series ◽

Laboratory Findings ◽

Reactive Protein ◽

Comprehensive Search ◽

Respiratory Outcomes ◽

Inflammatory Syndrome

Recent studies have shown that several children diagnosed with COVID-19 have developed Kawasaki Disease (KD)-like symptoms. This systematic review aims to assess the demographic, laboratory, and clinical characteristics of children with KD-like syndrome during the COVID-19 pandemic and evaluate efficacy of treatments and patients' outcome. A comprehensive search was carried out systematically through PubMed, Scopus, and Web of Science (WoS), medRxiv, and bioRxiv by two reviewers independently for all studies or preprints data on the demographic, laboratory, and clinical characteristics of children with K.D-like signs during the COVID-19 outbreak. Overall, 378 studies were identified by the systematic search, of which 25 studies were included in the study. The included studies involved 599 patients in total. Thirteen studies (52%) were case reports or case series, and the rest (48%) were cohort studies. In 19 studies, patients were diagnosed with Multisystem inflammatory syndrome in children (MIS-C). In 16 studies COVID-19 was diagnosed in all patients based on their polymerase chain reaction result, serological findings, and computed tomography results. Higher C-reactive protein and erythrocyte sedimentation rate level were the most prevalent laboratory findings. In most studies, patients had leucopenia with marked lymphopenia, hypoalbuminemia, and increased ferritin, as well as hyponatremia. Abnormal echocardiography and respiratory outcomes were the most common clinical outcomes. In 11 studies, all patients required intensive care unit admission. Findings of the present systematic review show that the incidence of KD-like syndrome in the COVID-19 pandemic increased significantly. Moreover, this study offers new insights in the KD-like syndrome pathogenesis and clinical spectrum during COVID-19 pandemic.

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Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature

Journal of Intensive Care Medicine ◽

10.1177/0885066620969350 ◽

2020 ◽

pp. 088506662096935

Author(s):

Gema de Lama Caro-Patón ◽

Amelia Martínez de Azagra-Garde ◽

Alberto García-Salido ◽

Marta Cabrero-Hernández ◽

Amalia Tamariz ◽

...

Keyword(s):

Kawasaki Disease ◽

Cardiogenic Shock ◽

Myocardial Injury ◽

Treatment Strategies ◽

Case Series ◽

Empirical Therapy ◽

Extensive Literature ◽

Retrospective Case ◽

Laboratory Findings ◽

Inflammatory Syndrome

Background: Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease. Objective: To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided. Methods: Retrospective case series including all children (age 1 month–18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock. Results: Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died. Conclusion: Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.

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Injectional anthrax at a Scottish district general hospital

Epidemiology and Infection ◽

10.1017/s0950268814001885 ◽

2014 ◽

Vol 143 (6) ◽

pp. 1311-1321 ◽

Cited By ~ 2

Author(s):

D. J. INVERARITY ◽

V. M. FORRESTER ◽

J. G. R. CUMMING ◽

P. J. PATERSON ◽

R. J. CAMPBELL ◽

...

Keyword(s):

Case Series ◽

District General Hospital ◽

Limb Amputation ◽

Case Definitions ◽

Laboratory Findings ◽

Single Location ◽

Clinical Presentations ◽

Antibiotic Management ◽

Levels Of Support ◽

Overall Mortality

SUMMARYThis retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

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Co-existence of multisystem inflammatory syndrome in children associated with COVID-19 and scrub typhus infection: a case series

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20214847 ◽

2021 ◽

Author(s):

Sarbani M. Roy ◽

Sushama Sahoo

Keyword(s):

Clinical Features ◽

Scrub Typhus ◽

Virus Disease ◽

Clinical Manifestations ◽

Case Series ◽

World Health ◽

Laboratory Findings ◽

Term Outcome ◽

Corona Virus ◽

Inflammatory Syndrome

We are in the midst of pandemic of corona virus disease (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome corona virus-2 (SARS-CoV-2). A clinical entity with hyperinflammatory syndrome, defined by World Health Organization (WHO) as multisystem inflammatory syndrome in children (MIS-C) and adolescents, temporarily related to COVID-19, is being reported in this pandemic from several countries. MIS-C has overlapping clinical features of Kawasaki disease (KD). KD has been described in association with various organisms including dengue, scrub typhus. MIS-C with concomitant infection has rarely been reported in literature till date. We report on ten sick pediatric patients presented with clinical features of MIS-C, in whom diagnosis of concomitant scrub typhus were also made. This retrospective study was conducted in the department of pediatric medicine of a medical college, in a district town of West Bengal, India. SARS-CoV-2 immunoglobulin G level was elevated in all of them and they were also positive with Scrub typhus serology. We reviewed and analysed their basic informations, clinical manifestations, epidemiological history, laboratory findings, treatment and short term outcome. Median age was 24 months (range 4 months-8 years), male: female was 1:1. All the patients survived. Concomitant tropical infection in a patient with MIS-C may play an important role in determining the prognosis of such patients. Early detection and intervention will result in better management and intact survival of them.

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COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

BMC Pediatrics ◽

10.1186/s12887-021-02743-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohammad Rubayet Hasan ◽

Khaled Al Zubaidi ◽

Karim Diab ◽

Yahia Hejazi ◽

Sharon Bout-Tabaku ◽

...

Keyword(s):

Clinical Features ◽

Early Recognition ◽

Tertiary Care ◽

Case Series ◽

Case Definition ◽

Cardiac Biomarkers ◽

Medical Attention ◽

Laboratory Findings ◽

First Case ◽

Inflammatory Syndrome

Abstract Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar. Methods Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed. Results The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70–100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors. Conclusions Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.

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