scholarly journals Multisystem Inflammatory Syndrome in Children: Unique Disease or Part of the Kawasaki Disease Spectrum?

2021 ◽  
Vol 9 ◽  
Author(s):  
Caterina Matucci-Cerinic ◽  
Roberta Caorsi ◽  
Alessandro Consolaro ◽  
Silvia Rosina ◽  
Adele Civino ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Kawasaki Disease ◽  
Children And Adolescents ◽  
Intravenous Immunoglobulin ◽  
Multiorgan Failure ◽  
Signs And Symptoms ◽  
Disease Spectrum ◽  
Myocardial Involvement ◽  
Inflammatory Syndrome ◽  
The Relationship

One of the most intriguing and mysterious phenomena observed during the COVID-19 pandemic has been represented by the occurrence of the multisystem inflammatory syndrome in children and adolescents (MIS-C). Patients with this condition have some overlapping signs and symptoms with those of Kawasaki disease (KD), but also display clinical features that are uncommon or less frequent in this illness, such as diarrhea, abdominal pain and myocardial involvement. The sickest patients may develop multiorgan failure and shock, usually due to myocarditis. Management is based on the administration of intravenous immunoglobulin, glucocorticoids and, in the most severe instances, anakinra. It is still debated whether MIS-C and KD represent different illnesses or are part of the same disease spectrum. The aim of the present review is to analyze critically the evidence in favor of the latter hypothesis and to provide the authors' personal interpretation of the relationship between the two conditions.

scholarly journals Multisystem Inflammatory Syndrome in Children and Adolescents (MIS-C) under the Setting of COVID-19: A Review of Clinical Presentation, Workup and Management

2021 ◽  
Vol 14 ◽  
pp. 117863372110266
Author(s):  
Ayesha Farooq ◽  
Fatima Alam ◽  
Asma Saeed ◽  
Farooq Butt ◽  
Muhammad Azeem Khaliq ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Children And Adolescents ◽  
Past History ◽  
Multiorgan Failure ◽  
Gastrointestinal Symptoms ◽  
Respiratory Illness ◽  
Intravenous Immunoglobulins ◽  
Cardiac Complications ◽  
Inflammatory Syndrome

Earlier in its course, SARS-CoV-2 was primarily identified to cause an acute respiratory illness in adults, the elderly and immunocompromised, while children were known to be afflicted with milder symptoms. However, since mid-April of 2020, latent effects of the virus have begun emerging in children and adolescents, which is characterised by a multisystem hyperinflammatory state; thus, the term Multisystem Inflammatory Syndrome in Children (MIS-C) was introduced by the WHO and CDC. The syndrome manifests itself approximately 4 weeks after COVID-19 infection, with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome. Demographically, MIS-C peaks in children aged 5 to 14 years, with clusters in Europe, North and Latin America seen, later followed by Asia. Although the exact pathophysiology behind the syndrome is unknown, recent studies have proposed a post-infectious immune aetiology, which explains the increased levels of immunoglobulins seen in affected patients. Patient presentation includes, but is not limited to, persistent fever, rash, gastrointestinal symptoms and cardiac complications including myocarditis. These patients also have raised inflammatory markers including C reactive protein, ferritin and interleukin-6. In poorly controlled patients, the syndrome can lead to multiorgan failure and death. The mainstay of treatment includes the use of intravenous immunoglobulins, steroids, immune modulators and aspirin. Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation. Currently very little is known about the syndrome, highlighting the need for awareness amongst healthcare workers and parents. Moreover, with increased cases of COVID-19 as a result of the second wave, it is essential to keep MIS-C in mind when attending patients with a past history of COVID-19 exposure or infection. Additionally, once these patients have been identified and treated, strict follow-up must be done in order carry out long term studies, and to identify possible sequelae and complications.

scholarly journals Refractory Multi-Inflammatory Syndrome in a Two Weeks Old Neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Magboul S
Keyword(s):  
Intravenous Immunoglobulin ◽  
Clinical Course ◽  
Virus Disease ◽  
Interleukin 1 ◽  
Signs And Symptoms ◽  
World Health ◽  
Case Presentation ◽  
Health Organization ◽  
Inflammatory Syndrome ◽  
Pulse Steroid

Background: World Health Organization (WHO) and other Health officials alert clinicians about a rare but severe inflammatory condition seen in children and linked to Corona Virus Disease 2019(COVID-19). The WHO is describing the condition as a multisystem inflammatory syndrome in children (MIS-C) and is recommending clinicians to report those cases to get a better understanding of the disease and clinicians can learn more. Case Presentation: We are reporting the clinical course of the youngest case of COVID-19 related MIS-c; a two-week-old term neonate with COVID-19 infection and features suggestive of MIS-C, managed with intravenous immunoglobulin (IVIG), pulse steroid, and interleukin-1 inhibitor (Anakinra). By reviewing the literature, our baby is the first neonatal case who has been diagnosed with MIS-C. Conclusion: COVID-19 infections in pediatrics are likely to present with a mild course; however, some may develop a hyperinflammatory syndrome. Pediatricians should be aware of such presentation, the clinical course, the management modalities,and inform parents and caregivers about common signs and symptoms. Anakinra may consider as effective second agent in (IVIG and steroid-refractory pediatric cases).

scholarly journals A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

PRILOZI ◽  
2021 ◽  
Vol 42 (2) ◽  
pp. 95-101
Author(s):  
Lidija Kareva ◽  
Katarina Stavrik ◽  
Kristina Mironska ◽  
Arjeta Hasani ◽  
Sonja Bojadzieva ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Close Contact ◽  
Multiorgan Failure ◽  
Gastrointestinal Symptoms ◽  
Gastrointestinal Diseases ◽  
Serological Testing ◽  
Inflammatory Syndrome ◽  
Pcr Test

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

scholarly journals Autoantibodies Detected in MIS-C Patients due to Administration of Intravenous Immunoglobulin

2021 ◽  
Author(s):  
Peter D. Burbelo ◽  
Riccardo Castagnoli ◽  
Chisato Shimizu ◽  
Ottavia M. Delmonte ◽  
Kerry Dobbs ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
High Dose ◽  
Autoantibody Production ◽  
Autoantibody Profile ◽  
Insulin Dependent ◽  
Inflammatory Syndrome ◽  
High Dose Ivig ◽  
Ivig Administration

The autoantibody profile associated with known autoimmune diseases in patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) remains poorly defined. Here we show that adults with COVID-19 had a moderate prevalence of autoantibodies against the lung antigen KCNRG, and SLE-associated Smith autoantigen. Children with COVID-19 rarely had autoantibodies; one of 59 children had GAD65 autoantibodies associated with acute insulin-dependent diabetes. While autoantibodies associated with SLE/Sjogren syndrome (Ro52, Ro60, and La) and/or autoimmune gastritis (gastric ATPase) were detected in 74% (40/54) of MIS-C patients, further analysis of these patients and of children with Kawasaki disease (KD), showed that the administration of intravenous immunoglobulin (IVIG) was largely responsible for detection of these autoantibodies in both groups of patients. Monitoring in vivo decay of the autoantibodies in MIS-C children showed that the IVIG-derived Ro52, Ro60, and La autoantibodies declined to undetectable levels by 45-60 days, but gastric ATPase autoantibodies declined more slowly requiring >100 days until undetectable. Together these findings demonstrate that administration of high-dose IVIG is responsible for the detection of several autoantibodies in MIS-C and KD. Further studies are needed to investigate autoantibody production in MIS-C patients, independently from IVIG administration.

scholarly journals Differentiating multisystem inflammatory syndrome in children: a single-centre retrospective cohort study

2021 ◽  
pp. archdischild-2021-322290
Author(s):  
Jordan E Roberts ◽  
Jeffrey I Campbell ◽  
Kimberlee Gauvreau ◽  
Gabriella S Lamb ◽  
Jane Newburger ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Oral Mucosa ◽  
Multivariable Analysis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Clinical Signs And Symptoms ◽  
Inflammatory Syndrome

ObjectiveFeatures of multisystem inflammatory syndrome in children (MIS-C) overlap with other febrile illnesses, hindering prompt and accurate diagnosis. The objectives of this study were to identify clinical and laboratory findings that distinguished MIS-C from febrile illnesses in which MIS-C was considered but ultimately excluded, and to examine the diseases that most often mimicked MIS-C in a tertiary medical centre.Study designWe identified all children hospitalised with fever who were evaluated for MIS-C at our centre and compared clinical signs and symptoms, SARS-CoV-2 status and laboratory studies between those with and without MIS-C. Multivariable logistic LASSO (least absolute shrinkage and selection operator) regression was used to identify the most discriminative presenting features of MIS-C.ResultsWe identified 50 confirmed MIS-C cases (MIS-C+) and 68 children evaluated for, but ultimately not diagnosed with, MIS-C (MIS-C-). In univariable analysis, conjunctivitis, abdominal pain, fatigue, hypoxaemia, tachypnoea and hypotension at presentation were significantly more common among MIS-C+ patients. MIS-C+ and MIS-C- patients had similar elevations in C-reactive protein (CRP), but were differentiated by thrombocytopenia, lymphopenia, and elevated ferritin, neutrophil/lymphocyte ratio, BNP and troponin. In multivariable analysis, predictors of MIS-C included age, neutrophil/lymphocyte ratio, platelets, conjunctivitis, oral mucosa changes, abdominal pain and hypotension.ConclusionsAmong hospitalised children undergoing evaluation for MIS-C, children with MIS-C were older, more likely to present with conjunctivitis, oral mucosa changes, abdominal pain and hypotension, and had higher neutrophil/lymphocyte ratios and lower platelet counts. These data may be helpful for discrimination of MIS-C from other febrile illnesses, including bacterial lymphadenitis and acute viral infection, with overlapping features.

scholarly journals Case report: Pediatric patients with COVID-19 presented as multi-system inflammatory syndrome

2020 ◽  
Author(s):  
Amir Saeed ◽  
anahita sanaei ◽  
shabnam Hajiani Ghotbabadi ◽  
Eslam shorafa
Keyword(s):  
Case Report ◽  
Kawasaki Disease ◽  
World Health Organization ◽  
Pediatric Patients ◽  
World Health ◽  
Atypical Presentation ◽  
Case Presentation ◽  
Myocardial Involvement ◽  
Health Organization ◽  
Inflammatory Syndrome

Abstract Background COVID-19 in pediatric patients is typically associated with minimal manifestations and is less severe than adult patients. Recently, there are reports of children with COVID 19 and myocardial involvement from Europe and America that first were assumed to be Kawasaki disease or its atypical presentation. However world health organization has set a new designation for this state; “multi-system involvement syndrome” in children with COVID-19; (MIS-C). Case presentation: Here we report two COVID-19 pediatric patients (two girls aged 10 and 13 years old) with MIS-C. Conclusion Presence of Kawasaki like signs in COVID 19 patients should be an alarming point to consider multi-system inflammatory syndrome; a syndrome with extensive organ involvement and yet indistinct exact pathophysiology.

The relationship of eosinophilia to intravenous immunoglobulin treatment failure in Kawasaki disease

2007 ◽  
Vol 18 (4) ◽  
pp. 354-359 ◽  
Author(s):  
Ho-Chang Kuo ◽  
Kuender D. Yang ◽  
Chi-Di Liang ◽  
Chin-Nam Bong ◽  
Hong-Ren Yu ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Treatment Failure ◽  
Intravenous Immunoglobulin ◽  
Immunoglobulin Treatment ◽  
Relationship Of ◽  
The Relationship

scholarly journals Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

2020 ◽  
Author(s):  
Samar Magboul ◽  
Ahmed Khalil ◽  
Ahmad Alshami ◽  
Mohamed Alaido ◽  
Abdulla Alhothi ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Clinical Course ◽  
Virus Disease ◽  
Interleukin 1 ◽  
Signs And Symptoms ◽  
World Health ◽  
Case Presentation ◽  
Health Organization ◽  
Inflammatory Syndrome ◽  
Pulse Steroid

Abstract Background: World Health Organization (WHO) and other Health officials alert clinicians about a rare but severe inflammatory condition seen in children and linked to Corona Virus Disease 2019(COVID-19). The WHO is describing the condition as a multisystem inflammatory syndrome in children (MIS-C) and is recommending clinicians to report those cases to get a better understanding of the disease and clinicians can learn more.Case presentation: We are reporting the clinical course of the youngest case of COVID-19 related MIS-c; a two-week-old term neonate with COVID-19 infection and features suggestive of MIS-C , managed with intravenous immunoglobulin (IVIG), pulse steroid, and interleukin-1 inhibitor (Anakinra).By reviewing the literature, our baby is the first neonatal case who has been diagnosed with MIS-C.Conclusion: COVID-19 infection in pediatrics are likely to present with a mild course; however, some may develop a hyper-inflammatory syndrome. Pediatricians should be aware of such presentation, the clinical course, the management modalities, and inform parents and caregivers about common signs and symptoms. Anakinra may consider as effective second agent in (IVIG and steroid-refractory pediatric cases).

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