scholarly journals Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 10 (15) ◽  
pp. 3360
Author(s):  
Domenico Sirico ◽  
Alessia Basso ◽  
Elena Reffo ◽  
Annachiara Cavaliere ◽  
Biagio Castaldi ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Clinical Laboratory ◽  
Global Longitudinal Strain ◽  
Myocardial Necrosis ◽  
Mri Findings ◽  
Severe Condition ◽  
Immune Mediated ◽  
Inflammatory Syndrome ◽  
Coronary Dilation ◽  
Microbiological Data

Multisystem Inflammatory Syndrome in Children (MIS-C) is a known severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the early cardiac abnormalities in patients with MIS-C, evaluated by speckle tracking echocardiography (STE) and cardiac MRI (CMR). Clinical, laboratory and microbiological data were measured for all patients. All children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS). Seventeen (75%) of the children were evaluated with CMR. Twenty-three patients (13M, 10F) were recruited, mean age was 8.1 ± 4 years. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission. In-hospital survival was 100%. TnI was elevated in 15 (65.2%) and BNP in 20 (86.9%) patients. The median time to STE evaluation was 8 days and to CMR was 18 days after fever onset. Mean LVEF was 59 ± 10%. Coronary dilation was observed in six (26.1%) patients. STE showed a reduced mean LVGLS (−17 ± 4.3%). LGE with a non-ischemic pattern was evident in six out of seventeen patients (35.2%). The elevation of myocardial necrosis markers, the reduction of LVGLS and the presence of LGE on CMR in about a quarter of MIS-C patients supports the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis.

scholarly journals 287 Acute and late echocardiographic and cardiac MRI findings in multisystem inflammatory syndrome in children

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Domenico Sirico ◽  
Alessia Basso ◽  
Elena Reffo ◽  
Annachiara Cavaliere ◽  
Biagio Castaldi ◽  
...  
Keyword(s):  
Median Time ◽  
Cardiac Mri ◽  
Global Longitudinal Strain ◽  
Disease Onset ◽  
Short Term ◽  
Mri Findings ◽  
Term Survival ◽  
Inflammatory Syndrome ◽  
Short Term Survival

Abstract Aims Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the acute and late cardiac abnormalities in patients with MIS-C, evaluated by speckle-tracking echocardiography (STE) and cardiac MRI (CMR). Methods and results Twenty-three (13 M, 10 F) patients with confirmed MIS-C diagnosis were recruited. All children underwent standard TTE, STE with analysis of LV global longitudinal strain (GLS). Seventeen (75%) were evaluated with CMR. All children received standard therapy. During follow-up echocardiography and CMR were repeated. Mean age was 8.1 ± 4 years. The majority (78.2%) was Caucasian. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission and three required inotropic support. Short-term survival was 100%. All patients showed a hyperinflammatory state. Tn-I was abnormal (>34 ng/l) in 15 patients (65.2%), BNP was elevated in 20 (86.9%). Median time to STE evaluation was 8 days and to CMR 18 days since fever onset. Mean LVEF and RVEF were, respectively, 59 ± 10% and 45 ± 7%. Coronary dilation was observed in six (26.1%) patients. STE showed reduced mean LVGLS (−17 ± 4.3%). LVEF on CMR was 60 ± 13%, LGE with non-ischaemic pattern was evident in 6/17 patients (35.2%). Median time to follow-up was 49 days for echocardiography and 200 days for CMR since disease onset. STE showed improvement of LVGLS (−18.8 ± 2.2%), while CMR displayed persistence of LGE in two patients and reduction or absence in two of the six patients previously diagnosed. Conclusions The elevation of myocardial necrosis markers, the myocardial injury testified by reduced LVGLS and the presence of LGE on CMR in about a quarter of the patients support the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis of MIS-C. Early follow-up shows improvement of STE and CMR findings corroborating the evidence of excellent short-term survival.

RISK FACTORS IN THE DEVELOPMENT OF LIVER ABSCESSES AND DIAGNOSTIC STRATEGY IN THEIR SUSPECTED PRESENCE

2016 ◽  
Vol 2 (1) ◽  
pp. 31
Author(s):  
Josiah Iju WILSON ◽  
Vladimir Egorovich MEDVEDEV
Keyword(s):  
Risk Factors ◽  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Bacterial Overgrowth ◽  
Diagnostic Strategy ◽  
Hydrogen Breath Test ◽  
Severe Condition ◽  
Liver Ultrasound ◽  
Liver Abscesses ◽  
History Of

Introduction: The main risk aetiological factors of liver abscesses and development of precision liver ultrasound recommendations to detect signs of possible abscess formation were studied.Material and methods: 248 patients of both sexes aged 4-81 years with liver abscesses were analyzed. Medical history, physical examination, clinical laboratory tests, hydrogen breath test with, ultrasound examination, if necessary - computed tomography and fine needle diagnostic biopsy under ultrasound guidance were carried out..Results and discussion: It was established that liver abscesses are aetiologically heterogeneous, in which the largest in the group was pylephlebitic (64.1%), posttraumatic (14.5%), cholangiogenic (12.5%) and contact abscesses (1.2 %). In connection with the effacement or nonspecific clinical picture, often severe condition of the patient, the prevalence of symptoms in some cases of other diseases, liver abscesses may not be promptly diagnosed.Conclusion: The presence of clinical and laboratory signs of suppurate inflammatory processes, risk factors such as the presence of bacterial overgrowth syndrome, inflammatory diseases of the intestines, history of the use of proton pump inhibitors, diseases in association with cholestasis, surgery, history of trauma, abscesses of other locations, it is recommended that precision liver ultrasound should be carried out to detect possible echo signs of liver abscesses.

scholarly journals Classical Cardiac MRI Findings in a Case of Hypertrophic Cardiomyopathy

2020 ◽  
Vol 1 (3-4) ◽  
pp. 198-198
Author(s):  
Sania Maheen ◽  
M. Jwala Srikala ◽  
B. Hygriv Rao ◽  
Lakshman Kolluru
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Cardiac Mri ◽  
Mri Findings

MIS-A associated myocardial injury: The art of diagnosis and follow-up

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Bellony Nzemenoh ◽  
◽  
Arianne C Agdamag ◽  
Valmiki Maharaj ◽  
Victoria Charpentier ◽  
...  
Keyword(s):  
Chest Pain ◽  
Early Identification ◽  
Myocardial Injury ◽  
Clinical Course ◽  
Full Recovery ◽  
Myocardial Inflammation ◽  
Severe Condition ◽  
Healthy Female ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe condition in adults with a clinical course similar to that described in children (MIS-C) following infection with the SARS-CoV-2 virus. Here we describe a case of a 21-year-old, otherwise healthy female who presented with chest pain and signs of sepsis six weeks after recovering from coronavirus disease 2019 (COVID-19). Early identification of MIS-A led to a favorable clinical course and full recovery. Given the highly variable disease presentation yet potentially deadly outcome, providers must remain vigilant to recognize and treat MIS-A early Keywords: MIS-A; myocardial inflammation; SARS-CoV-2; COVID-19 disease.

Cardiovascular Anomalies in Turner Syndrome: Spectrum, Prevalence, and Cardiac MRI Findings in a Pediatric and Young Adult Population

2011 ◽  
Vol 196 (2) ◽  
pp. 454-460 ◽  
Author(s):  
Hee Kyung Kim ◽  
William Gottliebson ◽  
Kan Hor ◽  
Philippe Backeljauw ◽  
Iris Gutmark-Little ◽  
...  
Keyword(s):  
Young Adult ◽  
Turner Syndrome ◽  
Cardiac Mri ◽  
Adult Population ◽  
Mri Findings ◽  
Young Adult Population ◽  
Cardiovascular Anomalies

scholarly journals Cardiac MRI in Children with Multisystem Inflammatory Syndrome Associated with COVID-19

Radiology ◽  
2020 ◽  
Vol 297 (3) ◽  
pp. E283-E288 ◽  
Author(s):  
Eléonore Blondiaux ◽  
Pauline Parisot ◽  
Alban Redheuil ◽  
Lucile Tzaroukian ◽  
Yaël Levy ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Inflammatory Syndrome

scholarly journals Myositis associated anti-NT5C1A autoantibody in clinical practice

2020 ◽  
Author(s):  
Chiseko Ikenaga ◽  
Andrew R. Findlay ◽  
Namita A. Goyal ◽  
Sarah Robinson ◽  
Jonathan Cauchi ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Laboratory ◽  
Clinicopathologic Features ◽  
Antisynthetase Syndrome ◽  
Muscle Diseases ◽  
Immune Mediated ◽  
Finger Flexion ◽  
Antibody Positivity ◽  
Diagnostic Sensitivity And Specificity ◽  
Washington University

ABSTRACTObjectiveTo define the diagnostic utility and clinicopathologic features correlating with anti-cytosolic 5′-nucleotidase 1A (NT5C1A) antibody positivity in idiopathic inflammatory myopathies (IIMs).Methods4987 patients had anti-NT5C1A status clinically tested between 2014 and 2019 in the Washington University neuromuscular clinical laboratory. Using clinicopathologic information available for 630 of these patients, we classified them as inclusion body myositis (IBM), dermatomyositis, antisynthetase syndrome, immune-mediated necrotizing myopathy (IMNM), non-specific myositis, or non-inflammatory muscle diseases.ResultsAnti-NT5C1A was found in 182/287 patients with IBM (63%), 11/53 patients with dermatomyositis (21%), 7/27 patients with antisynthetase syndrome (26%), 9/76 patients with IMNM (12%), 20/84 patients with non-specific myositis (24%), and 6/103 patients with non-inflammatory muscle diseases (6%). The sensitivity and specificity of anti-NT5C1A seropositivity for the diagnosis of IBM was 63% and 85%, respectively. Anti-NT5C1A positive IBM patients had a higher frequency of finger flexion weakness (p<0.01) and their biopsies harbored more COX negative fibers (p=0.04). 18% of anti-NT5C1A negative IBM patients seroconverted to anti-NT5C1A positive on repeat testing.ConclusionsThis is the largest description of patients tested by a clinical diagnostic lab for anti-NT5C1A. We confirm the sensitivity and specificity of anti-NT5C1A for IBM and identified clinicopathologic features in IBM which correlate with anti-NT5C1A status. Notably, anti-NT5C1A testing increased both the diagnostic sensitivity and specificity of IBM when combined with patient age, gender and creatine kinase (CK) level. We propose that future IBM diagnostic criteria include anti-NT5C1A testing.

scholarly journals Multi-Inflammatory Syndrome in Children: A View into Immune Pathogenesis from a Laboratory Perspective

2021 ◽  
Author(s):  
Mary Kathryn Bohn ◽  
Peter Yousef ◽  
Shannon Steele ◽  
Lusia Sepiashvili ◽  
Khosrow Adeli
Keyword(s):  
Clinical Laboratory ◽  
Disease Onset ◽  
Cardiovascular Complications ◽  
School Age Children ◽  
Inflammatory Disorder ◽  
Brain Natriuretic Peptides ◽  
Circulating Autoantibodies ◽  
Long Term Impact ◽  
Inflammatory Syndrome

Abstract Background Multi-inflammatory syndrome in children (MIS-C) is a novel and rare inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school-age children. Reports in the past year have suggested a multi-system pathophysiology characterized by hyperinflammation, gastrointestinal distress, and cardiovascular complications. Clinical laboratory investigations, including routine blood testing for inflammatory (e.g., CRP, ferritin) and cardiac (e.g., troponin, brain natriuretic peptides) markers have provided insight into potential drivers of disease pathogenesis, highlighting the role of the laboratory in the differential diagnosis of patients presenting with similar conditions (e.g., Kawasaki Disease, Macrophage Activating Syndrome). Content While few studies have applied high-dimensional immune profiling to further characterize underlying MIS-C pathophysiology, much remains unknown regarding predisposing risk factors, etiology, and long-term impact of disease onset. The extent of autoimmune involvement is also unclear. In the current review, we summarize and critically evaluate available literature on potential pathogenic mechanisms underlying MIS-C onset and discuss the current and anticipated value of various laboratory testing paradigms in MIS-C diagnosis and monitoring. Summary From initial reports, it is clear that MIS-C has unique inflammatory signatures involving both adaptive and innate systems. Certain cytokines, inflammatory markers, and cardiac markers assist in the differentiation of MIS-C from other hyperinflammatory conditions. However, there are still major gaps in our understanding of MIS-C pathogenesis, including T cell, B cell, and innate response. It is essential that researchers not only continue to decipher initial pathogenesis but also monitor long-term health outcomes, particularly given observed presence of circulating autoantibodies with unknown impact.

scholarly journals Immune-mediated Neuropathies Our Experience over 3 Years

2018 ◽  
Vol 09 (01) ◽  
pp. 030-035 ◽  
Author(s):  
Sadanandavalli Retnaswami Chandra ◽  
Venkata Raviteja Karru ◽  
M. A. Mukheem Mudabbir ◽  
Subashree Ramakrishnan ◽  
Anitha Mahadevan
Keyword(s):  
Clinical Laboratory ◽  
Clinical Course ◽  
Immune Dysregulation ◽  
Response To Treatment ◽  
Dominant Type ◽  
The Past ◽  
Immune Mediated ◽  
Sensory Motor ◽  
Chronic Neuropathy

ABSTRACT Introduction: Immune-mediated peripheral neuropathy is the term applied to a spectrum of peripheral nerve disorders where immune dysregulation plays a role. Therefore, they are treatable. We analyzed the cases seen in the past 3 years by us and evaluated the clinical, laboratory, and outcome parameters in these patients. Patients and Methods: Consecutive patients seen by the authors and diagnosed as immune-mediated neuropathy were analyzed for etiology, pathology, and outcome assessed. Results: A total of sixty patients, 31 acute and 29 chronic neuropathies, were identified. Their subtypes treatment and outcome assessed. Males were significantly more in both acute and chronic cases. Miller Fisher 4, AMAN 1, paraplegic type 1, motor dominant type 19, Sensory-motor 1, MADSAM 3, Bifacial 2. Nonsystemic vasculitis was seen in 16 out of 29 chronic neuropathy and HIV, POEMS, and diabetes mellitus one each. Discussion: There is a spectrum of immune-mediated neuropathy which varies in clinical course, response to treatment, etc., Small percentage of uncommon cases are seen. In this group, mortality was nil and morbidity was minimal. Conclusion: Immune-mediated neuropathies are treatable and hence should be diagnosed early for good quality outcome.

scholarly journals Acute Disseminated Encephalomyelitis: Current Perspectives

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 210
Author(s):  
Renata Barbosa Paolilo ◽  
Kumaran Deiva ◽  
Rinze Neuteboom ◽  
Kevin Rostásy ◽  
Ming Lim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Central Nervous System ◽  
Nervous System ◽  
Magnetic Resonance ◽  
Acute Disseminated Encephalomyelitis ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Immune Mediated ◽  
Magnetic Resonance Imaging Mri

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated central nervous system (CNS) disorder, characterized by polyfocal symptoms, encephalopathy and typical magnetic resonance imaging (MRI) findings, that especially affects young children. Advances in understanding CNS neuroimmune disorders as well as the association of myelin oligodendrocyte glycoprotein antibody (MOG-Ab) with both monophasic and recurrent forms of ADEM have led to new insights into its definition, management and outcome. In this review, we aim to provide an update based on current epidemiologic, clinical, radiological and immunopathological aspects and clinical outcome of ADEM.

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