scholarly journals Autoantibody Release in Children after Corona Virus mRNA Vaccination: A Risk Factor of Multisystem Inflammatory Syndrome?

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1353
Author(s):  
Reiner Buchhorn ◽  
Carlotta Meyer ◽  
Kai Schulze-Forster ◽  
Juliane Junker ◽  
Harald Heidecke
Keyword(s):  
Pericardial Effusion ◽  
Troponin T ◽  
Early Stage ◽  
Pediatric Population ◽  
Hashimoto Thyroiditis ◽  
Intravenous Immunoglobulins ◽  
Acute Onset ◽  
Vaccine Hesitancy ◽  
Current Case ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome (MIS) is a new systemic inflammatory acute onset disease that mainly affects children (MIS-C) and, at a lesser frequency, adults (MIS-A); it typically occurs 3–6 weeks after acute SARS-CoV infection. It has been postulated and shown in adults that MIS may occur after SARS-CoV-2 vaccination (MIS-V). Our current case is one of the first published cases with a multisystem inflammatory syndrome in an 18-year-old adolescent after the SARS-CoV-2 vaccine from Pfizer/BionTech (BNT162b2), who fulfills the published level 1 criteria for a definitive disease: age < 21 years, fever > 3 consecutive days, pericardial effusion, elevated CRP/NT-BNP/Troponin T/D-dimeres, cardiac involvement, and positive SARS-CoV-2 antibodies. The disease starts 10 weeks after the second vaccination, with a fever (up to 40 °C) and was treated with amoxicillin for suspected pneumonia. The SARS CoV-2-PCR and several antigen tests were negative. With an ongoing fever, he was hospitalized 14 days later. A pericardial effusion (10 mm) was diagnosed by echocardiography. The C-reactive protein (174 mg/L), NT-BNP (280 pg/mL), and Troponin T (28 pg/mL) values were elevated. Due to highly elevated D-dimeres (>35,000 μg/L), a pulmonary embolism was excluded by thoracal computer tomography. If the boy did not improve with intravenous antibiotics, he was treated with intravenous immunoglobulins; however, the therapy was discontinued after 230 mg/kg if he developed high fever and hypotension. A further specialized clinic treated him with colchicine and ibuprofen. The MIS-V was discovered late, 4 months after the onset of the disease. As recently shown in four children with MIS-C after SARS-CoV-2 infection and a girl with Hashimoto thyroiditis after BNT162b2 vaccination, we found elevated functional autoantibodies against G-protein-coupled receptors that may be important for pathophysiology but are not conclusive for the diagnosis of MIS-C. Conclusion: We are aware that a misattribution of MIS-V as a severe complication of coronavirus vaccination can lead to increased vaccine hesitancy and blunt the global COVID-19 vaccination drive. However, the pediatric population is at a higher risk for MIS-C and a very low risk for COVID-19 mortality. The publication of such cases is very important to make doctors aware of this complication of the vaccination, so that therapy with intravenous immunoglobulins can be initiated at an early stage.

Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children

2021 ◽  
pp. 1-9
Author(s):  
Ashraf S. Harahsheh ◽  
Anita Krishnan ◽  
Roberta L. DeBiasi ◽  
Laura J. Olivieri ◽  
Christopher Spurney ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pericardial Effusion ◽  
Acute Phase ◽  
Systolic Dysfunction ◽  
Interquartile Range ◽  
High Rate ◽  
Cardiac Complications ◽  
Valvular Regurgitation ◽  
Coronary Artery Abnormalities ◽  
Inflammatory Syndrome

Abstract Background: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. Objectives: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. Methods: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum. Results: Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). Conclusion: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

scholarly journals A Systematic Review of Characteristics Associated with COVID-19 in Children with Typical Presentation and with Multisystem Inflammatory Syndrome

2021 ◽  
Vol 18 (16) ◽  
pp. 8269
Author(s):  
Jeffrey Kornitzer ◽  
Jacklyn Johnson ◽  
Max Yang ◽  
Keith W. Pecor ◽  
Nicholas Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sore Throat ◽  
Literature Search ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Chinese Language ◽  
Clinical Information ◽  
Shortness Of Breath ◽  
Global Pandemic ◽  
Inflammatory Syndrome

Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.

scholarly journals Severe emphysematous cystitis complicated with perforation, bilateral renal cortical atrophy and sepsis: a case report

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052093792
Author(s):  
Wen-Jun Zhang ◽  
Zheng-Ming Zhu ◽  
Hong-Liang Luo
Keyword(s):  
Case Report ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Cortical Atrophy ◽  
Test Results ◽  
Lower Abdomen ◽  
Current Case ◽  
Emphysematous Cystitis ◽  
Frequent Micturition ◽  
Timely Treatment

Emphysematous cystitis (EC) is a rare bladder infection characterized by the presence of gas in the wall or cavity of the bladder. Most patients with EC will present with the typical symptoms of cystitis (e.g. frequent micturition, urgent micturition and dysuria), but other signs include distension and pain in the lower abdomen, drum sounds on percussion and a large amount of gas in the bladder. There can also be other complications such as sepsis. However, it is usually characterized by the typical symptoms of infection combined with pneumatinuria, the passage of gas mixed with urine. The early stage of EC is mostly limited to the submucosa and the symptoms of infection can be mild. Some patients may have no obvious clinical symptoms. If the infection becomes severe, it may result in difficulty urinating and kidney dysfunction. Therefore, timely treatment of these rare bladder infections is essential. This current case report describes an 80-year-old female patient with severe EC complicated by significant bilateral ureteral dilatation, bilateral renal cortical atrophy and sepsis. The patient was successfully treated with antibiotics and surgery. This report provides clinical data, test results and treatment experience that might be useful for clinicians that are involved in the treatment of EC.

scholarly journals Paediatric inflammatory multisystem syndrome temporally associated with COVID-19: a new virus and a new case presentation

2020 ◽  
Vol 13 (12) ◽  
pp. e238531
Author(s):  
Phoebe Makiello ◽  
Sima Svirpliene ◽  
Lisa Finlay ◽  
Jean McKnight
Keyword(s):  
Clinical Symptoms ◽  
Late Phase ◽  
Upper Airway ◽  
Intravenous Immunoglobulins ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Case Presentation ◽  
Full Resolution ◽  
Inflammatory Syndrome

An 11-year-old boy presented with features resembling those described in health alerts on Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), including persistent fever, haemodynamic instability and abdominal pain. Laboratory tests, including raised inflammatory markers, D-dimer, troponin and a coagulopathy, were consistent with PIMS-TS. Our patient required transfer to the paediatric intensive care unit; an echocardiography revealed left ventricular dysfunction. He was treated with intravenous immunoglobulins (Igs), corticosteroids and aspirin, with full resolution of clinical symptoms. A follow-up echocardiogram 1 month after discharge was unremarkable.Three SARS-CoV-2 PCRs on respiratory samples, taken over the initial 4-day period, were negative, as was a SARS-CoV-2 PCR on faeces 1 month after presentation; titres of IgG were clearly elevated. The negative PCRs in the presence of elevated titres of IgG suggest that the inflammatory syndrome might have developed in a late phase of COVID-19 infection when the virus was no longer detectable in the upper airway.

scholarly journals Establishment of a Pediatric COVID-19 Biorepository: Unique Considerations and Opportunities for Studying the Impact of the COVID-19 Pandemic on Children

2020 ◽  
Author(s):  
Rosiane Lima ◽  
Elizabeth Gootkind ◽  
Denis De La Flor ◽  
Laura Yockey ◽  
Evan Bordt ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Urgent Care ◽  
Sample Collection ◽  
Viral Susceptibility ◽  
Global Pandemic ◽  
Asymptomatic Children ◽  
Successful Establishment ◽  
Processing And Storage ◽  
Inflammatory Syndrome ◽  
The Impact

Abstract Background: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples in a standardized manner to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. Methods: A broad study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. Results: Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens.Conclusions: Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility, and, immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.

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

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.

scholarly journals Influence of sex on disease severity in children with COVID-19 and Multisystem Inflammatory Syndrome in Latin America

2021 ◽  
Author(s):  
Martin Brizuela ◽  
Jacopo Lenzi ◽  
Rolando Ulloa-Gutiérrez ◽  
Antúnez-Montes Omar Yassef ◽  
Jorge Alberto Rios Aida ◽  
...  
Keyword(s):  
Latin America ◽  
Disease Severity ◽  
Latin American ◽  
Pediatric Population ◽  
Large Cohort ◽  
Significant Difference ◽  
American Children ◽  
Inflammatory Syndrome

SummaryData from adult studies how that COVID-19 is more severe in men than women. However, no data are available for the pediatric population. For this reason, we performed this study aiming to understand if sex influenced disease severity and outcomes in a large cohort of latin-american children with COVID-19 and Multisystem Inflammatory Syndrome (MIS-C). We found that a higher percentage of male children developed MIS-C (8.9% vs 5% in females) and died (1.2% and 0.4% in females), although on multivariate adjusted analyses the only statistically significant difference was found in need of hospitalization, with females less frequently admitted compared with boys (25.6% vs 35.4%). This data are preliminary and need further independent studies to better assess the role of sex.

scholarly journals Management of ankle valgus in a skeletally immature patient by tension band plate hemiepiphysiodesis: A case report

2021 ◽  
pp. 461-464
Author(s):  
Rameshwar Datt ◽  
Gunjar Jain ◽  
Hira Lal Nag ◽  
Shubhankar Shekhar
Keyword(s):  
Case Report ◽  
Promising Result ◽  
Pediatric Population ◽  
Valgus Deformity ◽  
Tension Band ◽  
Skeletally Immature ◽  
Current Case ◽  
Tension Band Plate ◽  
Ankle Valgus ◽  
Skeletally Immature Patient

Temporary hemiepiphysiodesis is the procedure of choice to correct ankle valgus deformity in a skeletally immature patient. However, the literature is inconclusive regarding the ideal choice of implant and the timing of the surgery. In the current case report, a 9-year-old girl with multiple hereditary exostoses and unilateral ankle valgus deformity underwent tension band plate (TBP) hemiepiphysiodesis, and gained a modest correction at a rate of 0.61°/month. After 18 months of follow-up, there were no implant-related complications, and the functional outcome was also good. This case report shows a promising result of medial malleolar temporary hemiepiphysiodesis using a TBP for ankle valgus deformity in the pediatric population.

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