scholarly journals Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C/PIMS) at the time of COVID-19: are they all the same? Case series and literature review

Reumatismo ◽  
2021 ◽  
Vol 73 (1) ◽  
pp. 48-53
Author(s):  
A. Marino ◽  
T. Varisco ◽  
G. Quattrocchi ◽  
A. Amoroso ◽  
D. Beltrami ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Laboratory Tests ◽  
Clinical Presentation ◽  
Case Series ◽  
Northern Italy ◽  
C Reactive Protein ◽  
Typical Pattern ◽  
Reactive Protein ◽  
Inflammatory Activation ◽  
Myocardial Involvement

Since the coronavirus disease 2019 (COVID-19) outbreak started, children have been considered marginally involved compared to adults, with a quite significant percentage of asymptomatic carriers. Very recently, an overwhelming inflammatory activation, which shares clinical similarities with Kawasaki disease (KD), has been described in children exposed to COVID-19. We report three KD-like cases that occurred during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a highly affected area of Northern Italy. The clinical presentation was characterized by the presence of unremitting fever, diarrhea and elevated inflammatory markers. Case #1 and Case #2 occurred one week apart and shared other clinical features: laboratory tests confirmed COVID-19 exposure and high inflammatory activation with myocardial involvement. Case #3 followed a more typical pattern for KD. Interestingly, this patient showed lower levels of procalcitonin, C-reactive protein, D-dimers, and ferritin compared to the other two cases, whereas platelet count was higher. We hypothesize that SARS-CoV-2 might act in children as a trigger, either inducing a classical KD phenotype or causing a systemic inflammatory response leading to a severe KD-like phenotype, eventually characterized by myocardial impairment. We think that bringing these cases and their differences to the attention of the rheumatology community during the COVID-19 pandemic will be beneficial in order to highlight the importance of early diagnosis and to increase awareness of this new phenomenon.

Gender Differences in the Presentation and Outcomes of Hospitalized Patients With COVID-19

2021 ◽  
Vol 16 (6) ◽  
Author(s):  
Carloalberto Biolè ◽  
Matteo Bianco ◽  
Iván J Núñez-Gil ◽  
Enrico Cerrato ◽  
Amanda Spirito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Renal Failure ◽  
Cardiovascular Risk ◽  
Laboratory Tests ◽  
Clinical Presentation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
International Registry ◽  
Male Patients

Gender-related differences in COVID-19 clinical presentation, disease progression, and mortality have not been adequately explored. We analyzed the clinical profile, presentation, treatments, and outcomes of patients according to gender in the HOPE-COVID-19 International Registry. Among 2,798 enrolled patients, 1,111 were women (39.7%). Male patients had a higher prevalence of cardiovascular risk factors and more comorbidities at baseline. After propensity score matching, 876 men and 876 women were selected. Male patients more often reported fever, whereas female patients more often reported vomiting, diarrhea, and hyposmia/anosmia. Laboratory tests in men presented alterations consistent with a more severe COVID-19 infection (eg, significantly higher C-reactive protein, troponin, transaminases, lymphocytopenia, thrombocytopenia, and ferritin). Systemic inflammatory response syndrome, bilateral pneumonia, respiratory insufficiency, and renal failure were significantly more frequent in men. Men more often required pronation, corticosteroids, and tocilizumab administration. A significantly higher 30-day mortality was observed in men vs women (23.4% vs 19.2%; P = .039). Trial Numbers: NCT04334291/EUPAS34399.

Abstract 35: Common Variants in the CRP Promoter are Associated with a High C-reactive Protein Level in Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Jae-Jung Kim ◽  
Sin Weon Yun ◽  
Jeong Jin Yu ◽  
Kyung Lim Yoon ◽  
Kyung-Yil Lee ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Phenotypic Variation ◽  
Genome Wide Association Study ◽  
Replication Study ◽  
Common Variants ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
A Genome ◽  
Wbc Count ◽  
Stage 1

Kawasaki disease (KD) is an acute self-limiting form of vasculitis that afflicts infants and children and manifests as fever and signs of mucocutaneous inflammation. Children with KD show various laboratory inflammatory abnormalities, such as elevations in their white blood cell (WBC) count, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR). We here performed a genome-wide association study (GWAS) of 178 KD patients to identify the genetic loci that influence 10 important KD laboratory markers: WBC count, neutrophil count, platelet count, CRP, ESR, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, and total protein. A total of 165 loci passed our arbitrary stage 1 threshold for replication ( p < 1 * 10 -5 ). Of these, only 2 SNPs (rs12068753 and rs4786091) demonstrated a significant association with the CRP level in replication study of 473 KD patients ( p < 0.05). The SNP located at the CRP locus (rs12068753) demonstrated the most significant association with CRP in KD patients (beta = 4.73 and p = 1.20 * 10 -6 according to the stage 1 GWAS; beta = 3.65 and p = 1.35 * 10 -8 according to the replication study; beta = 3.97 and p = 1.11 * 10 -13 according to combined analysis) and explained 8.1% of the phenotypic variation observed. However, this SNP did not demonstrate any significant association with CRP in the general population (beta = 0.37 and p = 0.1732) and only explained 0.1% of the phenotypic variation in this instance. Furthermore, rs12068753 did not affect the development of coronary artery lesions or intravenous immunoglobulin resistance in KD patients. These results indicate that common variants in the CRP promoter can play an important role in the CRP levels in KD.

scholarly journals AIR SCORE ASSESSMENT FOR ACUTE APPENDICITIS

2015 ◽  
Vol 28 (3) ◽  
pp. 171-173 ◽  
Author(s):  
Bruno VON-MÜHLEN ◽  
Orli FRANZON ◽  
Murilo Gamba BEDUSCHI ◽  
Nicolau KRUEL ◽  
Daniel LUPSELO
Keyword(s):  
Acute Appendicitis ◽  
Polymorphonuclear Leukocytes ◽  
Laboratory Tests ◽  
Blood Count ◽  
C Reactive Protein ◽  
Exclusion Criteria ◽  
Clinical Criteria ◽  
Reactive Protein ◽  
Disease Stratification ◽  
Response Score

Background: Acute appendicitis is the most common cause of acute abdomen. Approximately 7% of the population will be affected by this condition during full life. The development of AIR score may contribute to diagnosis associating easy clinical criteria and two simple laboratory tests. Aim: To evaluate the score AIR (Appendicitis Inflammatory Response score) as a tool for the diagnosis and prediction of severity of acute appendicitis. Method: Were evaluated all patients undergoing surgical appendectomy. From 273 patients, 126 were excluded due to exclusion criteria. All patients were submitted o AIR score. Results: The value of the C-reactive protein and the percentage of leukocytes segmented blood count showed a direct relationship with the phase of acute appendicitis. Conclusion: As for the laboratory criteria, serum C-reactive protein and assessment of the percentage of the polymorphonuclear leukocytes count were important to diagnosis and disease stratification.

scholarly journals Low Albumin Levels Are Associated with Poorer Outcomes in a Case Series of COVID-19 Patients in Spain: A Retrospective Cohort Study

2020 ◽  
Vol 8 (8) ◽  
pp. 1106 ◽  
Author(s):  
Roberto de la Rica ◽  
Marcio Borges ◽  
Maria Aranda ◽  
Alberto del Castillo ◽  
Antonia Socias ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Poor Prognosis ◽  
Case Series ◽  
Hospital Length ◽  
Limited Information ◽  
C Reactive Protein ◽  
Icu Patients ◽  
Reactive Protein ◽  
Epidemiological Features ◽  
Initial Symptoms

There is limited information available describing the clinical and epidemiological features of Spanish patients requiring hospitalization for coronavirus disease 2019 (COVID-19). In this observational study, we aimed to describe the clinical characteristics and epidemiological features of severe (non-ICU) and critically patients (ICU) with COVID-19 at triage, prior to hospitalization. Forty-eight patients (27 non-ICU and 21 ICU) with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed (mean age, 66 years, [range, 33–88 years]; 67% males). There were no differences in age or sex among groups. Initial symptoms included fever (100%), coughing (85%), dyspnea (76%), diarrhea (42%) and asthenia (21%). ICU patients had a higher prevalence of dyspnea compared to non-ICU patients (95% vs. 61%, p = 0.022). ICU-patients had lymphopenia as well as hypoalbuminemia. Lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin were significantly higher in ICU patients compared to non-ICU (p < 0.001). Lower albumin levels were associated with poor prognosis measured as longer hospital length (r = −0.472, p < 0.001) and mortality (r = −0.424, p = 0.003). As of 28 April 2020, 10 patients (8 ICU and 2 non-ICU) have died (21% mortality), and while 100% of the non-ICU patients have been discharged, 33% of the ICU patients still remained hospitalized (5 in ICU and 2 had been transferred to ward). Critically ill patients with COVID-19 present lymphopenia, hypoalbuminemia and high levels of inflammation.

Nasopharyngeal Carriage of Invasive Pneumococcal Serotypes During Childhood Community-Acquired Alveolar Pneumonia Is Associated With Specific Clinical Presentation

2019 ◽  
Author(s):  
Yaniv Faingelernt ◽  
Ron Dagan ◽  
Noga Givon-Lavi ◽  
Shalom Ben-Shimol ◽  
Jacob Bar-Ziv ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Pediatric Emergency ◽  
Nasopharyngeal Carriage ◽  
Pneumococcal Serotypes ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Invasive Potential ◽  
Viral Detection ◽  
Reactive Protein ◽  
Lower Oxygen

Abstract Background Streptococcus pneumoniae (Pnc) serotypes differ in invasive potential. We examined whether community-acquired alveolar pneumonia (CAAP) in children carrying commonly recognized pneumonia invasive pneumococcal serotypes ([PnIST] 1, 5, 7F, 14, and 19A) differs from CAAP in children carrying less invasive serotypes (non-PnIST) or no Pnc (Pnc-neg). Methods Children <5 years, visiting the only regional Pediatric Emergency Room, with radiologically proven CAAP were enrolled. Nasopharyngeal cultures were processed for pneumococcal isolation and serotyping. Clinical and demographic characteristics were recorded. The study was conducted before pneumococcal conjugate vaccine implementation in Israel. Results A total of 1423 CAAP episodes were recorded: PnIST, 300 (21.1%); non-PnIST, 591 (41.5%); and Pnc-neg, 532 (37.4%). After adjustment for age, ethnicity, seasonality, and previous antibiotics, the following variables were positively associated with PnIST carriage compared with both groups: temperature ≥39°C, peripheral white blood cell count ≥20 000/mm3, C-reactive protein ≥70.0 mg/L, and serum sodium <135 mEq/L. Lower oxygen saturation, viral detection, and comorbidities were negatively associated with Pn-IST carriage (odds ratios, <1.0). Differences between non-PnIST carriers and Pnc-neg groups were smaller or nonsignificant. Conclusions Young children with CAAP carrying common PnIST had a lower proportion of comorbidities, hypoxemia, and viral detection and had more intense systemic inflammatory response than those carrying non-PnIST or not carrying Pnc.

scholarly journals Pseudo paralysis of the shoulder and increased C-reactive protein are predictive factors for septic shoulder in children superior to other clinical symptoms: a retrospective case series of 25 patients

2020 ◽  
Vol 14 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Cezara Danilov ◽  
Christoph Ihle ◽  
Francisco F. Fernandez ◽  
Gunnar Blumenstock ◽  
Thomas Wirth ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Clinical Symptoms ◽  
Case Series ◽  
Diagnostic Procedures ◽  
White Blood Count ◽  
C Reactive Protein ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Reactive Protein ◽  
Shoulder Arthritis

Purpose The aim of the study was to evaluate predictable parameters with the highest sensitivity used in the diagnosis of children septic shoulder arthritis. Methods All children treated in our paediatric orthopaedic hospital between 2000 and 2017 with intraoperative verified septic arthritis of the shoulder were included in this retrospective study. Diagnostic procedures e.g. ultrasound, MRI, radiograph or blood samples as well as typical clinical symptoms were evaluated as predictable parameters for septic shoulder arthritis in paediatric patients. Descriptive statistics as well as sensitivity analysis were performed. Results In all, 25 children, 20 boys and five girls, aged from eight days to 15 years, were included for further statistical analysis. All parameters included were tested for sensitivity with binomial confidence intervals (Cis) of 95%. Predictive parameters with highest sensitivity were pseudo paralysis (100%, CI 0.86 to 1.00) and C-reactive protein (CRP) (96%, CI 0.79 to 0.99) superior to temperature (52%, CI 0.3 to 0.73), white blood count (11%, CI 0.01 to 0.34), radiograph (21%, CI 0.04 to 0.50), ultrasound (71%, CI 0.47 to 0.88) or MRI (100%, CI 0.78 to 1.00). Conclusion The diagnosis of a septic arthritis of the shoulder in children can be challenging for the clinician and especially for the resident doctor. Clinical symptoms such as pseudo paralysis and increased CRP level must be considered as predictive markers not to delay further diagnostics and treatment. Level of Evidence IV

scholarly journals Clinical Implications of Procalcitonin in Kawasaki Disease: A Useful Candidate For Differentiating From Sepsis and Evaluating IVIG Responsiveness

2021 ◽  
Author(s):  
Man Man Niu ◽  
Qi Jiang ◽  
Jin Wei Ruan ◽  
Hui Hui Liu ◽  
Wei Xia Chen ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Implications ◽  
Healthy Children ◽  
C Reactive Protein ◽  
Significant Elevation ◽  
Ivig Infusion ◽  
Blood Samples ◽  
Reactive Protein ◽  
Cell Counts ◽  
Childhood Vasculitis

Abstract Objective Kawasaki disease (KD) is a common childhood vasculitis absent of the specific laboratory definitions, besides a significant elevation in several inflammatory mediators, such as procalcitonin (PCT). However, whether PCT can serve as a useful candidate for differentiating KD from sepsis, and even for predicting incomplete KD, intravenous immunoglobulin (IVIG) nonrespondsiveness and coronary artery abnormalities (CAAs) remains unclear.Methods 254 Chinese KD children were enrolled and divided into 6 subgroups, including complete KD, incomplete KD, IVIG-responsive KD, IVIG-nonresponsive KD, KD with CAAs and KD without CAAs. Blood samples were collected from all subjects within 24-h pre- and 48-h post-IVIG infusion, respectively. PCT, C-reactive protein, sedimentation rate and blood cell counts were detected. In addition, both 261 sepsis children and 251 healthy children sex- and age-matched with KD children were enrolled in the same period.Results (1) PCT experienced the highest increase in sepsis patients before antibiotic therapy, followed by acute KD patients and the healthy controls. (2) The proportion of KD patients with a PCT concentration below 0.25 ng/ml was 11 folds higher than that of sepsis patients. (3) PCT had a sensitivity of 91.7% and a specificity of 30.3% at a cut-off value of >0.15 ng/ml to predict IVIG nonresponsiveness, and the proportion of IVIG-nonresponders with a PCT concentration of 0.25-0.50 ng/ml was 2 folds higher than that of IVIG-responders. Conclusions The PCT concentrations below 0.25 ng/ml may be useful for discriminating KD from sepsis, and moreover, the PCT concentrations of 0.25-0.50 ng/ml may be helpful in predicting IVIG nonresponsiveness.

scholarly journals Procalcitonin vs. the combination of micro-erythrocyte sedimentation rate and C-reactive protein for diagnosing neonatal bacterial sepsis

2017 ◽  
Vol 57 (4) ◽  
pp. 205
Author(s):  
Afifa Ramadanti ◽  
Renya Hiasinta ◽  
Herman Bermawi ◽  
Erial Bahar
Keyword(s):  
Sedimentation Rate ◽  
Neonatal Sepsis ◽  
Clinical Presentation ◽  
High Sensitivity ◽  
Bacterial Sepsis ◽  
C Reactive Protein ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
Sepsis Risk ◽  
Complete Blood Counts

Background Given the high rates of mortality and morbidity in neonatal sepsis, rapid, easy-to-use, and inexpensive biomarkers with high sensitivity and specificity are needed to diagnose neonatal sepsis. Procalcitonin is often used as a predictor in identifying neonatal sepsis, but C-reactive protein (CRP) and micro-erythrocte sedimentation rate (m-ESR) may also be valid biomarkers of neonatal sepsis.Objective To compare the accuracy of procalcitonin to the combination of CRP and m-ESR, as well as to find cut-off points for the three tests, in diagnosing bacterial neonatal sepsis.Methods Subjects were neonates hospitalized from July to October 2016 in Mohammad Hoesin Hospital, Palembang with sepsis at clinical presentation and healthy neonates with sepsis risk factors. All subjects underwent complete blood counts, CRP, m-ESR, blood cultures, and  procalcitonin examinations.Results Ninety-four infants were included, of whom 26 had proven sepsis. The combined values of m-ESR and CRP had 85% sensitivity, 59% specificity, and 66% accuracy. A procalcitonin (PCT) cut-off point of 9.7ng/mL showed 100% sensitivity, 96% specificity, and 97% accuracy level, which were significantly higher than the combined values of m-ESR and CRP.Conclusion The combined values of m-ESR (13 mm/hour) - CRP (17 mg/dL) and procalcitonin alone (2ng/mL) are both valid for the diagnosis of bacterial neonatal sepsis, but the accuracy of procalcitonin at 9.7ng/mL is significantly greater. 

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