scholarly journals Multisystem Inflammatory Syndrome in Children; an Emerging Global Threat - A Review

2021 ◽  
Vol 8 (7) ◽  
pp. 481-485
Author(s):  
AR Shabaraya ◽  
Archana KU
Keyword(s):  
Kawasaki Disease ◽  
Gastrointestinal Symptoms ◽  
High Grade Fever ◽  
Management Options ◽  
Methyl Prednisolone ◽  
Markers Of Inflammation ◽  
Clinical Presentations ◽  
Global Threat ◽  
Available Information ◽  
Inflammatory Syndrome

MIS C (Multisystem Inflammatory Syndrome in Children) is a disease related to post COVID-19 sequelae. Differential diagnosis includes Kawasaki disease, Bacterial sepsis, toxic shock syndrome, Appendicitis, Macrophage activation syndrome. Clinical Presentations include high grade fever, rashes, Gastrointestinal symptoms like (abdominal pain, vomiting, diarrhea), hypotension and shock. The pathogenesis of MIS-C is unknown, and a postinfective etiology has been hypothetical but unproven. Antibodies to SARS-CoV-2 appear in the second week following infection, although their existence does not suggest infection resolution. Laboratory markers of inflammation, such as CRP, are elevated. IVIG, Glucocorticoids such as methyl prednisolone, Antibiotics, thromboprophylaxis with Light Molecular Weight Heparin are the management options. Since the available information doesn't allow to formulate well-established guidelines or recommendations for MIS-C treatment, and therefore the long-term sequelae of the illness aren't yet known. Keywords: MIS C, IVIG, Kawasaki disease.

scholarly journals P078 Multi-system inflammatory syndrome associated with SARS-CoV-2 in children: clinical and therapeutic characteristics

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Nacera Masmi
Keyword(s):  
United Kingdom ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Artery Aneurysm ◽  
Cardiac Insufficiency ◽  
Markers Of Inflammation ◽  
Wide Range ◽  
Inflammatory Syndrome

Abstract Background The COVID-19 pandemic was associated with the emergence of a new disease resembling the Kawasaki disease (kDa). That was primarily reported in children of western countries strongly affected by SARS-CoV-2. This syndrome was called Pediatric Multi-System Inflammatory Syndrome (PIMS or MIS-C), and has affected thousands of children, adolescents and young adults throughout the world since the alert launched by the National Health Service of the United Kingdom at the end of April 2020. This work is a literature review of data focusing on the clinical and prognostic characteristics of the MIS-C, the links between Covid-19 and MIS-C, and current therapeutic recommendations. Material and methods We carried out research of the studies recently published in the electronic bibliographic databases (Google Scholar, PubMed, Science direct, EmConsults, Research Gate, Medline, Cochrane, Trip). Results 25 studies were selected, involving 3015 MIS-C patients from different countries (France, United Kingdom, Italy, Germany, Spain, Brazil, Mexico, Chile, United States, India, Pakistan, Iran). Fever and gastrointestinal disorders were the most frequent clinical manifestations, followed by cardiovascular and respiratory symptom. Biological markers of inflammation and SARS-CoV-2 serology were assessed in all studies. Characteristics similar to Kawasaki disease, and toxic shock syndrome were reported in all studies. Complications such as coronary artery aneurysm; cardiac insufficiency, renal insufficiency, respiratory distress were noted as well as a significant rate of admission to intensive care units. Finally, the mortality rate was low in the majority of studies. The treatment adopted in the majority of the studies was an association of intravenous immunoglobulins and corticosteroids. Conclusion Although the fact that the exact pathogenesis of MIS-C remains unknown, post-infectious immune deregulation induced by the SARS-CoV-2 virus appears to be the trigger of MIS-C. MIS- C has been described as a new and serious disease entity with multi-organ involvement and a wide range of signs ranging from fever and gastrointestinal symptoms to myocardial damage, shock, and the development of coronary artery aneurysms. Keywords COVID-19, Multi-System Inflammatory Syndrome (MIS-C), Kawasaki Disease (kDa), Child

scholarly journals Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199661
Author(s):  
Anuja R. Shikhare ◽  
Rimsha M. Iqbal ◽  
Rabail Tariq ◽  
Daniel R. Turner ◽  
Bassam M. Gebara ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Asymptomatic Infection ◽  
Cardiac Monitoring ◽  
Delayed Presentation ◽  
Terminal Ileitis ◽  
Serologic Evidence ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.

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

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. 

scholarly journals COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Ashkan Baradaran ◽  
Abdolreza Malek ◽  
Nasrin Moazzen ◽  
Zahra Abbasi Shaye
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Multiple Organ ◽  
Current Evidence ◽  
Cardiac Complications ◽  
Clinical Presentations ◽  
Atypical Kawasaki Disease ◽  
Novel Coronavirus ◽  
Inflammatory Syndrome

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: (“novel coronavirus” Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.  

KAWASAKI DISEASE AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN WITH COVID-19 INFECTION

2020 ◽  
Vol 99 (6) ◽  
pp. 209-219
Author(s):  
L.V. Bregel ◽  
◽  
M.M. Kostik ◽  
L.Z. Fell ◽  
O.S. Efremova ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Hemophagocytic Syndrome ◽  
Early Recognition ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Interleukin 10 ◽  
Left Ventricular ◽  
Urgent Care ◽  
High Dose ◽  
Inflammatory Syndrome

During the COVD-19 pandemic, some pediatric patients in many countries around the world experienced a syndrome resembling a severe Kawasaki disease (KD), often accompanied by shock. Due to the incomplete signs of the classic KD in the era before the present pandemic, in many publications from European countries and the United States, this condition was called «multisystem inflammatory syndrome in children – MIS-C» or «hyperinflammatory shock» or «Kawasaki-like syndrome». This syndrome with a new coronavirus infection is characterized by refractory fever, frequent gastrointestinal symptoms, heart damage (including coronary dilation in some patients, and acute left ventricular failure in the majority), increased ESR and CRP levels, neutrophilia, extremely high troponin levels, increased ferritin, AST, ALT, lactate dehydrogenase, creatine phosphate kinase, interleukin-6 and interleukin-10, coagulopathy with an increase in D-dimer and fibrinogen, thrombocytopenia, sometimes procalcitonin increase. The manifestations of a cytokine storm may meet the criteria for secondary hemophagocytic syndrome. The mechanism of myocardial damage remains unclear. Treatment with high-dose intravenous immunoglobulin is effective, and in the presence of signs of hemophagocytic syndrome, dexamethasone or methylprednisolone. Further research is needed to understand the pathogenesis, resemblance and differences of this syndrome with classic KD, understanding of heart injuiry and early recognition for the need of urgent care.

Abstract 16566: Presentation and Outcome of Pediatric Multisystem Inflammatory Syndrome Temporally Associated With Sars-cov-2 Pandemic: An International Survey

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carles Bautista ◽  
Joan Sanchez-de-Toledo ◽  
Clark C Bradley ◽  
Jetrho Herberg ◽  
Fanny Bajolle ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Cardiac Involvement ◽  
Gastrointestinal Symptoms ◽  
Duration Of Symptoms ◽  
Entire Cohort ◽  
Common Presentation ◽  
Increased Risk ◽  
Life Threatening ◽  
The Mean ◽  
Inflammatory Syndrome

Introduction: Following the SARS-CoV-2 pandemic peak, children suffering from a multiorgan inflammatory disease that often leads to shock have been reported. This condition shares features with Kawasaki disease, but its etiopathogenesis is unknown. Hypothesis: We aimed to describe presentation and hospital course for this pediatric inflammatory multisystemic syndrome associated with COVID-19 (PIMS-TS). Methods: Data were collected from a retrospective review of children from 33 participating European, Asian and American sites. Results: We included 183 patients (109 males, 59·6%) with PIMS-TS, at a mean age of 7·0 (±4·7) years. Fifty-six (30·6%) had black ethnicity and obesity was present in 48 (26·2%) cases. Overall, 114/183 (62·3%) had biological evidence of current or recent SARS-CoV-2 infection. At admission, all presented with fever, 117/183 (63·9%) with gastrointestinal symptoms and 79/183 (43·2%) with shock, that was associated with more frequent black ethnicity, higher inflammatory markers and more cardiac involvement. Twenty-seven patients (14·7%) fulfilled criteria for Kawasaki disease. They were younger with no shock, fewer gastrointestinal, cardio-respiratory and neurological symptoms. Among the remaining PIMS-TS patients, 77 (49·3%) had mainly fever and inflammation with less cardiac involvement. For the entire cohort of 183 patients, the mean duration of admission was 8·6 (±5·6) days. Inotropic support, mechanical ventilation and ECMO were indicated in 72 (39·3%), 43 (23·5%) and 4 (2·2%) patients, respectively. Three patients (1·6%) died. A shorter duration of symptoms before admission was a risk factor for worse outcome and for ECMO/death, with 63% increased risk per day reduction (95%CI 0·39-0·93, p=0·03) and with 51·4% increased risk per day reduction (95%CI 0·36-0·9, p=0·03), respectively. Conclusions: We describe the first largest international series of children with PIMS-TS. Life-threatening shock is a common presentation. A shorter duration of symptoms prior to admission characterizes the fulminant form of the disease with potentially worse outcome.

scholarly journals The Trilogy of SARS-CoV-2 in Pediatrics (Part 2): Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 26 (4) ◽  
pp. 318-338
Author(s):  
Van L. Tran ◽  
Sarah Parsons ◽  
Andrew Nuibe
Keyword(s):  
Kawasaki Disease ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Febrile Illness ◽  
Current Treatment ◽  
Published Data ◽  
Treatment Considerations ◽  
Cardiac Manifestations ◽  
Effectiveness Studies ◽  
Inflammatory Syndrome

Multisystem Inflammatory Syndrome in Children (MIS-C) was first recognized as a novel illness in 2020 with manifestations similar to other hyperinflammatory syndromes, such as Kawasaki disease or macrophage activation syndrome. Severity varies from a self-limited febrile illness to shock requiring inotropes and mechanical ventilation. Gastrointestinal symptoms and persistent fevers are the most common clinical symptoms, with the addition of cardiac manifestations inclusive of ventricular dysfunction and coronary artery aneurysms. With no controlled trials or comparative effectiveness studies evaluating treatment of MIS-C to date, current treatment with immunomodulatory agents has mainly been derived from previous experience treating Kawasaki disease. This article provides a comprehensive review summarizing published data for the evaluation and management of MIS-C, with a focus on pharmacotherapy treatment considerations.

scholarly journals Phenotype, Susceptibility, Autoimmunity, and Immunotherapy Between Kawasaki Disease and Coronavirus Disease-19 Associated Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 12 ◽  
Author(s):  
Men-Ren Chen ◽  
Ho-Chang Kuo ◽  
Yann-Jinn Lee ◽  
Hsin Chi ◽  
Sung Chou Li ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Genetic Susceptibility ◽  
Protective Factor ◽  
Transforming Growth Factor ◽  
Gastrointestinal Symptoms ◽  
Treatment Resistance ◽  
Human Leukocyte ◽  
T Helper 17 ◽  
Inducible Protein ◽  
Inflammatory Syndrome

Coronavirus disease-19 (COVID-19) in children is usually mild but some are susceptible to a Kawasaki disease (KD)-like multisystem inflammatory syndrome in children (MIS-C) in the convalescent stage, posing a need to differentiate the phenotype, susceptibility, autoimmunity, and immunotherapy between KD and MIS-C, particularly in the upcoming mass vaccination of COVID-19. Patients with MIS-C are prone to gastrointestinal symptoms, coagulopathy, and shock in addition to atypical KD syndrome with fever, mucocutaneous lesions, lymphadenopathy, and/or cardiovascular events. MIS-C manifests KD-like symptoms that alert physicians to early recognize and adopt the KD treatment regimen for patients with MIS-C. MIS-C linked to COVID-19 teaches us infection-associated autoimmune vasculitis and vice versa. Studies on genetic susceptibility have identified certain human leukocyte antigen (HLA) locus and toll-like receptor (TLR) associated with KD and/or COVID-19. Certain HLA subtypes, such as HLA-DRB1 and HLA-MICA A4 are associated with KD. HLA-B*46:01 is proposed to be the risk allele of severe COVID-19 infection, and blood group O type is a protective factor of COVID-19. The autoimmune vasculitis of KD, KD shock syndrome (KDSS), or MIS-C is mediated by a genetic variant of HLA, FcγR, and/or antibody-dependent enhancement (ADE) resulting in hyperinflammation with T helper 17 (Th17)/Treg imbalance with augmented Th17/Th1 mediators: interleukin-6 (IL-6), IL-10, inducible protein-10 (IP-10), Interferon (IFNγ), and IL-17A, and lower expression of Treg-signaling molecules, FoxP3, and transforming growth factor (TGF-β). There are certain similarities and differences in phenotypes, susceptibility, and pathogenesis of KD, KDSS, and MIS-C, by which a physician can make early protection, prevention, and precision treatment of the diseases. The evolution of immunotherapies for the diseases has shown that intravenous immunoglobulin (IVIG) alone or combined with corticosteroids is the standard treatment for KD, KDSS, and MIS-C. However, a certain portion of patients who revealed a treatment resistance to IVIG or IVIG plus corticosteroids, posing a need to early identify the immunopathogenesis, to protect hosts with genetic susceptibility, and to combat Th17/Treg imbalance by anti-cytokine or pro-Treg for reversal of the hyperinflammation and IVIG resistance. Based on physiological and pathological immunity of the diseases under genetic susceptibility and host milieu conditions, a series of sequential regimens are provided to develop a so-called “Know thyself, enemy (pathogen), and ever-victorious” strategy for the prevention and immunotherapy of KD and/or MIS-C.

scholarly journals The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19

2020 ◽  
Author(s):  
Camila Rosat Consiglio ◽  
Nicola Cotugno ◽  
Fabian Sardh ◽  
Christian Pou ◽  
Donato Amodio ◽  
...  
Keyword(s):  
T Cell ◽  
Kawasaki Disease ◽  
Immune Cells ◽  
T Cell Subsets ◽  
Healthy Children ◽  
Cytokine Storm ◽  
Markers Of Inflammation ◽  
Arterial Damage ◽  
Inflammatory Syndrome ◽  
Autoimmune Etiology

SUMMARYSARS-CoV2 infection is typically very mild and often asymptomatic in children. A complication is the rare Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever and organ dysfunction and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology. We apply systems-level analyses of blood immune cells, cytokines and autoantibodies in healthy children, children with Kawasaki disease enrolled prior to COVID-19, children infected with SARS-CoV2 and children presenting with MIS-C. We find that the inflammatory response in MIS-C differs from the cytokine storm of severe acute COVID-19, is more similar to Kawasaki disease, but also differ from this with respect to T-cell subsets, IL-17A and biomarkers associated with arterial damage. Finally, autoantibody profiling suggests endoglin, an endothelial glycoprotein as one of several candidate targets of autoantibodies in MIS-C.HIGHLIGHTSHyperinflammation in MIS-C differs from that of acute COVID-19T-cell subsets discriminate Kawasaki disease patients from MIS-CIL-17A drives Kawasaki, but not MIS-C hyperinflammation.Autoantibodies to Endoglin are elevated in MIS-C and a subset of Kawasaki patients

Sign in / Sign up

Export Citation Format

Share Document