ABSTRACT
Symptoms of acute Covid-19 infection are less common in children than in adults. In most cases, the symptoms are mild or absent. However, after contact with SARS-CoV-2, children may develop post-infectious hyperinflammatory syndrome - multisystem inflammatory syndrome in children (Multisystem Inflammatory Syndrome in Children MIS-C). We present 6 children with MIS-C, observed in November and December 2020 during the peak incidence of Covid-19 infection in Bulgaria. Patients have a mean age of 9.7 years. Four of the children had a history of contact with Covid-19. Clinically, they presented with fever and gastrointestinal symptoms. SARSCoV2 IgM and IgG serology was positive in all patients. Troponin and pro-BNP (B-type natriuretic peptide) levels were elevated in all six children. Cardiac ultrasound revealed systolic dysfunction of the left ventricle (reduce ejection fraction) in all of them. When cardiac MRI was performed, limited areas of left ventricular myocardial edema, as well as areas of late non-ischemic gadolinium amplification involving up to 25% of the myocardium, were founded. Treatment in all patients includes a broad-spectrum antibiotic, intravenous immunoglobulin, corticosteroids, diuretic, ACE inhibitor, and low molecular weight heparin. At discharge, all patients were in good overall condition, with no signs of heart failure, normal echocardiographic findings, and laboratory tests. In children the mortality from MIS-C is not high, despite significant increase in inflammatory markers and multisystem symptoms. In our patients, the short term outcome of MIS-C is favorable. However, long-term follow-up is needed for late complications. © 2021 Academy of Medicine. All rights reserved.
ABSTRACT
Coronavirus disease - 2019 (COVID-19) was first identified in Wuhan, China. When compared with adults, children are less commonly symptomatic when having acute Covid-19 infection. In contrast to adults, most infected children appear to have a milder course and have better outcomes overall. Myositis is a rarely seen in COVID-19 patients. Its pathogenesis is probably multifactorial with direct myocyte invasion, toxin-mediated muscle damage, dysregulated immune response, and immune-mediated mechanisms playing a role. We report the clinical case of a 7-year-old boy with COV-ID-19 induced myositis with favorable outcome. At the fourth day of treatment the child is without clinical signs of myositis. At the sixth day creatine kinase levels normalized. The evolution of the myositis is favorable and corresponds to the reports in the literature. This was a second episode of myositis for the boy in the time frame of nine months. The first episode was defined as self-limiting benign acute childhood myositis with unknown trigger. COVID-19 myositis might develop at any time during the course of the infection, usually during the second week but it can be also the presenting symptom. COVID-19 induced myositis, although rare, might be accompanied by rhabdomyolysis and might be a life-threatening complication. Early recognition and effective management with intravenous hydration are crucial for the effective management and prevention of development of acute kidney failure. © 2021 Academy of Medicine. All rights reserved.
ABSTRACT
Compared with adults' children develop only mild or no symptoms of acute COVID-19 infection. However' exposed to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus type 2)' post-infectious hyperinflammatory syndrome can develop-Multisystem Inflammatory Syndrome in Children (MIS-C). Multisystem inflammatory syndrome in children develops 2-6 weeks after SARS-CoV2 infection. There is a discussion in the medical society whether this is a new disease entity or an expression of a well-known one. To report the demographic' clinical and laboratory characteristics' the treatment and evolution of children with multisystem inflammatory syndrome who were admitted to the Department of pediatric rheumatology' cardiology and hematology at Pediatric Hospital 'Prof. Ivan Mitev' for the period November 2020-July 2021. 14 children were hospitalized-8 girls and 6 boys with a mean age of 7.4 years. Seven of the children were admitted within 3 months after the first peak of coronavirus infection for the country. The remaining half of the children were hospitalized within 3 months after the second peak of coronavirus infection in Bulgaria. The mean period between initial onset of symptoms and hospitalization was 5.64 days. All children had fever at admission. Leading symptoms were mucocutaneous symptoms observed in 13/14 children and abdominal symptoms in 10/14 children. Myocardial involvement was reported in 11 of the patients' requiring inotropic support in 5 of them. One of the patients had acute renal failure on admission. Positive serology for SARS-CoV2 was detected in all 14 children. Combination of intravenous immunoglobulin and corticosteroid was administered to all patients with complete reversal of symptoms during follow up. Most commonly observed clinical manifestations in the described patients with multisystem inflammatory syndrome were fever' mucocutaneous and abdominal symptoms. In a large proportion (10/14) of patients' myocardial involvement was also detected. Timely treatment and follow up show reversal of the described symptoms.