Polymorphism of clinical manifestations, experience of diagnosis and treatment of multisystem inflammatory syndrome associated with COVID-19 in children

Purpose - to analyze the literature data on possible variants of the course of pediatric multisystem inflammatory syndrome (PIMS-TS) in children;to describe our own experience in the diagnosis and treatment of some cases of PIMS-TS in children of different age groups;to present possible variants of clinical manifestations of the above disease;to draw attention to the need for early diagnosis and team care and treatment of such children. This novel clinical syndrome later identified as PIMS-TS temporally associated with SARS-CoV-2. In contrast with KD, PIMS-TS appears to occur in children at an older age with a predominance of gastrointestinal symptoms, hemodynamic instability, and myocardial dysfunction. However, the exact pathomechanism remains to be understood. Nevertheless, the post-viral immunological reaction is postulated to be the underlying mechanistic underpinnings. The paper describes the clinical course of the disease in a 5-year-old boy who complained of abdominal pain and hyperthermia, and the disease was masked by surgical pathology. The phenomena of intoxication syndrome, polyserositis, skin manifestations in the form of a polymorphic rash, hyperemia of the conjunctiva, swelling of the feet and hands increased in dynamics. The course of the disease in a 10-year-old girl who had symptoms of a viral infection is also described. However, upon going to the hospital, both children were diagnosed with a serious condition, they were hospitalized and given appropriate treatment. Therefore, the multifaceted nature of the PIMS-TS' course underlines the need for early recognition and multispecialty care and management. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. © 2022 Group of Companies Med Expert, LLC. All rights reserved.

Komplikácie COVID-19 u detí: PIMSTS/ MISC-C

The outbreak of a new coronavirus disease (COVID-19), caused by SARS-CoV-2, appears to be the greatest medical challenge of the last decade. In adult patients, COVID-19 affects the lungs in particular, manifesting in the form of interstitial pneumonitis (NSIP) and acute respiratory distress syndrome (ARDS). According to available data, COVID-19 in children is less common and has a milder course, often in the form of asymptomatic carriage or with digestive problems only. It is very likely that the occurrence of the infection caused by SARS-CoV-2 in this age group is underestimated. Currently, it is estimated to range from 0.9 to 12 percent in the paediatric population. The latest data on new mutations of the virus suggest its new "peculiarities”. It has turned out that the SARS-CoV-2 virus is becoming more infectious, from the summer months there has been a growing incidence of the disease in children and, moreover, there are more and more cases when it causes damage to various organs, including the brain. Temporal association with the COVID-19 infection reveals new units: paediatric multisystem inflammatory system temporally associated with SARS-CoV-2 (PIMS-TS / MIS-C / Kawa-COVID-19) – a systemic inflammatory disease of unknown etiology, similar to the Kawasaki disease or the Kawasaki shock syndrome, with sudden onset of cardiogenic and circulatory shock. Symptoms of Kawa-COVID-19 occur in paediatric patients approximately 2 – 4 weeks after recovery from SARS-CoV-2 and the most common complication occurring in 50% cases is myocarditis. Development of vasculitis may also lead to aneurysms and other cardiovascular complications. Much depends on the stage of the disease in which the child is admitted to the hospital, as well as on how fast the treatment is initiated. The objective of this article is to draw the attention of the expert public to the previously mentioned risks and to prevent potential cardiovascular complications © 2022, Lekarsky Obzor.All Rights Reserved.

Acute phase of Kawasaki disease: a review of national guideline recommendations.

Key aspects of the medical management of Kawasaki disease (KD) are not yet supported by a high evidence level, thus making room for individual recommendations. We performed a structured comparison of existing international KD guidelines to analyze potential differences in the implementation of evidence-based KD recommendations regarding diagnosis and therapy. To identify country-specific guidelines, we took a multilateral approach including a comprehensive PubMed literature, online research, and directly contacting national pediatric associations. We then ran a structured guidelines' analysis and evaluated the diagnostic and therapeutic differences in the context of evidence-based medicine. In this structured guideline analysis, we identified nine national and one European guidelines. According to them all, the diagnosis of KD still relies on its clinical presentation with no reliable biomarker recommended. First-line treatment consistently involves only intravenous immunoglobulin (IVIG) therapy. Recommendations in terms of acetylsalicylic acid, corticosteroids, and additional therapeutic options vary considerably. CONCLUSION: According to all guidelines, KD is diagnosed clinically with some variance in defining incomplete KD and being a non-responder to treatment. First-line treatment consistently includes IVIG. Recommendations for additional therapeutic strategies are more heterogeneous. WHAT IS KNOWN: • The diagnosis of KD relies on the clinical presentation, entailing challenges in timely diagnosis. • Other treatment options then IVIG are not supported by a high evidence level, making room for individual recommendations. WHAT IS NEW: • Definition of incomplete KD and being non-responsive to an initial treatment vary to some extent between the national guidelines. • Only IVIG is consistently proposed throughout all guidelines, further therapeutic recommendations vary between the national recommendations.

Severe Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 in a 31-Year-Old Male Patient: The First Clinical Case Report From the Republic of Cyprus.

Multisystem inflammatory syndrome (MIS) in adults associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasingly reported in published literature, although published reports remain sparse. In this report, we describe our first experience with a 31-year-old Caucasian male who developed severe MIS 31 days after a mild SARS-CoV-2 infection. The patient developed fever, elevated C-reactive protein (CRP), procalcitonin (PCT), reduced ejection fraction (EF), and shock. After extensive diagnostic work-up, nothing was found to justify his shock manifestation. A similar treatment to MIS in children (MIS-C) with immunoglobulins, corticosteroids, and anticoagulants led to a remarkable clinical improvement. MIS in adults (MIS-A) can be fatal. The early identification of MIS plays a crucial role in the prompt initiation of suitable treatment. Therefore, differential diagnosis and exclusion of other causes of illness are of priority. We believe that MIS in children treatment guidelines can be reformed in a way to include MIS in adults as well.