Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study.

OBJECTIVE: To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) patients. METHODS: This is a case series study of a 12-wk, home-based exercise intervention in children and adolescents after MIS-C diagnosis. From 16 MIS-C patients followed at our clinic, 6 were included (age: 7-16 years; 3 females). Three of them withdrew before the intervention and served as controls. The primary outcome was health-related quality of life, assessed PODCI. Secondary outcomes were CFR assessed by 13N-ammonia PET-CT imaging, cardiac function by echocardiography, cardiorespiratory fitness, and inflammatory and cardiac blood markers. RESULTS: In general, patients showed poor health-related quality of life, which seemed to be improved with exercise. Additionally, exercised patients showed improvements in coronary flow reserve, cardiac function, and aerobic conditioning. Non-exercised patients exhibited a slower pattern of recovery, particularly in relation to health-related quality of life and aerobic conditioning. CONCLUSIONS: Our results suggest that exercise may play a therapeutic role in the treatment of post-discharge MIS-C patients. As our design does not allow inferring causality, randomized controlled trials are necessary to confirm these preliminary findings.

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).

[Kawasaki disease or SARS-CoV-2 related MIS-C? How to discriminate between these hyperinflammatory syndromes in children?]

Increasing waiting lists and a structural staff shortage are putting pressure on the health system. Because care production is lower than care demand, there is no longer competition. Competition is over and we are beginning to see the contours of the new health system. The new system takes health instead of care as its starting point by legally embedding health goals in addition to the duty of care. The new system is based on health regions, but does not require a regional health authority. It is based on health manifestos that include agreements about cooperation in good and bad times.

COVID-19 in children: multisystem inflammatory syndrome

Purpose — to analyze of peculiarities of MIS-C in children of Lviv region. Materials and methods. We have analyzed medical records of 16 children who were treated in Communal Non-Commercial Establishment of Lviv Regional Council «Lviv Regional Children Clinical Hospital «OKHMATDYT» in the period from September 2020 to January 2021 with the diagnosis of MIS-C, associated with SARS-CoV-2. Results. MIS-C was diagnosed in 16 children (average age was 8,2±0,065 years, girls:boys = 1:0.6). None of our patients was the «primary source of SARS-CoV-2» in the household but contracted coronavirus disease after a contact with the sick relatives. The disease occurred in 4 (25%) children against the background of acute coronavirus disease, in 4 (25%) more children during the first month and 8 (50%) children more than a month after acute SARS-CoV-2 infection. All children has febrile fever and general weakness. Besides, in most of the patients clinical progression of MIS-C was characterized by typical skin rashes and conjunctivitis (13 children — 81,5%), facial swelling and edema of distal parts of extremities (11 children — 68,75%). Muscle pain was present in 9 (56%) children, hyperesthesia — in 4 (25%) children, gastrointestinal symptoms — in 8 (50%) our patients. Myocarditis was diagnosed in 4 (25%) children, linear dilatation of coronary arteries (2 children — 12,5%) and small aneurysms (1 child — 6,25%) — in 3 (18,75%) our patients. All these changes returned to normal 1 month after discharge from the hospital. Conclusions. MIS-C response before the 48th day after acute coronavirus disease and is characterized by typical clinical course. Treatment with human immunoglobulin at the dose of 1–2 g/kg, glucocorticosteroids at the dose of 1–2 mg/kg, aspirin 3-5 mg/kg against the background of antibacterial therapy is effective for the prevention of changes in the coronary arteries and for the recovery of all patients. The research was conducted in accordance with the principles of bioethics set out in the WMA Declaration of Helsinki and Universal Declaration on Bioethics and was approved by the Commission on Ethics of Scientific Research, Experimental Developments and Scientific Works of Dany-lo Halytsky Lviv National Medical University. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors. © 2022, Group of Companies Med Expert, LLC. All rights reserved.

Two Case Reports of Newly Diagnosed Crohn's Disease after COVID-19 in Pediatric Patients.

Since the coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome-coronavirus-2 virus (SARS-CoV-2), various complications have been reported. Although most COVID-19 cases exhibited flu-like symptoms, COVID-19 may dysregulate the immune response and promote overwhelming levels of inflammation in some patients. Inflammatory bowel disease (IBD) is caused by dysregulated or inappropriate immune responses to environmental factors in a genetically susceptible host, and a SARS-CoV-2 infection may act as a possible cause of IBD. This paper describes two pediatric patients who developed Crohn's disease following a SARS-CoV-2 infection. They were previously healthy before the SARS-CoV-2 infection. On the other hand, they started to develop fever and gastrointestinal symptoms several weeks after recovery from the infection. They were diagnosed with Crohn's disease by imaging and endoscopic studies, and their symptoms improved after treatment with steroids and azathioprine. This paper suggests that a SARS-CoV-2 infection may trigger IBD in predisposed patients.

Clinical characteristics and short-term outcomes of multisystem inflammatory syndrome in a country with a high prevalence of KD.

Background: The COVID-19 pandemic has spread continuously. Multisystem inflammatory syndrome in children (MIS-C), like Kawasaki disease (KD), is a potentially severe illness in children that appears to be a delayed, post-infectious complication of COVID-19. However, based on the relatively low MIS-C prevalence and high KD prevalence in Asian children, the clinical features of MIS-C are not fully recognized, especially after the spread of the Omicron variant. Here, we aimed to identify the clinical characteristics of MIS-C in a country with high KD prevalence. Methods: We retrospectively analyzed 98 children diagnosed with KD and MIS-C admitted to Jeonbuk National University Hospital between January 1, 2021, and October 15, 2022. Twenty-two patients were diagnosed with MIS-C, following CDC diagnostic criteria for MIS-C. We reviewed medical records for clinical features, laboratory findings, and echocardiography. Results: Age, height, and weight were higher for patients with MIS-C than for those with KD. Lymphocytes percentage was lower, and the segmented neutrophil percentage was higher in the MIS-C group. The inflammation marker C-reactive protein was higher in the MIS-C group. Prothrombin time was prolonged in the MIS-C group. Albumin level was lower in the MIS-C group. The MIS-C group had lower potassium, phosphorus, chloride, and total calcium. Twenty-five percent of patients diagnosed with MIS-C had positive RT-PCR, and all the patients were N-type SARS-CoV-2 antibody-positive. Albumin ≤3.85 g/dl effectively predicted MIS-C. Regarding echocardiography, the right coronary artery z-score, the absolute value of apical 4-chamber left ventricle longitudinal strain, and the ejection fraction (EF) was significantly lower in the MIS-C group. A month after diagnosis using echocardiographic data, all coronary artery z-scores had reduced significantly. EF and fractional shortening (FS) also improved one month after diagnosis. Conclusion: Albumin values can differentiate MIS-C and KD. In addition, a decrease in the absolute LV longitudinal strain value, EF, and FS was observed in the MIS-C group using echocardiography. Coronary artery dilatation was not evident at the initial diagnosis; however, a change in coronary artery size, EF, and FS was observed on follow-up echocardiography a month after diagnosis.

COVID-19 vaccination in children: a public health priority.

OBJECTIVE: Covid-19 had a direct impact on children's health. The aim of this review was to analyze epidemiological and clinical data, the consequences of the pandemic, and vaccination aspects in this group. SOURCES OF DATA: The searches were carried out from January 2020 to November 2022, in the MEDLINE databases (PubMed) and publications of the Brazilian Ministry of Health and the Brazilian Society of Pediatrics. SUMMARY OF FINDINGS: Covid-19 has a mild presentation in most children; however, the infection can progress to the severe form and, in some cases, to MIS-C. The prevalence of the so-called long Covid in children was 25.24%. Moreover, several indirect impacts occurred on the health of children and adolescents. Vaccination played a crucial role in enabling the reduction of severe disease and mortality rates. Children and adolescents, as a special population, were excluded from the initial clinical trials and, therefore, vaccination was introduced later in this group. Despite its importance, there have been difficulties in the efficient implementation of vaccination in the pediatric population. The CoronaVac vaccines are authorized in Brazil for children over three years of age and the pediatric presentations of the Pfizer vaccine have shown significant effectiveness and safety. CONCLUSIONS: Covid-19 in the pediatric age group was responsible for the illness and deaths of a significant number of children. For successful immunization, major barriers have to be overcome. Real-world data on the safety and efficacy of several pediatric vaccines is emphasized, and the authors need a uniform message about the importance of immunization for all children.

MIS-C patients who were reinfected with SARS-CoV-2. Report of 2 cases. / Reinfección por SARS-CoV-2 en pacientes con antecedentes de MIS-C. Presentación de dos casos.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition. It is still unknown if children who have recovered from MIS-C are at a risk of recurrence of MIS-C when they are reinfected with SARSCoV-2. In this study, we aimed to report 2 children who recovered from MIS-C and reinfected with SARSCoV-2 without recurrence of MIS-C.

El síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés) es una enfermedad rara. Se desconoce si los niños que se recuperaron del MIS-C tienen riesgo de recurrencia de MIS-C cuando presentan reinfección por SARS-CoV-2. El objetivo de este estudio es describir los casos de dos niñas que se recuperaron del MIS-C y presentaron reinfección por SARS-CoV-2 sin recurrencia de MIS-C.

Kawasaki disease following SARS-CoV-2 infection: Stronger inflammation with no increase in cardiac complications.

Background: Herein we investigate the difference between Kawasaki disease (KD) with and without a recent history of SARS-CoV-2 infection. Methods: We compared the clinical characteristics of patients with KD during the SARS-CoV-2 pandemic in a single children's hospital in Korea. Fifty-two patients were enrolled and divided into group 1 (with a history of COVID-19, n = 26) and group 2 (without a history of COVID-19, n = 26) according to whether or not they contracted COVID-19 within the 8 weeks before hospitalization. Data, including clinical features and laboratory results, were analyzed and compared between groups. Results: The median age of patients was significantly higher in group 1 than in group 2 (53 months [IQR, 24-81] vs. 15 months [IQR, 6-33], p = 0.001). The incidence of cervical lymphadenopathy was significantly higher (p = 0.017), while that of BCGitis was significantly lower in group 1 (p = 0.023), and patients had a significantly longer hospital stay (5 days [IQR, 3-8] vs. 3 days [IQR, 3-4], p = 0.008). In group 1, platelet count was significantly lower (p = 0.006), and hemoglobin and ferritin levels were significantly higher (p = 0.013 and p = 0.001, respectively) on the first admission day. Following treatment with intravenous immunoglobulin (IVIG), the platelet count was significantly lower (p = 0.015), and the percentage of neutrophils and neutrophil-to-lymphocyte ratio were significantly higher in group 1 (p = 0.037 and p = 0.012). Although there was no statistical difference, patients requiring infliximab treatment due to prolonged fever was only in group 1. The incidence of cardiovascular complications did not differ between the groups. Conclusions: Post-COVID KD showed a stronger inflammatory response than KD-alone, with no differences in cardiac complications.

Acute Cardiovascular Manifestations in Patients with Multisystem Inflammatory Syndrome Associated to Sars-Cov-2 Infection

BACKGROUND AND AIM: To describe the cardiovascular and laboratory manifestations among children presenting with the multisystem inflammatory syndrome associated with SARS-CoV-2 infection (MIS-C). METHOD(S): Data obtained from the database of our PICU complemented by a review of the clinical records. Children from 1 month to 15 years of age, admitted to the hospital between August 1, 2020 and December 31, 2021 with a diagnosis of MIS-C were included. RESULT(S): A total of 8 children, represent 6% of our admissions during the study period, were included. Median age 5.7 years (IQR 1.5-10), 100% males, weight 10 to 59 kg, PICU LOS 1 to 11 days, median 2.6 days (IQR 1-7.5). PIM-3 median 1.75 (IQR 1.17- 2.54). Symptoms were persistent fever, gastrointestinal symptoms, polymorphic rash, conjunctivitis, and mucosal changes.The cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion and coronary artery dilatation. Reduced left ventricular ejection fraction and elevated troponin were present in half of them. The biochemical markers of inflammation were raised in most patients: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. Polymerase chain reaction for SARS-CoV-2 virus was negative in all patients, whereas immunoglobulin (Ig) M antibodies were positive in 50% and IgG in 87.5% cases. CONCLUSION(S): The children have significantly raised levels of biochemical markers of inflammation.Cardiac involvement, including ventricular dysfunction, coronary artery dilation or aneurysm, and arrhythmias, is common in children with SARS-CoV-2-associated multisystem inflammatory syndrome and needs to be carefully identified and monitored over time due to uncertain prognosis and risk of progression of cardiac manifestation. (Figure Presented).

Admissions to the Pediatric Icu Associated with Coronavirus 2 Disease (Sars-Cov-2) in a Pediatric Reference Hospital in Ecuador

BACKGROUND AND AIM: Multisystem inflammatory syndrome in children (MIS-C) has been associated with SARS-CoV-2 infection in pediatric population treated at Pediatric Intensive Care Unit (PICU). To compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also presented a diagnosis of MIS-C. METHOD(S): Retrospective cohort study with 167 patients admitted to the PICU Covid-19 at Baca Ortiz Pediatric Hospital (BOPH) located in Quito, Ecuador from June 2020 - June 2021, who developed PARDS with or without MIS-C. We performed a logistic regression analysis to calculated Odds Ratios (OR) with 95% CI. RESULT(S): Of the 167 patients, PCR test was positive in 20.1%. 58.7% of the study population developed MIS-C. This was associated with respiratory bacterial coinfection (OR: 3.63 [95% CI: 1.81-7.29]), circulatory support (OR: 38.8 [11.2-134.6]), acute renal failure (OR: 6.09 [2.4-15.5]), septic shock (OR: 89.9 [28.5-283.9]), coronary dilatation (OR: 3.79 [1.45-9.8]);multi-organ failure (OR: 44.9 [5.99- 337.3]), death (OR: 14.5 [4.27-49.5]). Further, a severe inflammatory state and high risk of sepsis were present as shown by an elevated D-dimer (OR: 6.53 [2.06-20.7]);total CPK (6.96 [3.5-13.9]);and procalcitonin (OR: 10.5 [5.06- 21.8]). Treatment in the MIS-C group included antibiotics (100%), corticoids (79.5%), immunoglobulin (IV) (86.4%), and ventilatory support (11.5 +/- 12.6 days). CONCLUSION(S): The MIS-C associated with Covid-19 produced a more severe condition, as a result of a dysregulated inflammatory state;which resulted in failure of various organ systems and high mortality in the PICU. This was evidenced by the clinical and analytical profile and the treatments used.

Clinical and Laboratory Characteristics of the Multisystem Inflammatory Syndrome in Children: A Case Series of 75 Patients

Background: SARS-CoV-2 has been characterized since December 2019 as the etiology of severe pneumonia throughout the world. However, the majority of children and adolescents with the respective infection have mild COVID-19. In April 2020, a warning was issued by the National Health Service (NHS), based on which a multisystem inflammatory syndrome in children (MIS-C) could be associated with COVID-19, presenting with cardiovascular shock, fever, and hyperinflammation. The syndrome presents with fever and organ involvement but with no pathognomonic findings or diagnostic tests, while some of the manifestations are almost the same as those of Kawasaki disease.Objectives: Knowledge of clinical course, demographic data, treatment, and prognosis can contribute to the more efficient man-agement of the patients and, consequently, a decrease in morbidity and mortality.Methods: Seventy-five patients < 18 years from September 22, 2020, to March 10, 2021, in Namazi hospital, Shiraz, Iran, with a diag-nosis as per MIS-C defined criteria, were recruited.Results: Median age of the patients was 6.2 years, and 58.6% were male. Of the patients, 46% had positive SARS-CoV-2 RT-PCR, an-tibody, or both. Thirty percent of the total patients reported contact with proven COVID-19 cases. The abdominal free fluid in 17 patients, hepatitis in one patient, and stasis in both kidneys of one patient were detected. Upon echocardiography on the first day, 77%, 48%, 21%, and one patient were with tricuspid regurgitation, mitral regurgitation, abnormal LV function, and myocarditis, re-spectively;however, after 5 -7 days, the repeated echocardiography revealed 44% of patients with tricuspid regurgitation, 30% with mitral regurgitation, and 6% with abnormal LV function. For the treatment, 18% of the patients received inotropes, 60% ASA, 32% IVIG, 84% glucocorticoids, and 25.3% received furosemide. All of the patients received antibiotics as well. Finally, 97% of the patients were discharged alive, while two cases died.Conclusions: The results of this study suggest the importance of cardiac consultation along with early hospital care during the course of MIS-C in order to prevent the associated short-term and long-term complications.

Clinical spectrum of neurological manifestations in pediatric COVID-19 and MIS-C in a Tertiary Care Center, Karnataka, India: a retrospective cross-sectional study

Objective: To study the clinical spectrum of neurological manifestations in Pediatric COVID-19 and MIS-C cases presented to tertiary care hospital. Study design: A Retrospective Cross-sectional study. Study population: All pediatric cases in the age group =14 years diagnosed to be COVID-19 positive or with MIS-C. Methods and Results: The study includes admitted cases of 29 out of 1577 diagnosed COVID-19 children and 13 MIS-C cases;data collected from records from medical record section. Among these 5 cases (17.2%) of COVID-19 and 7 cases (53.8%) of MIS-C presented with various neurological manifestations including convulsion, altered sensorium/behavior and stroke like features.

Orchitis as an unusual manifestation in multisystem inflammatory syndrome in children

This is a case report about an 8-year old boy who presented with complaints of fever for 5 days, loose stools, abdominal pain, and erythema of the palms and soles for 3 days. There was a history of short duration fever in all his family members 1 month back, but none of them were tested for COVID-19. On admission, the patient was febrile and had erythematous extremities. There was no organomegaly. He presented with hypotensive shock which was managed with fluid boluses and inotrope support. Fever workup including cultures were negative. His COVID-19 antibody was positive (16.17 index units). Inflammatory markers were elevated: ESR=50 mm/h=;C reactive protein=51 mg/dL;ferritin=>1000 ng/mL;D dimer=8260 ng/mL. Echocardiogram was normal and he was managed with intravenous immunoglobulin due to meeting the criteria for multisystem inflammatory syndrome (MISC) in children. The patient's fever subsided within 48 hours and his inflammatory markers showed declining trend. On the third day of becoming afebrile, the child complained of swelling, pain, and redness of right scrotum. There was no recurrence of fever, nor parotid swelling associated with orchitis. On examination, the right testis was enlarged, tender, located in the normal anatomic position with an intact ipsilateral cremasteric reflex. testicular tension was ruled out by ultrasound doppler. The unilateral orchitis was managed with supportive measures and subsided by 48 hours.

Global Myocardial Strain in Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Healthy Children: A Network Meta-Analysis.

Background: Nearly 6,000 multisystem inflammatory syndrome in children (MIS-C) have been reported in the United States by November 2021. Left ventricular global myocardial strain has been proved to be one of the best evidence of the diagnostic and prognostic implications for cardiac dysfunction. The global myocardial strain change of MIS-C in the acute phase was still unclear. Methods: PubMed and other sources were searched. A network meta-analysis was conducted. MIS-C was divided into two groups according to left ventricular ejection fraction (LVEF): MIS-C with depressed ejection fraction (MIS-C dEF) and MIS-C with preserved ejection fraction (MIS-C pEF). Global longitudinal strain (GLS) and global circumferential strain (GCS) were compared among MIS-C, Kawasaki disease (KD), and healthy children. Results: In total, nine case-control studies were included, published between 2014 and 2021. These studies involved 107 patients with MIS-C, 188 patients with KD, and 356 healthy children. After Bayesian analysis, MIS-C dEF group was found to have a lower LVEF, higher GLS and GCS than the KD groups. Both MIS-C pEF and KD had similar GLS and GCS, which were higher than healthy controls. There was no difference of LVEF among MIS-C pEF, KD, and healthy controls. Conclusion: MIS-C dEF was more severe than KD, both in LVEF and global myocardial strain. MIS-C pEF and KD were similar with mild impaired left ventricular myocardial strain compared with the healthy children. Global myocardial strain may be a monitoring index for MIS-C. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021264760].

Characteristics and Outcomes of Cases of Children and Adolescents With Pediatric Inflammatory Multisystem Syndrome in a Tertiary Care Center in Mexico City.

Background: Pediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City. Methods: This was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiologic evaluations, treatment, and clinical outcomes were analyzed. Results: Seventy-five cases fulfilled the case definition criteria for PIMS [median age: 10.9 years, Interquartile range (IQR): 5.6-15.6]. Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms. Conclusion: There were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

[Reinfection by SARS-CoV-2 in a child with history of multisystem inflammatory syndrome: a case report]. / Reinfección por SARS-CoV-2 en un niño con antecedente de síndrome inflamatorio multisistémico: a propósito de un caso.

The multisystem inflammatory syndrome in children temporally related to COVID-19 (MIS-C) is a rare disease in pediatrics, which emerges related to the SARS-CoV-2 pandemic and was initially described in May 2020. Given the short time of evolution of this disease, little is known about the pathophysiology, prognosis, and the possibility of recurrence. We present a clinical case of a 12-year-old patient who presented symptoms compatible with MIS-C in January 2021, with good subsequent clinical evolution. He developed reinfection by SARS-CoV-2 at five months later (June 2021), with mild symptoms and without recurrence of MIS-C.

El síndrome inflamatorio multisistémico en niños y adolescentes relacionado temporalmente con la COVID-19 (SIM-C) es una entidad poco frecuente en pediatría, que emerge en relación con la pandemia por el coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y fue descripto por primera vez en mayo de 2020. Debido al escaso tiempo de evolución de esta enfermedad, hay aspectos sobre su fisiopatología, pronóstico y posibilidad de recurrencia, que aún se desconocen. Se presenta el caso clínico de un paciente de 12 años que cursó un cuadro compatible con SIM-C en enero de 2021, con buena evolución clínica posterior. Luego presentó una reinfección por SARS-CoV-2 a los 5 meses de la infección inicial (junio de 2021), con síntomas leves y sin recurrencia del SIM-C.

Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience.

Background: Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. Objective: To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. Methods: Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. Results: We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. Conclusion: This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.