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2.
APMIS ; 130(2): 101-110, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1650387

ABSTRACT

In the milieu of coronavirus disease 2019 (COVID-19), there are increasing reports of paediatric hyperinflammatory conditions (PHICs), including multisystem inflammatory syndrome in children (MIS-C), paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD). Few analyses of PHIC prevalence in paediatric and adolescent hospitalized COVID-19 patients exist. The purpose of this study was to perform a meta-analysis to determine a pooled prevalence estimate of PHICs in paediatric and adolescent hospitalized patients admitted for treatment due to COVID-19. Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane databases. Relevant prevalence, baseline, treatment and outcome data were extracted using a standardized datasheet. The systematic review and meta-analysis were conducted as per the PRISMA and MOOSE guidelines. Overall, 14 studies with 2202 patients admitted for treatment due to COVID-19, among whom 780 were diagnosed with PHICs, were included. The crude estimate of prevalence was 35.42%, and the pooled estimate of prevalence was 29% (random pooled ES = 0.29; 95% CIs = 0.18-0.42; p < 0.0001; z = 7.45). A sizeable proportion of paediatric and adolescent hospitalized patients admitted for treatment due to COVID-19 are diagnosed with a PHIC warranting a high index of clinical suspicion for PHICs. Further studies are required to validate these findings.


Subject(s)
COVID-19/complications , Mucocutaneous Lymph Node Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/epidemiology , Adolescent , COVID-19/epidemiology , COVID-19/immunology , COVID-19/therapy , COVID-19/virology , Child , Child, Preschool , Female , Hospitalization , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome/immunology , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , Prevalence , SARS-CoV-2/physiology , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology
3.
Arch Cardiol Mex ; 91(Suplemento COVID): 040-046, 2021 Dec 20.
Article in Spanish | MEDLINE | ID: covidwho-1609039

ABSTRACT

We present an institutional guide for a referral to the specialized care center and initial management of pediatric patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with severe manifestations of pediatric inflammatory multisystemic syndrome or symptoms similar to Kawasaki syndrome, and who must have a multidisciplinary approach to ensure adequate treatment and safety for the team of Health.


Presentamos una guía para la referencia al centro de atención especializada y el manejo inicial de pacientes pediátricos infectados por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) con manifestaciones graves del síndrome multisistémico inflamatorio pediátrico o síntomas semejantes al síndrome de Kawasaki y que deben tener un abordaje multidisciplinario para garantizar un adecuado tratamiento y la mayor seguridad para el equipo de salud.


Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , Referral and Consultation , COVID-19/complications , Cardiology , Child , Humans , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , SARS-CoV-2
4.
Sci Rep ; 11(1): 13840, 2021 07 05.
Article in English | MEDLINE | ID: covidwho-1383121

ABSTRACT

To characterize the new SARS-Co-V-2 related multisystem inflammatory syndrome in children (MIS-C) among Israeli children and to compare it with Kawasaki disease (KD). We compared, in two medical centers, the clinical and laboratory characteristics of MIS-C, KD and an intermediate group, which met the case definitions of both conditions. MIS-C patients were older, were more likely to be hypotensive, to have significant gastrointestinal symptoms, lymphopenia and thrombocytopenia and to have non-coronary abnormal findings in their echocardiogram. Lymphopenia was an independent predictor of MIS-C. Most of our MIS-C patients responded promptly to corticosteroid therapy. KD incidence in both centers was similar in 2019 and 2020. Although there is clinical overlap between KD and MIS-C, these are separate entities. Lymphopenia clearly differentiates between these entities. MIS-C patients may benefit from corticosteroids as first-line therapy.


Subject(s)
COVID-19/complications , COVID-19/pathology , Lymphopenia/pathology , Mucocutaneous Lymph Node Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/virology , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Lymphopenia/diagnosis , Male , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/pathology , Mucocutaneous Lymph Node Syndrome/virology , Risk Factors , SARS-CoV-2/pathogenicity , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/virology , Young Adult
6.
BMJ Case Rep ; 14(3)2021 Mar 24.
Article in English | MEDLINE | ID: covidwho-1388475

ABSTRACT

SARS-CoV-2 infection has recently been related to a spectrum of hyper-inflammatory states in children. There is a striking similarity between these hyper-inflammatory states and Kawasaki disease (KD). We present an interesting case of KD recurrence in a 10-year-old child, who had previously developed KD at 4 years of age. His symptoms included fever, maculopapular rash and altered sensorium. Investigations showed noticeably elevated inflammatory markers, and an echocardiography revealed dilated coronary arteries. SARS-CoV-2 IgG antibodies were positive. The child responded dramatically to intravenous immunoglobulin and intravenous methylprednisolone. It is possible that SARS-CoV-2 infection triggered the recurrence of KD in this child who might have been genetically predisposed to KD.


Subject(s)
COVID-19/complications , Mucocutaneous Lymph Node Syndrome/etiology , Anti-Inflammatory Agents/therapeutic use , Antibodies, Viral/isolation & purification , COVID-19/therapy , Child , Echocardiography/methods , Humans , Immunoglobulins, Intravenous/administration & dosage , Male , Methylprednisolone/therapeutic use , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , Recurrence , SARS-CoV-2 , Treatment Outcome
7.
J Leukoc Biol ; 109(1): 35-47, 2021 01.
Article in English | MEDLINE | ID: covidwho-1372745

ABSTRACT

The SARS-CoV-2 pandemic has led to hundreds of thousands of deaths and billions of dollars in economic damage. The immune response elicited from this virus is poorly understood. An alarming number of cases have arisen where COVID-19 patients develop complications on top of the symptoms already associated with SARS, such as thrombosis, injuries of vascular system, kidney, and liver, as well as Kawasaki disease. In this review, a bioinformatics approach was used to elucidate the immune response triggered by SARS-CoV-2 infection in primary human lung epithelial and transformed human lung alveolar. Additionally, examined the potential mechanism behind several complications that have been associated with COVID-19 and determined that a specific cytokine storm is leading to excessive neutrophil recruitment. These neutrophils are directly leading to thrombosis, organ damage, and complement activation via neutrophil extracellular trap release.


Subject(s)
COVID-19/immunology , SARS-CoV-2/immunology , Signal Transduction/immunology , Thrombosis/immunology , Vascular System Injuries/immunology , COVID-19/pathology , Cytokines/immunology , Humans , Mucocutaneous Lymph Node Syndrome/immunology , Mucocutaneous Lymph Node Syndrome/pathology , Mucocutaneous Lymph Node Syndrome/virology , Pulmonary Alveoli/immunology , Pulmonary Alveoli/pathology , Pulmonary Alveoli/virology , Thrombosis/pathology , Thrombosis/virology , Vascular System Injuries/pathology , Vascular System Injuries/virology
8.
J Med Virol ; 93(9): 5458-5473, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1272201

ABSTRACT

Kawasaki-like disease (KLD) and multisystem inflammatory syndrome in children (MIS-C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID-19). A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS-C associated with COVID-19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS-C, or inflammatory shock syndromes were included. A total number of 133 children in 45 studies were reviewed. A total of 74 (55.6%) cases had been admitted to pediatric intensive care units (PICUs). Also, 49 (36.8%) patients had required respiratory support, of whom 31 (23.3%) cases had required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4%) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. Similar outcomes had not been reported in other patients. Approximately two-thirds of the children with KLD associated with COVID-19 had been admitted to PICUs, around one-fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children that present with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID-19.


Subject(s)
Brain Infarction/complications , COVID-19/complications , Heart Failure/complications , Mucocutaneous Lymph Node Syndrome/complications , SARS-CoV-2/pathogenicity , Shock/complications , Systemic Inflammatory Response Syndrome/complications , Adolescent , Brain Infarction/diagnostic imaging , Brain Infarction/mortality , Brain Infarction/virology , COVID-19/diagnostic imaging , COVID-19/mortality , COVID-19/virology , Child , Child, Preschool , Female , Heart Failure/diagnostic imaging , Heart Failure/mortality , Heart Failure/virology , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Mucocutaneous Lymph Node Syndrome/diagnostic imaging , Mucocutaneous Lymph Node Syndrome/mortality , Mucocutaneous Lymph Node Syndrome/virology , Patient Readmission/statistics & numerical data , Respiration, Artificial , SARS-CoV-2/physiology , Shock/diagnostic imaging , Shock/mortality , Shock/virology , Survival Analysis , Systemic Inflammatory Response Syndrome/diagnostic imaging , Systemic Inflammatory Response Syndrome/mortality , Systemic Inflammatory Response Syndrome/virology
9.
J Infect Dev Ctries ; 15(5): 630-638, 2021 05 31.
Article in English | MEDLINE | ID: covidwho-1262629

ABSTRACT

INTRODUCTION: Viral infections have been described as triggers for Kawasaki Disease (KD), a medium vessel vasculitis that affects young children. Akin to the H1N1 pandemic in 2009, there is a similar rise in the incidence of KD in children affected with Coronavirus disease 2019 (COVID-19). Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) has been reported to induce an exaggerated systemic inflammatory response resulting in multi-organ involvement, particularly initiated with pulmonary parenchymal damage. This review article will discuss KD-like manifestations in COVID-19 patients in the pediatric cohort. METHODOLOGY: Search terms "Kawasaki" "COVID-19" "SARS-COV-2" "PIM-TS" and "MIS-C" were used to look for relevant articles in PubMed and Google Scholar published in the last 5 years. RESULTS: There is some evidence to suggest that SARS-CoV-2 stimulates dysfunctional and hyperactive immune reactions mimicking KD in young patients. CONCLUSIONS: Therapeutic options, both investigational and repurposed, include intravenous immunoglobulins, steroids and anticoagulation. More studies are required to evaluate the effectiveness of these treatment options.


Subject(s)
COVID-19/complications , Mucocutaneous Lymph Node Syndrome , Child , Humans , Immunoglobulins, Intravenous/therapeutic use , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/physiopathology , Mucocutaneous Lymph Node Syndrome/virology , SARS-CoV-2
10.
N Engl J Med ; 383(4): 334-346, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-1254114

ABSTRACT

BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.).


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/virology , Adolescent , Betacoronavirus , COVID-19 , Centers for Disease Control and Prevention, U.S. , Child , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care , Female , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunomodulation , Inflammation , Length of Stay , Male , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Prospective Studies , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/therapy , United States
11.
Int J Mol Sci ; 22(10)2021 May 20.
Article in English | MEDLINE | ID: covidwho-1244035

ABSTRACT

Previous studies have shown that COVID-19 leads to thrombotic complications, which have been associated with high morbidity and mortality rates. Neutrophils are the largest population of white blood cells and play a pivotal role in innate immunity. During an infection, neutrophils migrate from circulation to the infection site, contributing to killing pathogens. This mechanism is regulated by chemokines such as IL-8. Moreover, it was shown that neutrophils play an important role in thromboinflammation. Through a diverse repertoire of mechanisms, neutrophils, apart from directly killing pathogens, are able to activate the formation of thrombi. In COVID-19 patients, neutrophil activation promotes neutrophil extracellular trap (NET) formation, platelet aggregation, and cell damage. Furthermore, neutrophils participate in the pathogenesis of endothelitis. Overall, this review summarizes recent progress in research on the pathogenesis of COVID-19, highlighting the role of the prothrombotic action of neutrophils in NET formation.


Subject(s)
COVID-19/immunology , Extracellular Traps/immunology , Immunity, Innate , Lung/immunology , Neutrophils/immunology , Thrombosis/immunology , COVID-19/complications , COVID-19/pathology , COVID-19/therapy , Cytokine Release Syndrome/metabolism , Cytokine Release Syndrome/virology , Extracellular Traps/virology , Humans , Inflammation/immunology , Inflammation/pathology , Kidney/cytology , Kidney/immunology , Kidney/pathology , Kidney/virology , Lung/cytology , Lung/pathology , Lung/virology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/immunology , Mucocutaneous Lymph Node Syndrome/virology , SARS-CoV-2 , Thrombosis/complications , Thrombosis/pathology , Thrombosis/virology
12.
J Exp Med ; 218(6)2021 06 07.
Article in English | MEDLINE | ID: covidwho-1203555

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) emerged in April 2020 in communities with high COVID-19 rates. This new condition is heterogenous but resembles Kawasaki disease (KD), a well-known but poorly understood and clinically heterogenous pediatric inflammatory condition for which weak associations have been found with a myriad of viral illnesses. Epidemiological data clearly indicate that SARS-CoV-2 is the trigger for MIS-C, which typically occurs about 1 mo after infection. These findings support the hypothesis of viral triggers for the various forms of classic KD. We further suggest that rare inborn errors of immunity (IEIs) altering the immune response to SARS-CoV-2 may underlie the pathogenesis of MIS-C in some children. The discovery of monogenic IEIs underlying MIS-C would shed light on its pathogenesis, paving the way for a new genetic approach to classic KD, revisited as a heterogeneous collection of IEIs to viruses.


Subject(s)
COVID-19/etiology , Mucocutaneous Lymph Node Syndrome/genetics , Mucocutaneous Lymph Node Syndrome/virology , SARS-CoV-2/pathogenicity , Systemic Inflammatory Response Syndrome/etiology , Biomarkers/blood , COVID-19/epidemiology , COVID-19/immunology , Child , Cytokines/blood , Genetic Predisposition to Disease , Genome-Wide Association Study , Humans , Inflammation/etiology , Inflammation/genetics , Inflammation/immunology , Inflammation Mediators/blood , Lymphohistiocytosis, Hemophagocytic/genetics , Lymphohistiocytosis, Hemophagocytic/virology , Models, Biological , Mucocutaneous Lymph Node Syndrome/epidemiology , Pandemics , SARS-CoV-2/immunology , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/immunology
14.
N Engl J Med ; 383(4): 347-358, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-712744

ABSTRACT

BACKGROUND: A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. METHODS: Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020. RESULTS: As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days. CONCLUSIONS: The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/virology , Adolescent , Betacoronavirus , COVID-19 , Child , Child, Preschool , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Infant , Infant, Newborn , Intensive Care Units , Length of Stay , Male , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , New York/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/therapy , Young Adult
15.
Arch Cardiol Mex ; 91(Suplemento COVID): 040-046, 2021 Dec 20.
Article in Spanish | MEDLINE | ID: covidwho-1115629

ABSTRACT

We present an institutional guide for a referral to the specialized care center and initial management of pediatric patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with severe manifestations of pediatric inflammatory multisystemic syndrome or symptoms similar to Kawasaki syndrome, and who must have a multidisciplinary approach to ensure adequate treatment and safety for the team of Health.


Presentamos una guía para la referencia al centro de atención especializada y el manejo inicial de pacientes pediátricos infectados por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) con manifestaciones graves del síndrome multisistémico inflamatorio pediátrico o síntomas semejantes al síndrome de Kawasaki y que deben tener un abordaje multidisciplinario para garantizar un adecuado tratamiento y la mayor seguridad para el equipo de salud.


Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , Referral and Consultation , COVID-19/complications , Cardiology , Child , Humans , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , SARS-CoV-2
16.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 136-142, 2020. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1042138

ABSTRACT

SUMMARY OBJECTIVE To present scientific evidence based on a systematic literature review (PRISMA) evaluating the association of Kawasaki Disease (DK) and COVID-19 in children. METHODS For the selection of studies, a combination based on the Medical Subject Heading Terms (MeSH) was used. The Medline (Pubmed), LILACS, SciELO, COCHRANE, and BIREME databases were used. The search period for the articles comprised the last 10 years (2010 to 2020). RESULTS 840 articles with potential for inclusion were retrieved, one of which met the inclusion criteria and the guiding question that consisted of evaluating the association of Kawasaki disease and COVID-19 in children. CONCLUSION A significant increase in the incidence of Kawasaki-type diseases after the onset of the epidemic has been reported, suggesting an association between the COVID-19 epidemic and the high incidence of a severe form of KD. However, further studies are needed to conduct an investigation of the association between these two diseases.


RESUMO OBJETIVO Apresentar evidências científicas com base em revisão sistemática da literatura (Prisma) avaliando a associação da Doença de Kawasaki (DK) e COVID-19 em crianças. MÉTODOS Para a seleção dos estudos foi utilizada a combinação baseada no Medical Subject Heading Terms (MeSH). Foram utilizadas as bases de dados Medline (PubMed), Lilacs, SciELO, Cochrane e Bireme.O período de busca dos artigos compreendeu os últimos dez anos (2010 a 2020). RESULTADOS Foram recuperados 840 artigos com potencial de inclusão, sendo que um respondeu aos critérios de inclusão e à pergunta norteadora que consistiu em avaliar a associação da Doença de Kawasaki e COVID-19 em crianças. CONCLUSÃO Um aumento significativo na incidência de doenças do tipo Kawasaki após o início da epidemia já foi relatado, sugerindo a associação entre a epidemia de COVID-19 e a elevada incidência de uma forma grave da DK. Contudo, mais estudos são necessários para conduzir a investigação da associação entre essas duas doenças.


Subject(s)
Humans , Child , Pneumonia, Viral/complications , Coronavirus Infections/complications , Systemic Inflammatory Response Syndrome/virology , Betacoronavirus/isolation & purification , Mucocutaneous Lymph Node Syndrome/virology , Pneumonia, Viral/immunology , Pneumonia, Viral/epidemiology , Coronavirus Infections , Coronavirus Infections/immunology , Coronavirus Infections/epidemiology , Pandemics , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/epidemiology
17.
Euro Surveill ; 25(48)2020 12.
Article in English | MEDLINE | ID: covidwho-961570

ABSTRACT

We assessed the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and Kawasaki disease (KD)-like multisystem inflammatory syndrome in a retrospective case-control study in France. RT-PCR and serological tests revealed SARS-CoV-2 infection in 17/23 cases vs 11/102 controls (matched odds ratio: 26.4; 95% confidence interval: 6.0-116.9), indicating strong association between SARS-CoV-2 infection and KD-like illness. Clinicians should keep a high level of suspicion for KD-like illness during the COVID-19 pandemic.


Subject(s)
COVID-19 , Coronavirus Infections/diagnosis , Coronavirus/genetics , Mucocutaneous Lymph Node Syndrome/virology , Pneumonia, Viral/diagnosis , Systemic Inflammatory Response Syndrome , Case-Control Studies , Child , Child, Preschool , Coronavirus/isolation & purification , France/epidemiology , Humans , Mucocutaneous Lymph Node Syndrome/complications , Pneumonia, Viral/epidemiology , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction
18.
J Intensive Care Med ; 36(4): 392-403, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-910321

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease. OBJECTIVE: To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided. METHODS: Retrospective case series including all children (age 1 month-18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock. RESULTS: Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died. CONCLUSION: Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.


Subject(s)
COVID-19/complications , Heart Injuries/virology , SARS-CoV-2 , Shock/virology , Systemic Inflammatory Response Syndrome/complications , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Mucocutaneous Lymph Node Syndrome/virology , Retrospective Studies , Spain , Ventricular Dysfunction/virology
19.
Clin Immunol ; 221: 108613, 2020 12.
Article in English | MEDLINE | ID: covidwho-866590
20.
Front Immunol ; 11: 2055, 2020.
Article in English | MEDLINE | ID: covidwho-807548

ABSTRACT

The clinical and laboratory features of COVID-19 are reviewed with attention to the immunologic manifestations of the disease. Recent COVID-19 publications describe a variety of clinical presentations including an asymptomatic state, pneumonia, a hemophagocytic lymphohistiocytosis like syndrome, Multisystem Inflammatory Syndrome in Children (MIS-C) but, also called Pediatric Inflammatory Multisystem Syndrome-Toxic Shock (PIMS-TS), Kawasaki Disease, and myocarditis. A common theme amongst multiple reports suggests an overexuberant autoimmune component of the disease but a common pathophysiology to explain the variations in clinical presentation has been elusive. Review of the basic science of other viral induced autoimmune disorders may give clues as to why immunosuppressive and immunomodulating regimens now appear to have some efficacy in COVID-19. Review of the immunopathology also reveals other therapies that have yet to be explored. There is potential use of T cell depleting therapies and possibly anti-CD20 therapy for COVID-19 and clinical research using these medications is warranted.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections , Immunosuppressive Agents/therapeutic use , Lymphocyte Depletion , Pandemics , Pneumonia, Viral , Systemic Inflammatory Response Syndrome , T-Lymphocytes , COVID-19 , Child , Child, Preschool , Coronavirus Infections/immunology , Coronavirus Infections/pathology , Coronavirus Infections/therapy , Humans , Lymphohistiocytosis, Hemophagocytic/immunology , Lymphohistiocytosis, Hemophagocytic/pathology , Lymphohistiocytosis, Hemophagocytic/therapy , Lymphohistiocytosis, Hemophagocytic/virology , Mucocutaneous Lymph Node Syndrome/immunology , Mucocutaneous Lymph Node Syndrome/pathology , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , Myocarditis/immunology , Myocarditis/therapy , Myocarditis/virology , Pneumonia, Viral/immunology , Pneumonia, Viral/pathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology , T-Lymphocytes/immunology , T-Lymphocytes/pathology
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