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1.
J Emerg Med ; 62(1): 28-37, 2022 01.
Article in English | MEDLINE | ID: covidwho-2180429

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a newly recognized condition affecting children with recent infection or exposure to coronavirus disease 2019 (COVID-19). MIS-C has symptoms that affect multiple organs systems, with some clinical features resembling Kawasaki disease (KD) and toxic shock syndrome (TSS). OBJECTIVE OF THE REVIEW: Our goal was to review the current literature and describe the evaluation and treatment algorithms for children suspected of having MIS-C who present to the emergency department. DISCUSSION: MIS-C has a wide clinical spectrum and diagnosis is based on a combination of both clinical and laboratory findings. The exact mechanism of immune dysregulation of MIS-C is not well understood. Physical findings may evolve and do not necessarily appear at the same time. Gastrointestinal, cardiac, inflammatory, and coagulopathy manifestations and dysfunction are seen frequently in MIS-C. CONCLUSIONS: The diagnosis of MIS-C is based on clinical presentation and specific laboratory findings. In the emergency setting, a high level of suspicion for MIS-C is required in patients exposed to COVID-19. Early diagnosis and prompt initiation of therapy offer the best chance for optimal outcomes.


Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , COVID-19/complications , Child , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology
2.
Ann Ital Chir ; 112022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2101707

ABSTRACT

AIM: As more data about coronavirus disease-2019 (COVID-19) has been gathered it has become evident that children who have had or have been exposed to COVID-19 can develop a rare complication; multisystem inflammatory syndrome in children (MIS-C). We report the case of a 9-year-old boy, who was brought to the emergency room with suspected acute abdomen and was diagnosed with MIS-C. METHODS: The patient had had a positive molecular test for COVID-19, 25 days earlier and fever that started 4 days prior to presentation, He tested negative for COVID on arrival at the emergency room. After physical examination, and diagnostic tests were performed the differential diagnosis included appendiceal inflammation and MIS-C. Surgical exploration was performed laparoscopically. RESULTS: The immune morphological picture was reactive lymphogranular hyperplasia. Postoperatively the abdominal symptoms improved rapidly but the patient developed diffuse erythema as well as some cardiovascular and neurological disturbances. The patient was discharged on postoperative day 14 in good general condition with a diagnosis of MIS-C. CONCLUSIONS: In patients with a recent positive COVID test and mainly gastroenterological manifestations surgical exploration is necessary in order to prevent delayed diagnosis and inadequate/inappropriate treatment. KEY WORDS: Acute abdomen, COVID-19, MIS-C, Gastrointestinal symptoms.


Subject(s)
Abdomen, Acute , COVID-19 , Child , Male , Humans , COVID-19/complications , Abdomen, Acute/etiology , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology , Emergency Service, Hospital
3.
J Korean Med Sci ; 37(41): e299, 2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2089756

ABSTRACT

Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the Pfizer-BioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks. This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.


Subject(s)
COVID-19 , Humans , Male , Middle Aged , Colchicine/therapeutic use , COVID-19/drug therapy , COVID-19 Vaccines/adverse effects , Prednisolone/therapeutic use , RNA, Messenger , Steroids , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/etiology , Vaccination/adverse effects
4.
Medicina (Kaunas) ; 58(11)2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2081854

ABSTRACT

Multisystem Inflammatory Syndrome (MIS) is a rare but increasingly recognized complication of SARS-CoV-2 infection, usually presenting 2 to 6 weeks after the onset of COVID-19 infection symptoms and affecting mainly children. However, there have been reported several cases of a similar multisystem inflammatory syndrome in adults (MIS-A). We describe the case of a previously healthy 28-year-old male who presented with a clinical profile with multiorgan involvement within four weeks after confirmed SARS-CoV-2 infection, suggestive for multisystem inflammatory syndrome (MIS-A). The clinical presentation included persistent high grade of fever, gastrointestinal and mucocutaneous lesions, lymphadenopathy, elevated cardiac and inflammatory biomarkers, cytopenia and shock. This case report illustrates the wide range of presentations, diagnosis, and treatment modalities of multisystem inflammatory syndrome. The pathophysiology and the mechanisms by which SARS-CoV-2 triggers an abnormal immune response leading to MIS remain poorly understood. Better characterization of MIS-A and early recognition of MIS is important because it is associated with high mortality if left untreated.


Subject(s)
COVID-19 , Child , Male , Young Adult , Humans , Adult , COVID-19/complications , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology
6.
J Card Surg ; 37(11): 3947-3950, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1968159

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) is rare, however, severe hyperinflammatory condition in children generally weeks after acute SARS-CoV-2 infection. A subset of MIS-C patients is presented with severe heart failure. We hereby report 8-year-old girl presenting acute severe left ventricular failure. Various medical treatments including inotropic agents and drugs related to SARS-CoV-2 infection and MIS-C were applied. However, venoarterial extracorporeal membrane oxygenation (ECMO) was needed to be performed. Due to unsuccessful attempts for ECMO weaning, left ventricular assist device was implanted to the patient with temporary right ventricular support from ECMO.


Subject(s)
COVID-19 , Heart Failure , Heart-Assist Devices , COVID-19/complications , Child , Female , Heart Failure/etiology , Heart Failure/therapy , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/therapy
9.
Transplant Proc ; 54(4): 1167-1168, 2022 May.
Article in English | MEDLINE | ID: covidwho-1778475

ABSTRACT

Several reviews have shown that COVID-19 in children is a relatively mild disease. However, a rare complication affecting children and adolescents after COVID-19 has been identified. Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), which in some cases manifests itself as a hyperinflammatory syndrome with a multiorgan failure, may lead to death. We report a case of a 17-year-old patient who was admitted to the hospital with cardiogenic shock of unknown etiology. The disease was life-threatening, thus necessitating mechanical ventilation, circulatory support, and extracorporeal therapy due to renal and liver dysfunction. The patient tested negative for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction. Other infectious causes of illness were excluded. However, the patient had a positive IgG antibody test result and high levels of interleukin-6, which helped to diagnose PIMS-TS. Intravenous immunoglobulin and steroid therapies were initiated, unfortunately, with poor outcome. The patient's critical condition, particularly end-stage heart failure, led to mechanical circulatory support implantation and finally orthotopic heart transplantation. After the surgery, the patient's condition improved gradually. PIMS-TS manifests itself with different clinical images and as a state of varying severity, ultimately causing multiorgan dysfunction with shock resembling toxic shock syndrome. Ultimately, myocardial complications of PIMS-TS necessitated heart transplantation in the described patient.


Subject(s)
COVID-19 , Heart Transplantation , Adolescent , COVID-19/complications , Child , Heart Transplantation/adverse effects , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology
11.
Immunity ; 55(2): 201-209, 2022 02 08.
Article in English | MEDLINE | ID: covidwho-1720107

ABSTRACT

SARS-CoV-2 infections mostly lead to mild or even asymptomatic infections in children, but the reasons for this are not fully understood. More efficient local tissue responses, better thymic function, and cross-reactive immunity have all been proposed to explain this. In rare cases of children and young people, but very rarely in adults, post-infectious hyperinflammatory syndromes can develop and be serious. Here, I will discuss our current understanding of SARS-CoV-2 infections in children and hypothesize that a life history and energy allocation perspective might offer an additional explanation to mild infections, viral dynamics, and the higher incidence of rare multisystem inflammatory syndromes in children and young people.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Host-Pathogen Interactions , SARS-CoV-2/physiology , Adaptive Immunity , Age Factors , COVID-19/complications , COVID-19/diagnosis , COVID-19/etiology , Disease Susceptibility , Energy Metabolism , Host-Pathogen Interactions/genetics , Host-Pathogen Interactions/immunology , Humans , Patient Outcome Assessment , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/etiology , Trauma Severity Indices , Virus Replication
13.
Pediatr Infect Dis J ; 41(3): e93-e94, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1684870

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection is well known. We describe a 12-year-old child developing MIS-C after receiving 2 doses of mRNA COVID-19 vaccines without clinical evidence of COVID-19 infection. A possible association between the SARS-CoV-2 vaccine and MIS-C cannot be excluded.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/complications , Systemic Inflammatory Response Syndrome/etiology , /adverse effects , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/etiology , COVID-19/prevention & control , Child , Diagnosis, Differential , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy
14.
Am J Emerg Med ; 54: 122-126, 2022 04.
Article in English | MEDLINE | ID: covidwho-1664599

ABSTRACT

Although children with Covid-19 generally present with mild symptoms or are often asymptomatic, there is increasing recognition of a delayed multi-organ inflammatory syndrome (MIS-C) following SARS-CoV-2 infection. We report the case of MIS-C associated arrhythmic myocarditis which recovered after anti-inflammatory therapy and immunoglobulin infusion.


Subject(s)
COVID-19 , Myocarditis , Adolescent , COVID-19/complications , Child , Humans , Male , Myocarditis/diagnosis , Myocarditis/etiology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology
15.
World J Pediatr ; 18(2): 83-90, 2022 02.
Article in English | MEDLINE | ID: covidwho-1603411

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that develops from and is linked to coronavirus disease 2019. MIS-C is considered a multi-organ dysfunction involving cardiac, renal, respiratory, hematologic, gastrointestinal and neurological symptoms and groups of signs and symptoms such as rash or bilateral non-purulent conjunctivitis, hypotension or shock and acute gastrointestinal problems, which require immediate therapeutic intervention to prevent the aggravation of the patient's health condition. MIS-C is relatively new in the field of evidence-based medicine; however, there are several clinical guidelines for good clinical practice. For every disorder, the guidelines have different suggestions. Hence, based on the current status of the evidence, recommendations have been combined to form a unified guideline for therapeutic management. METHODS: This paper compares and evaluates the current MIS-C-specific clinical practice guidelines (namely, American Academy of Pediatrics, American College of Rheumatology, Helen DeVos Children's Hospital Foundation, Children's Hospital of The King's Daughters, and the Infectious Diseases Society of America). The compiled literature was then assessed by the authors separately, and an algorithm was proposed for each disorder, taking into consideration the various guidelines proposed for the management of the disorder. RESULTS: The features of MIS-C patients are unified; this is very helpful in managing its symptoms and decreasing mortality rates. In addition, recommendations for pharmacological treatment for MIS-C symptoms are formulated after cross-comparison across five different guidelines. CONCLUSIONS: This study provides a general interpretation of the results in the context of other evidence and implications for future research. It proposes a unified guideline based on the current evidence, with the best potential to maintain suitable clinical standards in the Saudi Arabian Ministry of Health.


Subject(s)
COVID-19 , Systemic Inflammatory Response Syndrome/therapy , COVID-19/complications , Child , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/therapy , Humans , Practice Guidelines as Topic , SARS-CoV-2 , Saudi Arabia , Systemic Inflammatory Response Syndrome/etiology
16.
Pediatr Infect Dis J ; 41(3): e87-e89, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1608728

ABSTRACT

The pathophysiology of multisystem inflammatory syndrome (MIS) in children (MIS-C) is unknown. It occurs several weeks after COVID-19 infection or exposure; however, MIS is rarely reported after COVID-19 vaccination, and cases are mostly in adults. Herein, we present a 12-year-old male who had no prior COVID-19 infection or exposure and developed MIS-C after his first dose of COVID-19 mRNA vaccine.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/complications , Systemic Inflammatory Response Syndrome/etiology , Vaccines, Synthetic/adverse effects , /adverse effects , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/etiology , COVID-19/prevention & control , Child , Diagnosis, Differential , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Methylprednisolone/therapeutic use , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy
17.
Pediatr Infect Dis J ; 41(3): e104-e105, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1592757

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) is a serious complication that is observed most commonly in pediatric patients following severe acute respiratory syndrome coronavirus 2 infections. However, the mechanism and predictors of disease are poorly understood. There are no prior reports of MIS-C among patients who have been fully vaccinated, and only a single case of MIS in an adult patient who had received his second shot just 4 days prior to symptom onset. Here, we present an adolescent with sickle cell disease who was fully vaccinated against severe acute respiratory syndrome coronavirus 2 and had no prior history of known or suspected infection, who presented in shock and was ultimately diagnosed with MIS-C. This case highlights the importance of clinical suspicion for MIS-C even when patients are fully vaccinated.


Subject(s)
Anemia, Sickle Cell/complications , COVID-19 Vaccines/adverse effects , COVID-19/complications , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology , Vaccines, Synthetic/adverse effects , /adverse effects , Adolescent , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/etiology , COVID-19/prevention & control , Diagnosis, Differential , Drug Therapy, Combination , Female , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Methylprednisolone/therapeutic use , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/drug therapy
18.
Pediatr Rheumatol Online J ; 19(1): 172, 2021 Dec 16.
Article in English | MEDLINE | ID: covidwho-1577202

ABSTRACT

BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare hyperinflammatory condition that occurs following SARS-CoV-2 infection. There is a paucity of research describing risk factors, optimal management, and outcomes of this life-threatening condition. METHODS: This is a case series of 26 patients diagnosed with MIS-C in a West Michigan pediatric tertiary care center from April 2020 to February 2021. We describe the clinical, imaging, and laboratory characteristics of these patients and detail their treatments and outcomes with comparisons between Pediatric Intensive Care Unit (PICU) and non-PICU patients. Categorical testing utilized Chi-square and Fisher's Exact tests. Comparison between groups used T-tests or Kruskal-Wallis. RESULTS: Fifteen patients (57%) required intensive care. There was no statistically significant difference in demographics between PICU and non-PICU patients, however all Black patients required intensive care. Gastrointestinal symptoms were present in 22 patients (84%). Seventeen patients (65%) had Kawasaki-like features and 12 (46%) developed coronary artery dilation. Patients requiring intensive care were less likely to have a reported history of COVID-19 disease or exposure (p = 0.0362). Statistically significant differences were also noted in peak ferritin (p = 0.0075), procalcitonin, and BNP in those who required intensive care. CONCLUSIONS: Although overlap exists with other hyperinflammatory conditions, our study provides further evidence that MIS-C is a distinct, albeit heterogenous, disorder with various degrees of cardiac involvement. Anakinra, in conjunction with steroid use, appears to be effective and safe in the treatment of MIS-C. This report identifies procalcitonin, peak ferritin, and BNP as potentially useful biomarkers for severity of disease.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/etiology , Adolescent , COVID-19/epidemiology , COVID-19/etiology , COVID-19/therapy , Child , Female , Humans , Intensive Care Units, Pediatric , Male , Michigan/epidemiology , Risk Factors , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
19.
Int J Infect Dis ; 116: 34-37, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1587624

ABSTRACT

Multisystem inflammatory syndrome in adults is a rare and life-threatening complication that follows natural COVID-19 infection and primarily affects young unvaccinated adults. This complication is seldom described following vaccination, which would have important implications for the vaccination timing and platform in this population. COVID-19 vaccines are extremely effective; however, the risk of rare adverse events needs to be balanced with the vaccination benefits.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , COVID-19 Vaccines/adverse effects , Humans , Immunization , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/etiology , Vaccination/adverse effects
20.
Microvasc Res ; 140: 104303, 2022 03.
Article in English | MEDLINE | ID: covidwho-1568955

ABSTRACT

Systemic inflammatory response, as observed in sepsis and severe COVID-19, may lead to endothelial damage. Therefore, we aim to compare the extent of endothelial injury and its relationship to inflammation in both diseases. We included patients diagnosed with sepsis (SEPSIS group, n = 21), mild COVID-19 (MILD group, n = 31), and severe COVID-19 (SEVERE group, n = 24). Clinical and routine laboratory data were obtained, circulating cytokines (INF-γ, TNF-α, and IL-10) and endothelial injury markers (E-Selectin, Tissue Factor (TF) and von Willebrand factor (vWF)) were measured. Compared to the SEPSIS group, patients with severe COVID-19 present similar clinical and laboratory data, except for lower circulating IL-10 and E-Selectin levels. Compared to the MILD group, patients in the SEVERE group showed higher levels of TNF-α, IL-10, and TF. There was no clear relationship between cytokines and endothelial injury markers among the three studied groups; however, in SEVERE COVID-19 patients, there is a positive relationship between INF-γ with TF and a negative relationship between IL-10 and vWF. In conclusion, COVID-19 and septic patients have a similar pattern of cytokines and endothelial dysfunction markers. These findings highlight the importance of endothelium dysfunction in COVID-19 and suggest that endothelium should be better evaluated as a therapeutic target for the disease.


Subject(s)
COVID-19/pathology , Endothelium, Vascular/pathology , SARS-CoV-2 , Sepsis/pathology , Systemic Inflammatory Response Syndrome/blood , Aged , Aged, 80 and over , Biomarkers , Blood Cell Count , C-Reactive Protein/analysis , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , E-Selectin/blood , Female , Humans , Interferon-gamma/blood , Interleukin-10/blood , Male , Middle Aged , Retrospective Studies , Sepsis/blood , Sepsis/complications , Sepsis/physiopathology , Severity of Illness Index , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/physiopathology , Thromboplastin/analysis , Tumor Necrosis Factor-alpha/analysis , von Willebrand Factor/analysis
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