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Background: Pediatric Infammatory Multisystemic Syndrome associated to SARS-CoV2 (PIMS) happens 4 to 6 weeks after SARS-CoV2 infection1-2. Its early diagnostic recognition as well as its early management is important to avoid cardiac complications related to this pathology. Objectives: To highlight a frequent symptom in PIMS and improve its therapeutic care. Methods: The JIR Cohort database, an international registry collecting data on patients with pediatric infammatory diseases, was consulted to include patients between 03/15/20 and 12/31/2021. Results: Of the 140 patients in whom a diagnosis of PIMS was retained, we present a series of 38 patients (27%) who presented at diagnosis or during evolution, febrile torticollis or painful cervical involvement. These patients were on average 8.2 years old (0.6-15.2). The proportion of boys was 14 out of 38 (37%). Twenty-four patients out of 33 (73%) were hospitalized in intensive care. Ten patients out of 38 (26%) underwent cervical imaging, 5 (50%) had abnormalities such as collection or infltration of the soft tissues. At the therapeutic level, 27/38 patients (71%) received corticosteroid therapy, 33/38 (87%) immunoglobulins, and 26/38 (68%) antibiotic therapy. Conclusion: PIMS is a pathology with signifcant clinical heterogeneity and severe consequences in case of delay in therapeutic management. In this epidemic context, it is important to consider PIMS in any patient with febrile torticollis, especially if he does not respond to antibiotics.
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Background: Paediatric infammatory multisystem Syndrome (PIMS) is a new systemic infammatory disease linked to SARS-CoV2 that affects children. It was frst reported in may 2020 [1-2]. Objectives: The objectives of this study were to describe patients with PIMS through the international JIR cohort registry and to compare the different profiles and treatments of these patients over the different waves. Methods: Study patients with international PIMS criteria were included from March 2020 to June 2021. Patients were identifed in the JIR cohort, an international registry collecting demographic, clinical and paraclinical data on patients with pediatric infammatory diseases. Two groups were distinguished: from March 2020 to July 2020 for patients in the frst wave, from July 2020 to June 2021 for patients in the 2nd and 3rd waves. These two groups were compared using a Fischer test for categorical data and a Mann-Whitney test for quantitative data Results: 136 patients meeting the PIMS criteria were included (64 patients in the 1st wave, 72 patients after). Patients had less frequent myocarditis (51 patients in wave 1 vs. 36 patients after, p=0,0003) and respiratory distress (34 patients vs 10 patients, p<0,0001). Corticosteroids were used more frequently in the second wave (32 patients in wave 1 vs. 67 patients after July 2020, p<0,0001). Intravenous immunoglobulins were used as much over the waves (58 patients in wave 1 vs 68 patients after, p=0.5). Antibiotics were less used since the second wave (53 patients received antibiotics before July 2020 vs 11 after, p<0,0001). The duration of hospitalization decreased sig-nifcantly (p<0,0001) with a median duration of 9 days during the frst wave (interquartile range, 7-12) and 7 days (interquartile range, 5-10) after the frst wave. Conclusion: There was a decrease in the number of complications of PIMS, particularly cardiac and respiratory complications, and a decrease in the length of hospitalization over time. The treatment of PIMS has also evolved, with a clear increase in the use of corticosteroids and a decrease in the use of antibiotics.
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Children appeared to be initially spared by the SARS-CoV-2 pandemic, however, in spring 2020, a new clinical entity was described related to the SARS-CoV-2 infection and named multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS). The gravity of this inflammatory syndrome, the time interval between infection and MIS-C, the response to the various immunomodulatory treatments are all suggestive of an immunologic reaction rather than a virus-mediatred phenomenon. The pathophysiological mechanisms and possible risk factors for MIS-C have not been elucidated. In this article, we summarize what is known to date about the immune response to SARS-CoV-2 in children and about the immune response to SARSCoV-2 in children and about the MIS-C.
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Introduction: Since the beginning of the severe SARS-CoV-2 pandemic, an increasing number of countries reported cases of a systemic hyperinflammatory condition defined as multi-system inflammatory syndrome in children (MIS-C). The clinical features of MIS-C can be an overlap of Kawasaki Disease (KD), Toxic Shock Syndrome (TSS), Macrophage Activation Syndrome (MAS) or can have an acute abdominal presentation. Objectives: We report the demographic profile, clinical presentation, management, and outcome of this emerging syndrome in 15 children in Switzerland. Understanding these parameters will enable streamlining of early diagnosis and treatment, thus leading to a favorable outcome. Methods: Our clinical study is a case series that includes patients identified during the study registration period (consecutive, formal) at Geneva, Zurich and Lausanne. The data for most of Lausanne patients were extracted from JIR cohort database. This is an observational (descriptive research design), retrospective, multicentric study of a case series. Results: The socio-demographic profile showed male predilection (12 male patients (80%) and 3 female), with no significant racial predisposition. Concerning the symptoms, fever was always present (15/15, 100%). A high incidence of gastrointestinal (10/15 with abdominal pain (67%), 10/15 with emesis (67%) and 9/15 with diarrheas (60%)- these symptoms did not necessarily overlap) and mucocutaneous symptoms (rash 9/15 (60%), conjunctival ejection 11/15 (73%), cheilitis 3/15 (20%)) and extremity changes 9/15 (60%)) was noted. Other manifestations included adenopathy (6/15, 40%), neurological symptoms (6/15, 40%), respiratory insufficiency (10/15, 67%), shock (8/15, 53%), cardiac abnormalities (9/15, 60%)- either like coronary artery anomaly (5/15, 33%) or left ventricular dysfunction (7/15, 47%). Concerning the biological profile, serological evidence of SARS-CoV-2 was present in all our patients (15/15, 100%) as was also the case for the elevated inflammatory markers (C-reactive protein and sedimentation rate). Serum cytokine profile investigations showed increased IL1RA levels in all tested patients (6/6 patients, 9 patients had not been tested) and increased IL6 levels for 3 patients (3/7 patients tested). Concerning the treatment, 13/15 patients (87%) received at least one dose of intravenous immunoglobulins (IVIG), while 8/15 (53%) patients also had a steroid treatment. One patient did not need any treatment except from supportive care. One patient received only anakinra with favorable evolution, and five combined with other treatments (6/15 in total, 40%). The treatments combined with anakinra were: IVIG for all the 5 patients;4 of them received additionally corticosteroids, while 2 patients further needed one dose of Tocilizumab (anti-IL6 treatment, because of their cytokine profile demonstrating high levels of IL6). Nine out of 15 (60%) patients were transferred to the PICU (pediatric intensive care unit), and there were no deaths. Most of the patients (14/15) recovered fully and only one showed long COVID symptoms. Conclusion: Awareness about post COVID inflammatory syndrome should be raised among pediatricians because early diagnosis and management of this syndrome by a multidisciplinary specialized team can lead to a favorable outcome. In conclusion, our case series reports on clinical and laboratory findings, as well as on the management of Swiss cases with MIS-C.
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Background: Facing the global COVID-19 pandemic University teaching has been digitalized and German medical faculties took great effort to offer curricular contents online as they agreed that semesters during pandemic should not be suspended. Skill training is an essential part of medical education and cannot be fully digitalized nor should it be omitted. The pandemic demonstrates that skills like ultrasound are essential when treating critical ill patients. Medical faculties use peer assisted learning (PAL) concepts to teach skills, like ultrasound through specially trained student tutors. Aim: Here, we would like to share our experiences and elaborate how ultrasound teaching can be safely performed during the pandemic with an emphasis on adjustment of an existing PAL teaching concept. Method: At the hospital of Saarland University, we implemented a PAL teaching concept for abdominal, including emergency, ultrasound, and echocardiography, called "sonoBYstudents" to teach sonography to undergraduate medical students. Students are generally taught in small groups of 5 people in 90min sessions over a time of 8 weeks with an objective structured clinical exam (OSCE) at the end of the course program. Each semester nearly 50 students are taught in abdominal and emergency ultrasound and 30 students in echocardiography. Over five years, more than 600 students have been taught with at least 30 students being trained as student tutors. Given the pandemic, course size, course interval and total course time and total course time were adapted to the hygienic precautions. Results: 45 and 30 students were taught in abdominal ultrasound and echocardiography respectively achieving their learning goals measured via OSCE at the end of the courses. OSCE results were the same when compared to previous semesters. Conclusion: PAL as a teaching concept lives out of sustained educational strategies like practical and didactical trainings and an ongoing recruitment of new student tutors. Suspending PAL and its skill teaching would require starting from the beginning which is a time and cost consuming process. With sonoBYstudents we were able to demonstrate that an existing PAL concept can, with some effort, be adjusted to changing teaching circumstances. Apart from this ultrasound is a non-omittable part of medical skill training with easily appliable hygienic precautions during teaching sessions.