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Management of severe hyperinflammation in the COVID-19 era: the role of the rheumatologist.
Papadopoulou, Charalampia; Al Obaidi, Muthana; Moraitis, Elena; Compeyrot-Lacassagne, Sandrine; Eleftheriou, Despina; Brogan, Paul.
  • Papadopoulou C; Department of Paediatric Rheumatology, London, UK.
  • Al Obaidi M; Infection, Inflammation and Rheumatology Section, London, UK.
  • Moraitis E; NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
  • Compeyrot-Lacassagne S; Department of Paediatric Rheumatology, London, UK.
  • Eleftheriou D; Infection, Inflammation and Rheumatology Section, London, UK.
  • Brogan P; NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Rheumatology (Oxford) ; 60(2): 911-917, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-944404
Semantic information from SemMedBD (by NLM)
1. 2019 novel coronavirus PROCESS_OF Child
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Child
2. Differential Diagnosis AFFECTS Multi-disciplinary team
Subject
Differential Diagnosis
Predicate
AFFECTS
Object
Multi-disciplinary team
3. 2019 novel coronavirus PROCESS_OF Child
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Child
4. Differential Diagnosis AFFECTS Multi-disciplinary team
Subject
Differential Diagnosis
Predicate
AFFECTS
Object
Multi-disciplinary team
ABSTRACT

OBJECTIVES:

The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context.

METHODS:

This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework.

RESULTS:

Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19.

CONCLUSIONS:

We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Antiviral Agents / Shock / Abdominal Pain / Adrenal Cortex Hormones / Systemic Inflammatory Response Syndrome / Antirheumatic Agents / COVID-19 / Immunologic Factors / Mucocutaneous Lymph Node Syndrome Subject: Antiviral Agents / Shock / Abdominal Pain / Adrenal Cortex Hormones / Systemic Inflammatory Response Syndrome / Antirheumatic Agents / COVID-19 / Immunologic Factors / Mucocutaneous Lymph Node Syndrome Language: English Journal: Rheumatology (Oxford) Clinical aspect: Diagnosis / Prognosis / Therapy Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Antiviral Agents / Shock / Abdominal Pain / Adrenal Cortex Hormones / Systemic Inflammatory Response Syndrome / Antirheumatic Agents / COVID-19 / Immunologic Factors / Mucocutaneous Lymph Node Syndrome Subject: Antiviral Agents / Shock / Abdominal Pain / Adrenal Cortex Hormones / Systemic Inflammatory Response Syndrome / Antirheumatic Agents / COVID-19 / Immunologic Factors / Mucocutaneous Lymph Node Syndrome Language: English Journal: Rheumatology (Oxford) Clinical aspect: Diagnosis / Prognosis / Therapy Year: 2021
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