A child with a severe multisystem inflammatory syndrome following an asymptomatic COVID‐19 infection: A novel management for a new disease?

Giannattasio, Antonietta; Maglione, Marco; Zenzeri, Letizia; Mauro, Angela; Mita, Onorina Di; Iodice, Raffaella; Tipo, Vincenzo

doi:10.1002/jmv.26189

Cited by 18 publications

(24 citation statements)

References 8 publications

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“…The patient median age and IQRs are shown in Table 1. The median patient age of the observational studies ranged from 3.5 to 16 years, with Ng et al [41] reporting the highest median age of 16 years (IQR [13][14][15][16][17]. The largest age IQR was reported by Miller et al [22], with a median age of 7.3 years (IQR 0.6-20), although this was not the largest study (Miller et al n = 44, versus Feldstein et al n = 186) [4,22].…”

Section: Age Gender and Comorbidity Of Mis-c Patientsmentioning

confidence: 92%

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

Panigrahy¹,

Policarpio²,

Ramanathan³

2020

PRM

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PURPOSE: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 43 million people resulting in over 1 million deaths. Approximately 2% of cases in the United States are children, and in most cases the child is either asymptomatic or has mild symptoms. However, some pediatric cases can present with Multisystem Inflammatory Syndrome (MIS-C). Understanding the epidemiology, clinical presentation, and management of MIS-C related to SARS-CoV-2 will help to streamline early diagnosis and treatment, particularly in pediatric patients with complex medical conditions. METHODS: This scoping review adopted methods from the Joanna Briggs Institute (JBI) manual for evidence synthesis and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies of patients meeting the Centers for Disease Control and Prevention (CDC) criteria for MIS-C from December 31st, 2019 to Oct 5th, 2020 were identified using PubMed and Scopus. Articles were screened for eligibility, and data collection was conducted on those fulfilling inclusion criteria. RESULTS: Of 417 studies identified, 57 met inclusion criteria, accounting for 875 patients from 15 countries. Globally, 57% of children affected with MIS-C were males. The median age was 9 years old, ranging from 6 months to 21 years. Forty-five percent of the patients had underlying comorbidities including obesity and lung disease. Fever, conjunctivitis and GI symptoms were common. Most MIS-C patients had high biomarkers including troponin I, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), interleukin 6 (IL-6), procalcitonin, and ferritin. The treatment for most patients included IVIG and inotropic support. CONCLUSION: MIS-C can be a unique and potentially life-threatening manifestation of SARS-CoV-2 in children and often requires medical intervention.

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Section: Age Gender and Comorbidity Of Mis-c Patientsmentioning

confidence: 92%

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

Panigrahy¹,

Policarpio²,

Ramanathan³

2020

PRM

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“…Current or recent SARS-CoV-2 infection was assessed with RT-PCR (nasopharyngeal or fecal swab) and/or serological assays (IgG/IgM/IgA) [ 12 – 17 , 25 , 26 , 30 – 34 , 36 – 53 , 55 , 57 – 72 , 75 – 82 , 84 – 86 ]. Two-thirds of patients were IgG-positive (362/569; 63.6%).…”

Section: Resultsmentioning

confidence: 99%

“…IgM (substantial variation between 5.7 and 100%) [ 16 , 26 , 59 , 82 ] and IgA positivity (25/35; 71.4%) [ 59 ] were documented in only four and one cohort(s), respectively. All single patients being IgA-positive (19/138; 13.8%) [ 36 , 62 , 70 ] or IgM-positive (8/138; 5.8%) [ 12 , 34 , 46 , 47 , 69 , 72 ], had detectable IgG as well. Only 338/901 (37.5%) had positive respiratory RT-PCR.…”

Section: Resultsmentioning

confidence: 99%

“…Positive fecal RT-PCR was rare (7/268; 2.6%) [ 16 , 39 , 40 , 45 , 58 , 59 , 62 , 64 , 79 ]. Close contacts with COVID-19 were registered in 168/598 (28.1%) [ 11 – 13 , 17 , 24 , 34 , 36 , 40 , 44 , 47 , 48 , 53 , 59 , 61 , 63 – 65 , 70 , 72 , 73 , 75 , 77 , 78 , 80 – 82 ]. Of single cases, 115/138 (83.3%) had a microbiologically confirmed SARS-CoV-2 infection (PCR and/or serology-positive).…”

Section: Resultsmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

2021

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An association between a novel pediatric hyperinflammatory condition and SARS-CoV-2 was recently published and termed pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome (in children) (MIS(-C)). We performed a systematic review and describe the epidemiological, clinical, and prognostic characteristics of 953 PIMS-TS/MIS(-C) cases in 68 records. Additionally, we studied the sensitivity of different case definitions that are currently applied. PIMS-TS/MIS(-C) presents at a median age of 8 years. Epidemiological enrichment for males (58.9%) and ethnic minorities (37.0% Black) is present. Apart from obesity (25.3%), comorbidities are rare. PIMS-TS/MIS(-C) is characterized by fever (99.4%), gastrointestinal (85.6%) and cardiocirculatory manifestations (79.3%), and increased inflammatory biomarkers. Nevertheless, 50.3% present respiratory symptoms as well. Over half of patients (56.3%) present with shock. The majority of the patients (73.3%) need intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%. Despite severe disease, mortality is rather low (1.9%). Of the currently used case definitions, the WHO definition is preferred, as it is more precise, while encompassing most cases. Conclusion : PIMS-TS/MIS(-C) is a severe, heterogeneous disease with epidemiological enrichment for males, adolescents, and racial and ethnic minorities. However, mortality rate is low and short-term outcome favorable. Long-term follow-up of chronic complications and additional clinical research to elucidate the underlying pathogenesis is crucial. What is Known: • A novel pediatric inflammatory syndrome with multisystem involvement has been described in association with SARS-CoV-2. • To date, the scattered reporting of cases and use of different case definitions provides insufficient insight in the full clinical spectrum, epidemiological and immunological features, and prognosis. What is New: • This systematic review illustrates the heterogeneous spectrum of PIMS-TS/MIS(-C) and its epidemiological enrichment for males, adolescents, and racial and ethnic minorities. • Despite its severe presentation, overall short-term outcome is good. • The WHO MIS definition is preferred, as it is more precise, while encompassing most cases. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-021-03993-5.

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“…The relative absence of pulmonary findings in pediatric COVID‐19 cases in comparison with adults 9 raises additional questions regarding pathogenesis, as pulmonary involvement does not appear to be the major driver of dysfunction in SARS‐CoV‐2 infection in children. Findings in KD provide an interesting parallel.…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children related to COVID‐19: A New York City experience

Riollano‐Cruz

Akkoyun

Briceno-Brito

et al. 2020

Journal of Medical Virology

155

300

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In December 2019, the 2019 novel coronavirus disease (COVID‐19) caused by Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as low risk for severe COVID‐19. However, reports have emerged recently of cases of COVID‐19 in children with a systemic inflammatory disease, with features that overlap with Kawasaki Disease (KD). We describe the first 15 cases with multi‐system inflammatory syndrome in children (MIS‐C), temporally related to COVID‐19, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and black/African‐American ancestry, the distinct cytokine signature across the disease spectrum (IL‐1/IL‐6), and the potential role and pathogenesis of SARS‐CoV‐2 in this new clinical entity. This article is protected by copyright. All rights reserved.

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A child with a severe multisystem inflammatory syndrome following an asymptomatic COVID‐19 infection: A novel management for a new disease?

Cited by 18 publications

References 8 publications

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

Multisystem inflammatory syndrome in children related to COVID‐19: A New York City experience

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