Characterizing the differences between multisystem inflammatory syndrome in children and Kawasaki disease

Bar-Meir, Maskit; Guri, Alex; Godfrey, Max E; Shack, Avram R.; Hashkes, Philip J.; Goldzweig, Gil; Megged, Orli

doi:10.1038/s41598-021-93389-0

Cited by 38 publications

(43 citation statements)

References 14 publications

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“…6 Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy. 7 IRCCS Bambino Gesù Children Hospital, Rome, Italy. 8 Department of Translational Medical Sciences, Section of Pediatrics, University Federico II of Naples, Naples, Italy.…”

Section: Abbreviationsmentioning

confidence: 99%

“…The latter are the most dangerous as vasogenic shock, myocardial dysfunction or infarction, coronary artery dilation or aneurysm, and arrhythmias can lead to admission to the intensive care unit and, although rarely, to death [ 6 ]. For some aspects, the clinical picture of MIS-C resembles that of Kawasaki disease (KD), especially in cases with shock, toxic shock syndrome, and macrophage activation syndrome [ 7 ]. As for KD, early identification of suspected cases is essential to assure a favorable prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Italian intersociety consensus on management of long covid in children

et al. 2022

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Background Two sequelae of pediatric COVID-19 have been identified, the multisystem inflammatory syndrome in children (MIS-C) and the long COVID. Long COVID is much less precisely defined and includes all the persistent or new clinical manifestations evidenced in subjects previously infected by SARS-CoV-2 beyond the period of the acute infection and that cannot be explained by an alternative diagnosis. In this Intersociety Consensus, present knowledge on pediatric long COVID as well as how to identify and manage children with long COVID are discussed. Main findings Although the true prevalence of long COVID in pediatrics is not exactly determined, it seems appropriate to recommend evaluating the presence of symptoms suggestive of long COVID near the end of the acute phase of the disease, between 4 and 12 weeks from this. Long COVID in children and adolescents should be suspected in presence of persistent headache and fatigue, sleep disturbance, difficulty in concentrating, abdominal pain, myalgia or arthralgia. Persistent chest pain, stomach pain, diarrhea, heart palpitations, and skin lesions should be considered as possible symptoms of long COVID. It is recommended that the primary care pediatrician visits all subjects with a suspected or a proven diagnosis of SARS-CoV-2 infection after 4 weeks to check for the presence of symptoms of previously unknown disease. In any case, a further check-up by the primary care pediatrician should be scheduled 3 months after the diagnosis of SARS-CoV-2 infection to confirm normality or to address emerging problems. The subjects who present symptoms of any organic problem must undergo a thorough evaluation of the same, with a possible request for clinical, laboratory and / or radiological in-depth analysis in case of need. Children and adolescents with clear symptoms of mental stress will need to be followed up by existing local services for problems of this type. Conclusions Pediatric long COVID is a relevant problem that involve a considerable proportion of children and adolescents. Prognosis of these cases is generally good as in most of them symptoms disappear spontaneously. The few children with significant medical problems should be early identified after the acute phase of the infection and adequately managed to assure complete resolution. A relevant psychological support for all the children during COVID-19 pandemic must be organized by health authorities and government that have to treat this as a public health issue.

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Section: Abbreviationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Italian intersociety consensus on management of long covid in children

et al. 2022

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“…Table 2 provides distinguishing features of acute COVID-19, MIS-C, and KD. The presence of leukopenia, thrombocytopenia, hypotension, myocardial dysfunction, prominent gastrointestinal symptoms, and presentation at an older age favor MIS-C over KD as the diagnosis [ 6 , 45 ]. The majority of children with KD are less than 5 years of age, and children of East Asian ancestry have the highest incidence [ 42 ].…”

Section: Mis-c and Kdmentioning

confidence: 99%

“…The role of IVIG in treatment remains unclear. Some centers have had success with corticosteroid treatment without IVIG in some patients [ 45 ][ 69 ]. Patients who do not appear to respond to IVIG and corticosteroid are often treated with anakinra or infliximab, but the efficacy and role of these agents are also presently unknown.…”

Section: Treatmentmentioning

confidence: 99%

Current Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome in Children

Vella

Rowley

2021

Curr Pediatr Rep

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Purpose of Review We highlight the new clinical entity multisystem inflammatory syndrome in children (MIS-C), the progress in understanding its immunopathogenesis, and compare and contrast the clinical and immunologic features of MIS-C with Kawasaki disease (KD). Recent Findings Studies show immune dysregulation in MIS-C including T lymphocyte depletion and activation, T cell receptor Vbeta skewing, elevated plasmablast frequencies, increased markers of vascular pathology, and decreased numbers and functional profiles of antigen-presenting cells. Summary MIS-C is a late manifestation of infection with SARS-CoV-2 associated with marked immune activation and many potential mechanisms of immunopathogenesis. MIS-C and KD have clinical similarities but are distinct. Myocardial dysfunction with or without mild coronary artery dilation can occur in MIS-C but generally corrects within weeks. In contrast, the coronary arteries are the primary target in KD, and coronary artery sequelae can be lifelong. Supportive care and anti-inflammatory therapy appear to hasten improvement in children with MIS-C, and there is hope that vaccines will prevent its development.

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“…Total platelet counts in MIS-C tend to be lower than normal, while it is normal to elevated in KD and KD with SS. [ 10 ]…”

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confidence: 99%