Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Patel, Pragna; DeCuir, Jennifer; Abrams, Joseph Y.; Campbell, Angela P; Godfred‐Cato, Shana; Belay, Ermias D.

doi:10.1001/jamanetworkopen.2021.26456

Cited by 181 publications

(349 citation statements)

References 79 publications

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“…Recently, there has been further clinical support that the pathogenesis of COVID-19 involves a spectrum of mild and severe, acute and chronic, respiratory and multisystem inflammatory syndromes that affect all age groups [ 13 – 15 ]. Multisystem inflammatory syndrome in adults (MIS-A) has recently been described [ 12 – 15 ]. MIS-A presents more than four weeks after initial infection with SARS-CoV-2 in young adults more than 21 years of age [ 12 – 15 ].…”

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confidence: 99%

“…Multisystem inflammatory syndrome in adults (MIS-A) has recently been described [ 12 – 15 ]. MIS-A presents more than four weeks after initial infection with SARS-CoV-2 in young adults more than 21 years of age [ 12 – 15 ]. Although there have been several case reports of MIS-A in young adults, it was not until August 2021 that Davogustto and colleagues described 15 adult patients with MIS-A who had a recent infection with SARS-CoV-2, confirmed by laboratory testing [ 13 ].…”

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“…The clinical overlap between MIS-A and acute COVID-19 is likely to make it difficult to diagnose. This diagnostic difficulty is less likely in children who mainly have an asymptomatic infection or mild COVID-19 symptoms before presenting with symptomatic MIS-C [ 11 , 13 , 15 ]. Also, there may be a diversity of individual and age-related phenotypes for MIS-A [ 13 , 15 ].…”

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“…This diagnostic difficulty is less likely in children who mainly have an asymptomatic infection or mild COVID-19 symptoms before presenting with symptomatic MIS-C [ 11 , 13 , 15 ]. Also, there may be a diversity of individual and age-related phenotypes for MIS-A [ 13 , 15 ]. Children with MIS-C in younger cohorts more commonly present with mucocutaneous symptoms and signs [ 11 , 14 ].…”

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“…A systematic review of the literature on reported cases and studies, published in September 2021, represents the most comprehensive clinical information in MIS-A to date [ 15 ]. Patel and colleagues reviewed 221 patients with MIS-A from the published literature and cases reported to the US Centers for Disease Control and Prevention (CDC) between May 2020 to May 2021 [ 15 ]. The review identified 221 patients with MIS-A worldwide [ 15 ].…”

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Editorial: Multisystem Inflammatory Syndrome in Adults (MIS-A) and the Spectrum of COVID-19

Parums¹

2021

Med Sci Monit

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Recent studies on the pathogenesis and clinical spectrum of human disease following infection with the new human pathogen, SARS-CoV-2, have identified the varied presentations and sequelae of COVID-19. Acute ‘cytokine storm’ in severe COVID-19 results in multiorgan damage due to vascular hyperpermeability, edema, and hypercoagulation. The long-term consequences of infection from SARS-CoV-2 include long COVID. or post-COVID syndrome, and multisystem inflammatory syndrome in children (MIS-C). Several case reports of multisystem inflammatory syndrome in adults (MIS-A) have shown the presentation at more than four weeks after initial infection with SARS-CoV-2 in adults more than 21 years of age. In September 2021, a published systematic review of the literature identified 221 patients with MIS-A, representing the most comprehensive clinical study to date. MIS-A occurs in the post-acute COVID-19 period. The pathogenesis may involve a dysregulated antibody-mediated immune response, similar to MIS-C. Therefore, patients with MIS-A may respond to supportive therapies that control hyperinflammation. This Editorial aims to describe MIS-A and discuss COVID-19 as a spectrum of hyperinflammatory disease in terms of severity, extent, duration, and patient age.

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Editorial: Multisystem Inflammatory Syndrome in Adults (MIS-A) and the Spectrum of COVID-19

Parums¹

2021

Med Sci Monit

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Antibody tests for identification of current and past infection with SARS-CoV-2

Fox

Geppert

Dinnes

et al. 2022

Cochrane Database of Systematic Reviews

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Background The diagnostic challenges associated with the COVID‐19 pandemic resulted in rapid development of diagnostic test methods for detecting SARS‐CoV‐2 infection. Serology tests to detect the presence of antibodies to SARS‐CoV‐2 enable detection of past infection and may detect cases of SARS‐CoV‐2 infection that were missed by earlier diagnostic tests. Understanding the diagnostic accuracy of serology tests for SARS‐CoV‐2 infection may enable development of effective diagnostic and management pathways, inform public health management decisions and understanding of SARS‐CoV‐2 epidemiology. Objectives To assess the accuracy of antibody tests, firstly, to determine if a person presenting in the community, or in primary or secondary care has current SARS‐CoV‐2 infection according to time after onset of infection and, secondly, to determine if a person has previously been infected with SARS‐CoV‐2. Sources of heterogeneity investigated included: timing of test, test method, SARS‐CoV‐2 antigen used, test brand, and reference standard for non‐SARS‐CoV‐2 cases. Search methods The COVID‐19 Open Access Project living evidence database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) was searched on 30 September 2020. We included additional publications from the Evidence for Policy and Practice Information and Co‐ordinating Centre (EPPI‐Centre) ‘COVID‐19: Living map of the evidence’ and the Norwegian Institute of Public Health ’NIPH systematic and living map on COVID‐19 evidence’. We did not apply language restrictions. Selection criteria We included test accuracy studies of any design that evaluated commercially produced serology tests, targeting IgG, IgM, IgA alone, or in combination. Studies must have provided data for sensitivity, that could be allocated to a predefined time period after onset of symptoms, or after a positive RT‐PCR test. Small studies with fewer than 25 SARS‐CoV‐2 infection cases were excluded. We included any reference standard to define the presence or absence of SARS‐CoV‐2 (including reverse transcription polymerase chain reaction tests (RT‐PCR), clinical diagnostic criteria, and pre‐pandemic samples). Data collection and analysis We use standard screening procedures with three reviewers. Quality assessment (using the QUADAS‐2 tool) and numeric study results were extracted independently by two people. Other study characteristics were extracted by one reviewer and checked by a second. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and, for meta‐analysis, we fitted univariate random‐effects logistic regression models for sensitivity by eligible time period and for specificity by reference standard group. Heterogeneity was investigated by including indicator variables in the random‐effects logistic regression models. We tabulated result...

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Two cases of multisystem inflammatory syndrome in adults after improvement in severe acute respiratory distress syndrome due to coronavirus disease 2019

Nonaka

Bunya

Nakayama

et al. 2022

Acute Medicine & Surgery

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Background Multisystem inflammatory syndrome in adults (MIS‐A) is a postacute coronavirus disease 2019 (COVID‐19) syndrome occurring weeks after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Although this hyperinflammatory syndrome causes significant morbidity, mortality is low. Reports of MIS‐A following acute respiratory distress syndrome (ARDS) due to SARS‐CoV‐2 infection have rarely been reported. We describe two cases of MIS‐A that developed after recovery from critical acute COVID‐19. Case Presentation We present two cases of MIS‐A. In both cases, approximately 4 weeks after the onset of COVID‐19, the patients developed gastrointestinal disorders, complicated by other organ damage, and died. Conclusion ARDS and MIS‐A can occur in a patient with COVID‐19 at different times of onset. Clinicians should consider MIS‐A when unexplained multisystemic abnormalities are noted after the treatment of ARDS due to COVID‐19.

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Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Cited by 181 publications

References 79 publications

Editorial: Multisystem Inflammatory Syndrome in Adults (MIS-A) and the Spectrum of COVID-19

Editorial: Multisystem Inflammatory Syndrome in Adults (MIS-A) and the Spectrum of COVID-19

Antibody tests for identification of current and past infection with SARS-CoV-2

Two cases of multisystem inflammatory syndrome in adults after improvement in severe acute respiratory distress syndrome due to coronavirus disease 2019

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