COVID‐19 multisystem inflammatory syndrome in three teenagers with confirmed SARS‐CoV‐2 infection

Ng, Khuen Foong; Kothari, Trishul; Bandi, Srini; Bird, Paul; Goyal, Kanika; Mohammad, Z.; Rai, Vinayak; Tang, Julian W.

doi:10.1002/jmv.26206

Cited by 51 publications

(89 citation statements)

References 15 publications

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“…Because many cases met the diagnostic criteria of classic or incomplete Kawasaki disease, most reported MIS-C cases were treated using the standard protocol for Kawasaki disease, which is intravenous immunoglobulin with or without aspirin ( appendix 6 pp 3–4 ). 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 107 , 108 A large proportion of MIS-C cases (67%) have a similar presentation to Kawasaki disease shock syndrome, mainly shock, so supportive and inotropic or vasoactive treatment should also be applied. Steroids have also been used to treat MIS-C. Because clinical and laboratory features of MIS-C overlap with those of Kawasaki disease, Kawasaki disease shock syndrome, and macrophage activation syndromes, patients with severe MIS-C have received immunomodulatory agents such as infliximab (anti-tumour necrosis factor drug), 18 , 25 tocilizumab (IL-6 antagonist), 16 , 17 , 22 , 24 , 25 and anakinra (IL-1 receptor antagonist), 15 , 17 , 18 , 20 , 22 , 24 , 25 , 26 , 27 which have been shown to be effective in similar diseases.…”

Section: Management Of Mis-cmentioning

confidence: 99%

“…The clinical features of these paediatric cases are both similar and distinct from other well described inflammatory syndromes in children, including Kawasaki disease, Kawasaki disease shock syndrome, and toxic shock syndrome. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 This COVID-19-associated multisystem inflammatory syndrome in children and adolescents is referred to interchangeably as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, and herein is referred to as MIS-C. MIS-C can lead to shock and multiple organ failure requiring intensive care. The European and US Centers for Disease Prevention and Control (CDC), Australian Government Department of Health, and WHO have released scientific briefs or advisories for MIS-C in response to this emerging challenge.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 and multisystem inflammatory syndrome in children and adolescents

Jiang

Tang

Levin

et al. 2020

The Lancet Infectious Diseases

719

833

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Summary As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from Europe, North America, Asia, and Latin America describing children and adolescents with COVID-19-associated multisystem inflammatory conditions. However, the association between multisystem inflammatory syndrome in children and COVID-19 is still unknown. We review the epidemiology, causes, clinical features, and current treatment protocols for multisystem inflammatory syndrome in children and adolescents associated with COVID-19. We also discuss the possible underlying pathophysiological mechanisms for COVID-19-induced inflammatory processes, which can lead to organ damage in paediatric patients who are severely ill. These insights provide evidence for the need to develop a clear case definition and treatment protocol for this new condition and also shed light on future therapeutic interventions and the potential for vaccine development. Translations For the French, Chinese, Arabic, Spanish and Russian translations of the abstract see Supplementary Materials section.

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Section: Management Of Mis-cmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 and multisystem inflammatory syndrome in children and adolescents

Jiang

Tang

Levin

et al. 2020

The Lancet Infectious Diseases

719

833

View full text Add to dashboard Cite

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“…We identified a total of 34 case series 3 , 6 , 7 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 and case reports 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 published between May and July 2020 that mention dermatologic findings in 736 unique children with MIS-C. Cutaneous manifestations were present in 417 of 736 patients (57%). Fifteen (44%) of these articles state “rash” as the sole descriptor of skin findings.…”

Section: Dermatologic Presentationmentioning

confidence: 99%

“…Some smaller case series and case reports provide more detailed characterizations: polymorphic, maculopapular, morbilliform, and diffuse erythroderma were the most common morphologies noted. 3 , 25 , 34 , 38 , 39 , 40 , 45 , 46 , 48 , 51 Skin lesions in single case reports were described as urticarial 34 , reticular 47 , petechial 32 , and purpuric. 46 …”

Section: Dermatologic Presentationmentioning

confidence: 99%

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

Brumfiel

DiLorenzo

Petronic‐Rosic

2021

Clinics in Dermatology

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Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. Skin findings are often present in these patients and while initially compared to Kawasaki disease, likely represent distinct phenomena and overall remain poorly characterized. In this retrospective review of 34 case reports and series, we identified cutaneous manifestations documented in 417 of 736 patients (57%) with MIS-C associated with COVID-19. “Rash” was the sole descriptor of skin findings in nearly half of patients. Case reports and smaller case series provided more detail, outlining a broad range of lesion morphologies (polymorphic, maculopapular, morbilliform, erythrodermic, urticarial, reticular, petechial, purpuric) in variable anatomic distribution. More thorough descriptions of dermatologic manifestations in patients with MIS-C are warranted to better characterize this syndrome, as they may lend important insight into pathogenic mechanisms of disease.

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“…We included studies from the following countries: 19 from the USA [6,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], 7 from the UK [29][30][31][32][33][34][35], 6 from France [36][37][38][39][40][41], 3 from Italy [42][43][44], 2 from both India [45,46] and Switzerland [47,48], and 1 from each of Luxembourg [49], Israel [50], and…”

Section: Resultsmentioning

confidence: 99%

Multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection: a scoping review of the literature

Sabbour

El-Swaify

Farrag

et al. 2020

Preprint

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Background: With the rise of the COVID-19 pandemic, a new severe life-threatening inflammatory syndrome has been reported in some pediatric populations. Global attention was shifted towards the syndrome termed multisystem inflammatory syndrome in children (MIS-C), with new case reports flooding in. Objectives: The aim of this scoping review is to summarize the existing reports on MIS-C and focus on the demographics, diagnosis, clinical presentation, laboratory investigations, imaging studies, treatment, and patient outcomes. Methods: We conducted a systemic search using LitCovid and MEDLINE electronic databases. We screened citations, titles and abstracts, then reviewed potentially relevant articles in full. After data extraction, we reported our final data under subheadings of demographics, diagnosis, clinical presentation, laboratory investigations, imaging studies, treatment, and patient outcomes. Results: Our search strategy yielded 42 original studies reporting 674 pediatric patients fitting the case definition of MIS-C. The studies included 21 case reports, 16 case series and 5 cohort studies. The most common reported symptom of MIS-C was fever (98%). Gastrointestinal symptoms were common (N=557, 83%). Interleukin-6 (IL-6) levels were measured in 125 patients and was elevated in 94 % (N=117). Echocardiography detected coronary artery lesions in 100 patients. Prophylactic and/or therapeutic heparin was required in 34% (N=227) of patients. The most commonly administered treatment modality targeting MIS-C was intravenous immunoglobulin (IVIG) (N=490). Corticosteroids (N=347) and aspirin (N=112) were also integral parts of the treatment regimens. Biologic therapy was integrated into the treatment regimen for 116 patients. Intensive care unit (ICU) admission was alarming (N=478, 71%). 9 fatalities were recorded due to MIS-C Conclusions: We believe MIS-C bears pathophysiological resemblance to the well-known Kawasaki disease but with some key differences highlighted. Understanding those differences will aid our management plan for such patients.

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COVID‐19 multisystem inflammatory syndrome in three teenagers with confirmed SARS‐CoV‐2 infection

Cited by 51 publications

References 15 publications

COVID-19 and multisystem inflammatory syndrome in children and adolescents

COVID-19 and multisystem inflammatory syndrome in children and adolescents

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

Multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection: a scoping review of the literature

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