Current Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome in Children

Vella, Laura A.; Rowley, Anne H.

doi:10.1007/s40124-021-00257-6

Cited by 58 publications

(80 citation statements)

References 70 publications

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“…In our pediatric cohort, only one Hispanic patient developed a transient ectasia of the main left coronary, which quickly resolved after therapy. There are conflicting descriptions about the data regarding the involvement of coronary arteries; the incidence of coronary artery dilatation/aneurysms varies significantly among reports (8-24%) [14,29], and the pathological mechanism is, as yet, unknown. Abrams et al showed some degree of association between muco-cutaneous alterations, conjunctival hyperemia, and coronary artery alterations, suggesting a possible overlap between MIS-C and Kawasaki disease [22].…”

Section: Discussionmentioning

confidence: 99%

Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study

et al. 2022

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Background Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients. Methods A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children’s Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge. Results Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5–15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7–13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients. Conclusion Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.

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Section: Discussionmentioning

confidence: 99%

Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study

et al. 2022

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“…MIS-C is better characterized than long COVID. It is an acute and potentially fatal condition that occurs after 2 to 6 weeks after SARS-CoV-2 infection in less than 0.1% of pediatric COVID-19 cases and that is associated with marked immune activation and many potential mechanisms of immunopathogenesis [5]. Children with MIS-C present with several multisystemic manifestations, among which those involving the gastrointestinal tract, the skin and the mucous membranes, and the cardiovascular system are the most common.…”

Section: Introductionmentioning

confidence: 99%

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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“…If true, this should be considered in vaccine development against SARS-CoV-2 [ 100 ]. Further studies implied the pathogenesis consistent with the postinfectious inflammatory syndrome, characterised by an elevation in all cytokines and markers of recent T-cell activation (sIL-2R) despite a strong and specific humoral response to SARS-CoV-2 [ 102 , 113 ].…”

Section: Multisystem Inflammatory Syndrome In Children (Mis-c)mentioning

confidence: 99%

The COVID-19 pandemic in children and young people during 2020-2021: Learning about clinical presentation, patterns of spread, viral load, diagnosis and treatment

et al. 2021

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Current Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome in Children

Cited by 58 publications

References 70 publications

Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study

Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study

Italian intersociety consensus on management of long covid in children

The COVID-19 pandemic in children and young people during 2020-2021: Learning about clinical presentation, patterns of spread, viral load, diagnosis and treatment

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