Inclusion of Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID -19 in the Differential Diagnosis of Kawasaki Disease

Jagzape, Tushar; Goel, Anil Kumar; Shenoy, Bhaskar

doi:10.1007/s13312-021-2146-1

Cited by 2 publications

(3 citation statements)

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“…Diagnostic criteria of MIS-C include age less than 19 years, evidence of previous COVID-19 infection, fever for more than three days, involvement of at least two body organs, high inflammation markers, and the absence of active infection. All prior six criteria mentioned must be met for the diagnosis of MIS-C [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the exact mechanism by which the immune system is abnormally triggered remains uncertain; however, few theories could explain MIS. A possible cause of MIS-A is the dysregulation of host tissue's innate and adaptive immune system leading to multi-organ failure [ 5 ]. This is also thought to be due to the homology between SARS-CoV-2 spike protein and staph enterotoxin B super-antigen structure and sequence resulting in a hyper-inflammatory state [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…A possible cause of MIS-A is the dysregulation of host tissue's innate and adaptive immune system leading to multi-organ failure [ 5 ]. This is also thought to be due to the homology between SARS-CoV-2 spike protein and staph enterotoxin B super-antigen structure and sequence resulting in a hyper-inflammatory state [ 5 ]. SARS-CoV-2 binds to the angiotensin-converting enzyme 2 (ACE2) receptors in the vascular endothelium, which might explain endothelial damage and thrombo-inflammation complications.…”

Section: Discussionmentioning

confidence: 99%

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Late-Onset COVID-19-Related Multi-System Inflammatory Syndrome in a Middle-Aged Man

Al-Falahi¹,

Alharthi²,

Farhan³

et al. 2021

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Late-Onset COVID-19-Related Multi-System Inflammatory Syndrome in a Middle-Aged Man

Al-Falahi¹,

Alharthi²,

Farhan³

et al. 2021

Cureus

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Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalized children: a multicenter cohort study

Schober

Caya

Barton

et al. 2021

Preprint

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ImportanceChildren are less likely than adults to have severe outcomes from SARS-CoV-2 infection and the corresponding risk factors are not well established.ObjectiveTo identify risk factors for severe disease in symptomatic children hospitalized for PCR-positive SARS-CoV-2 infection.DesignCohort study, enrollment from February 1, 2020 until May 31, 2021Setting15 children’s hospitals in Canada, Iran, and Costa RicaParticipantsPatients <18 years of age hospitalized with symptomatic SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C)ExposuresVariables assessed for their association with disease severity included patient demographics, presence of comorbidities, clinical manifestations, laboratory parameters and chest imaging findings.Main Outcomes and MeasuresThe primary outcome was severe disease defined as a WHO COVID-19 clinical progression scale of ≥6, i.e., requirement of non-invasive ventilation, high flow nasal cannula, mechanical ventilation, vasopressors, or death. Multivariable logistic regression was used to evaluate factors associated with severe disease.ResultsWe identified 403 hospitalizations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Severe disease occurred in 33.8% (102/403). In multivariable analyses, presence of multiple comorbidities (adjusted odds ratio 2.24, 95% confidence interval 1.04-4.81), obesity (2.87, 1.19-6.93), neurological disorder (3.22, 1.37-7.56), anemia, and/or hemoglobinopathy (5.88, 1.30-26.46), shortness of breath (4.37, 2.08-9.16), bacterial and/or viral coinfections (2.26, 1.08-4.73), chest imaging compatible with COVID-19 (2.99, 1.51-5.92), neutrophilia (2.60, 1.35-5.02), and MIS-C diagnosis (3.86, 1.56-9.51) were independent risk factors for severity. Comorbidities, especially obesity (40.9% vs 3.9%, p<0.001), were more frequently present in adolescents ≥12 years of age. Neurological disorder (3.16, 1.19-8.43) in children <12 years of age and obesity (3.21, 1.15-8.93) in adolescents were the specific comorbidities associated with disease severity in age-stratified adjusted analyses. Sensitivity analyses excluding the 81 cases with MIS-C did not substantially change the identified risk factors.Conclusions and RelevancePediatric risk factors for severe SARS-CoV-2 infection vary according to age and can potentially guide vaccination programs and treatment approaches in children.Key pointsQuestionWhat are the risk factors for severe disease in children hospitalized for PCR-positive SARS-CoV-2 infection?FindingsIn this multinational cohort study of 403 children, multiple comorbidities, obesity, neurological disorder, anemia, and/or hemoglobinopathy, shortness of breath, bacterial and/or viral coinfections, chest imaging compatible with COVID-19, neutrophilia, and MIS-C diagnosis were independent risk factors for severity. The risk profile and presence of comorbidities differed between pediatric age groups, but age itself was not associated with severe outcomes.MeaningThese results can inform targeted treatment approaches and vaccine programs that focus on patient groups with the highest risk of severe outcomes.

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Inclusion of Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID -19 in the Differential Diagnosis of Kawasaki Disease

Cited by 2 publications

References 3 publications

Late-Onset COVID-19-Related Multi-System Inflammatory Syndrome in a Middle-Aged Man

Late-Onset COVID-19-Related Multi-System Inflammatory Syndrome in a Middle-Aged Man

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalized children: a multicenter cohort study

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