Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study

Lima‐Setta, Fernanda; Magalhães‐Barbosa, Maria Clara de; Santos, Gustavo Rodrigues dos; Figueiredo, Elaine Augusta das Neves; Jacques, Melissa de Lorena; Zeitel, Raquel de Seixas; Sapolnik, Roberto; Borges, Cibelle Teixeira da Siva; Lanziotti, Vanessa Soares; Castro, Roberta Esteves Vieira de; Bellinat, Ana Paula Novaes; Silva, Thiago Peres da; Oliveira, Felipe Rezende Caino de; Reis, Bárbara Carvalho Santos dos; Castro, Natália Almeida de Arnaldo Silva Rodriguez; Macedo, João Henrique Garcia Cobas; Scarlato, Ana Carolina Cabral Pinheiro; Riveiro, Paula Marins; Mota, Isabele Coelho Fonseca da; Lorenzo, Vivian Botelho; Lucena, Natalia Martins Lima de; Azevedo, Zina Maria Almeida de; Cunha, Antônio José Lêdo Alves da; Prata‐Barbosa, Arnaldo

doi:10.1016/j.jped.2020.10.008

Cited by 78 publications

(127 citation statements)

References 28 publications

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Section: Resultsmentioning

confidence: 99%

“…When considering imaging studies, ileitis or colitis were present approximately in 4–28% of cases [ 6 , 7 , 13 , 23 , [27] , [28] , [29] , [30] , [31] ]. Moreover, a diagnosis of mesenteric adenitis in MIS-C has been accounted by 8 case-series, with a prevalence of 9–20% of the abdominal imaging studies [ 6 , 8 , 13 , 16 , 23 , 27 , 31 , 32 ]. In addition, the latter condition has been also described in six recent case-reports from different geographic areas [ 9 , 25 , 26 , 30 , 33 , 34 ]: notably, in one of those patients mesenteric lymphadenitis was even confirmed on surgical specimens by pathologists [ 9 ].…”

Section: Resultsmentioning

confidence: 99%

“…Severe pulmonary involvement (e.g. acute respiratory distress syndrome) is rather uncommon; however, when present, respiratory symptoms (tachypnea, dyspnea) are most often due to severe shock [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

Valitutti

Verde

Pepe

et al. 2021

Journal of Pediatric Surgery Case Reports

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Background/purpose Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening condition occurring 2–6 weeks after Coronavirus disease 2019 (COVID-19) in previously healthy children and adolescents, characterized by clinical and laboratory evidence of multiorgan inflammation. We reported the case of a 6-year-old child presented with acute abdomen and then diagnosed with MIS-C. In addition, to better portray this new entity, we performed a systematic review of MIS-C gastrointestinal features and particularly on those mimicking surgical emergencies. Methods We described the clinical presentation, the diagnostic approach and the therapeutic outcomes of our MIS-C patient. Parallel to this, we conducted a systematic literature search using Google Scholar, PubMed, EMBASE, Scopus, focusing on gastrointestinal MIS-C. Results Our patient was initially assessed by the surgical team due to his query acute abdomen. Following the diagnosis of MIS-C with myocarditis, intravenous methylprednisolone (2 mg/Kg/day) and intravenous immunoglobulins (2 gr/Kg single infusion) were promptly started, leading to clinical improvement. According to our literature search, patients with MIS-C have a high rate of severe abdominal symptoms resembling surgical emergencies (appendicitis, obstruction, etc.) and a not negligible number of those patients have been surgically explored with variable findings. Conclusions We encourage pediatric surgeons in the upcoming months of COVID-19 pandemic to evaluate myocardial function prior to surgical abdominal exploration. In children with query acute abdomen, MIS-C should be promptly ruled out in order to avoid unnecessary surgeries that could worsen the already frail outcome of this new syndrome. Nevertheless, it should be considered that MIS-C might well encompass complications (e.g. appendicitis, segmental intestinal ischemia) which need swift surgical treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

Valitutti

Verde

Pepe

et al. 2021

Journal of Pediatric Surgery Case Reports

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“…Chest imaging features of MIS-C can mimic acute COVID-19 infection. Lima-Setta’s study reported that ground-glass opacities were observed in 31% of patients [ 17 ]. Whereas in our cohort, however, pulmonary involvement, including ground-glass opacities and local patchy shadowing, was rare.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcome of MIS-C patients: an experience from Central Anatolia

et al. 2021

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Background Multisystem inflammatory syndrome in children (MIS-C) is a new clinical condition characterized by signs of inflammation and multiorgan dysfunction due to cytokine storm associated with SARS-CoV-2. The clinical spectrum of MIS-C ranges from mild to severe, and even to mortal multisystem involvement. To guide clinicians, we evaluated detailed demographic characteristics, clinical features, laboratory findings, and outcomes of MIS-C cases. Methods We performed a retrospective study of patients with MIS-C who were managed in the Department of Pediatric Infectious Disease in the Selcuk University Faculty of Medicine, Konya, Turkey. MIS-C patients were divided into three clinical severity groups (mild, moderate, and severe) and separated into three age groups (< 5 years, 5–10 years, > 10 years). We compared the characteristics of MIS-C cases according to the severity of the disease and by age groups. Result Thirty-six children with MIS-C were evaluated (52.8% male, median age of 7.8 years). A clinical spectrum overlapping with Kawasaki disease (KD) was the most common presentation (69.4%) in all age groups. The most common clinical symptoms were fever (100%), mucocutaneous rash (69.4%), and gastrointestinal symptoms (66.6%). There was no statistically significant difference in echocardiographic abnormality between KD-like and the other clinical spectra ( p > 0.05). All life-threatening rhythm disturbances were observed in severe cases. No patients died. Conclusion It is important to increase the awareness of physicians about the MIS-C disease, which can present with different combinations of different systemic findings, so that patients can be diagnosed and treated in a timely manner. Key Points • A single tertiary centre study shows that children with MIS-C can present with different clinic spectra other than Kawasaki diseases . • Electrocardiographic and echocardiographic evaluation is important in early diagnosis of children with MIS-C. • Pro-BNP can be used as a screening test in the emergency room for children with prolonged and unexplained fever for determine early cardiac involvement of MIS-C. • The lack of require biological agents and favourable outcomes in children with MIS-C may be related with administration of steroid therapy with IVIG in early stage of disease.

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“…The laboratory findings also revealed significant elevation of cardiac and inflammatory markers, including Troponin, pro-Btype natriuretic peptide (proBNP), C-reactive protein (CRP), and erythrocyte sediment rate (ESR). Epidemiologic studies of MIS-C have suggested that younger children are more likely to present with KD-like features while older children are prone to develop myocarditis or myocardial dysfunction (20)(21)(22)(23)(24)(25)(26). Cardiovascular complications in the acute phase of KD were reported in 9.2% (10.2% of boys and 7.7% of girls) of patients in Japan's 25th national survey (27).…”

Section: Epidemiology Of Kdmentioning

confidence: 99%

An Update on Cardiovascular Risk Factors After Kawasaki Disease

Zeng

Zhang

et al. 2021

Front. Cardiovasc. Med.

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First described in Japan 50 years ago, Kawasaki disease is a worldwide multisystem disease. It is an acute self-limited vasculitis of unknown etiology that can lead to coronary artery lesions, such as dilatation, aneurysms, and stenosis in children. It is one of the common causes of acquired heart disease among children in developed countries. The coronary aneurysm is a severe complication in the acute stage, possibly leading to stenotic lesions or myocardial ischemia. More concerns have centered on endothelial damage and the early onset of atherosclerosis in patients with KD. Although the coronary artery aneurysm is small or degenerated, the vascular structure does not return to normal, vascular endothelial dysfunction and remodeling continue. Most patients diagnosed with coronary artery sequelae are at risk of long-term complications. There are still many unknown aspects regarding the long-term prognosis of patients. Concerns have centered on the early onset of atherosclerosis in patients with KD. There is still no consensus on the relationship between Kawasaki disease and atherosclerosis. This study aimed to evaluate if patients with a history of KD were at risk of accelerated atherosclerosis.

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Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study

Cited by 78 publications

References 28 publications

Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

Clinical features and outcome of MIS-C patients: an experience from Central Anatolia

An Update on Cardiovascular Risk Factors After Kawasaki Disease

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