Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City

Cheung, Eva W.; Zachariah, Philip; Gorelik, Mark; Boneparth, Alexis; Kernie, Steven G.; Orange, Jordan S.; Milner, Joshua D.

doi:10.1001/jama.2020.10374

Cited by 540 publications

(850 citation statements)

References 6 publications

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“…The median age of children was 7 years (range between 10 months and 17 years). Similar to previous reports, patients with MIS-C tend to be older than 5 years old [3,5,6,10,17,26] and it is in contrast to the epidemiology of Kawasaki disease that approximately 80% of cases occurring in children <5 years of age [4]. Median time from the onset of symptoms prior to hospitalisation was 5 days that was similar to previous reports [15,26].…”

Section: Discussionsupporting

confidence: 89%

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Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

et al. 2020

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During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has a similar clinical presentation to Kawasaki disease, toxic shock syndrome and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the three paediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom and Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between 7 March and 23 June 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) with median duration of symptoms prior to presentation of 5 (interquartile range (IQR) 3, 7) days. Fifty-three percent of children showed lymphopaenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (>500 ng/ml) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dl, D-dimer was 3909 (IQR 848, 4528) ng/ml and troponin was 0.6 (IQR 0.1, 26) ng/ml, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatraemia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis and pericardial effusions were found in 18%, 11%, 4% and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalised children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin and albumin; and multi-organ involvement.

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Section: Discussionsupporting

confidence: 89%

“…Gastrointestinal signs and symptoms appear predominantly as presenting features of MIS-C [12,15,17,26]. Mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) were the other prevalent findings that were similar to the report of Whittaker et al in the UK [13].…”

Section: Discussionsupporting

confidence: 80%

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

et al. 2020

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“…The original studies 5,39,[56][57][58][59][60][61][62][63][64] on the laboratory findings on children with MIS during the COVID-19 pandemic are shown in Table 2.…”

Section: Mis In Children With Covid-19mentioning

confidence: 99%

Hematological manifestations of SARS‐CoV‐2 in children

Kosmeri

Koumpis

Tsabouri

et al. 2020

Pediatric Blood & Cancer

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Infection from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), though mainly a respiratory disease, can impair many systems, including causing hematological complications. Lymphopenia and hypercoagulability have been reported in adults with coronavirus disease 2019 (COVID-19) and are considered markers of poor prognosis. This review summarizes the hematological findings in children with SARS-CoV-2 infection. The majority of infected children had a normal leukocyte count, while the most common white blood cell abnormality was leukopenia. Lymphopenia, which may be a marker of severe disease, was rarer in children than in adults, possibly due to their immature immune system or due to the less severe manifestation of COVID-19 in this age group. Age may have an impact, and in neonates and infants the most common abnormality was lymphocytosis. Abnormalities of red blood cells and platelets were uncommon. Anemia and hypercoagulability were reported mainly in children presenting the novel multisystem inflammatory syndrome (MIS) associated with SARS-CoV-2.

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“…As a betacoronavirus, SARS-CoV-2 is related to two other highly pathogenic respiratory viruses, SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). SARS-CoV-2 infection results in a clinical syndrome, Coronavirus Disease 2019 that can progress to respiratory failure (Guan et al, 2020) and also present with cardiac pathology, gastrointestinal disease, coagulopathy, and a hyperinflammatory syndrome (Cheung et al, 2020;Mao et al, 2020;Wichmann et al, 2020). The elderly, immunocompromised, and those with co-morbidities (e.g., obesity, diabetes, and hypertension) are at greatest risk of death from COVID-19 (Zhou et al, 2020a).…”

Section: Introductionmentioning

confidence: 99%

A single intranasal dose of chimpanzee adenovirus-vectored vaccine confers sterilizing immunity against SARS-CoV-2 infection

Hassan

Kafai

Dmitriev

et al. 2020

Preprint

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SUMMARYThe Coronavirus Disease 2019 pandemic has made deployment of an effective vaccine a global health priority. We evaluated the protective activity of a chimpanzee adenovirus-vectored vaccine encoding a pre-fusion stabilized spike protein (ChAd-SARS-CoV-2-S) in challenge studies with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and mice expressing the human angiotensin-converting enzyme 2 receptor. Intramuscular dosing of ChAd-SARS-CoV-2-S induces robust systemic humoral and cell-mediated immune responses and protects against lung infection, inflammation, and pathology but does not confer sterilizing immunity, as evidenced by detection of viral RNA and induction of anti-nucleoprotein antibodies after SARS-CoV-2 challenge. In contrast, a single intranasal dose of ChAd-SARS-CoV-2-S induces high levels of systemic and mucosal IgA and T cell responses, completely prevents SARS-CoV-2 infection in the upper and lower respiratory tracts, and likely confers sterilizing immunity in most animals. Intranasal administration of ChAd-SARS-CoV-2-S is a candidate for preventing SARS-CoV-2 infection and transmission, and curtailing pandemic spread.

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Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City

Abstract: Severe coronavirus disease 2019 (COVID-19) has been reported rarely in children. 1,2 International data suggest the development of a proinflammatory syndrome with features of Kawasaki disease (KD) or toxic shock syndrome (TSS) in children, possibly related to COVID-19.

Cited by 540 publications

References 6 publications

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

Hematological manifestations of SARS‐CoV‐2 in children

A single intranasal dose of chimpanzee adenovirus-vectored vaccine confers sterilizing immunity against SARS-CoV-2 infection

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