Paediatric Inflammatory Multisystem Syndrome Temporally-Associated with SARS-CoV-2 Infection: An Overview

Carter, Michael J.; Shankar-Hari, Manu; Tibby, Shane M.

doi:10.1007/s00134-020-06273-2

Cited by 51 publications

(60 citation statements)

References 15 publications

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“…One plausible explanation for this is that antibody concentrations may have decayed to below the threshold of detection by the time testing was clinically available in our patients. 10 Alternatively, antibody specificity and concentrations are known to differ in children with PIMS-TS in comparison to adults with COVID-19, 11 explaining an incomplete seroprevalence in this PIMS-TS cohort. Seronegative patients with PIMS-TS were phenotypically similar to seropositive patients with PIMS-TS, presented in the period of the first surge of cases in the UK COVID-19 pandemic, and were negative by PCR and relevant serology to extensive virologic testing.…”

Section: Discussionmentioning

confidence: 97%

Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2

Mirza

Carter

et al. 2021

Neurol Neuroimmunol Neuroinflamm

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ObjectivePediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a severe immune-mediated disorder. We aim to report the neurologic features of children with PIMS-TS.MethodsWe identified children presenting to a large children's hospital with PIMS-TS from March to June 2020 and performed a retrospective medical note review, identifying clinical and investigative features alongside short-term outcome of children presenting with neurologic symptoms.ResultsSeventy-five patients with PIMS-TS were identified, 9 (12%) had neurologic involvement: altered conciseness (3), behavioral changes (3), focal neurology deficits (2), persistent headaches (2), hallucinations (2), excessive sleepiness (1), and new-onset focal seizures (1). Four patients had cranial images abnormalities. At 3-month follow-up, 1 child had died, 1 had hemiparesis, 3 had behavioral changes, and 4 completely recovered. Systemic inflammatory and prothrombotic markers were higher in patients with neurologic involvement (mean highest CRP 267 vs 202 mg/L, p = 0.05; procalcitonin 30.65 vs 13.11 μg/L, p = 0.04; fibrinogen 7.04 vs 6.17 g/L, p = 0.07; d-dimers 19.68 vs 7.35 mg/L, p = 0.005). Among patients with neurologic involvement, these markers were higher in those without full recovery at 3 months (ferritin 2284 vs 283 μg/L, p = 0.05; d-dimers 30.34 vs 6.37 mg/L, p = 0.04). Patients with and without neurologic involvement shared similar risk factors for PIMS-TS (Black, Asian and Minority Ethnic ethnicity 78% vs 70%, obese/overweight 56% vs 42%).ConclusionsBroad neurologic features were found in 12% patients with PIMS-TS. By 3-month follow-up, half of these surviving children had recovered fully without neurologic impairment. Significantly higher systemic inflammatory markers were identified in children with neurologic involvement and in those who had not recovered fully.

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Section: Discussionmentioning

confidence: 97%

Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2

Mirza

Carter

et al. 2021

Neurol Neuroimmunol Neuroinflamm

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“…Treatment includes IV immunoglobulin ( 12 ), high-dose IV corticosteroids, and control of hypercytokinemia. For the control of hypercytokinemia, the use of interleukin-1 (IL-1) ( 13 ) antagonist (anakinra) and interleukin 6 (IL-6) receptor antagonist (tocilizumab) ( 14 ) has been suggested. Recent studies in SARS-CoV-2 patients have shown that these antagonists do not improve mortality ( 15 – 19 ), and tocilizumab has been associated with an increased risk of nosocomial infections ( 20 ).…”

Section: Discussion/conclusionmentioning

confidence: 99%

Hemadsorption as a Treatment Option for Multisystem Inflammatory Syndrome in Children Associated With COVID-19. A Case Report

et al. 2021

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“…At present, professionals remain confronted with substantial uncertainties regarding clinical phenotypes, long-term outcomes, and optimal management ( 20 ). In the absence of randomized trials, evidence for best treatment is minimal for the diagnostic, anti-inflammatory, anti-infectious, and supportive measures which have been proposed ( 9 , 21 ). Recommendations therefore are based primarily on expert opinion and similar recommendations in the United Kingdom.…”

Section: Statement Of Uncertaintymentioning

confidence: 99%

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland

et al. 2021

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Background: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce.Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing.Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach >80% agreement for acceptance.Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation.Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged.

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Paediatric Inflammatory Multisystem Syndrome Temporally-Associated with SARS-CoV-2 Infection: An Overview

Cited by 51 publications

References 15 publications

Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2

Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2

Hemadsorption as a Treatment Option for Multisystem Inflammatory Syndrome in Children Associated With COVID-19. A Case Report

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland

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