Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: a New Challenge amid the Pandemic

Lawrensia, Sherly; Henrina, Joshua; Wijaya, Ellen; Suciadi, Leonardo Paskah; Saboe, Aninka; Cool, Charlotte Johanna

doi:10.1007/s42399-020-00602-8

Cited by 24 publications

(48 citation statements)

References 20 publications

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“…Published literature has pointed out different phenotypes of MIS-C patients including fever with inflammation, shock with MODS and myocarditis, and picture of classical KD [ 6 , 8 , 23 ]. Age younger than 1 year, high viral load and chronic comorbidities are risk factors for increased severity [ 24 ].…”

Section: Pathophysiology Of Mis-c and Link With Covid-19mentioning

confidence: 99%

“…A high proportion of patients with positive serology suggest antibody-dependent enhancement of acquired immune response to virus rather than direct viral replication has a major role. The role of a particular genetic locus [ 25 ] and some ethnic groups (e.g., Hispanic and African) has been associated with more severe disease [ 23 , 26 ]. Even though the exact pathophysiology of this new entity is not known, the evidence which has emerged from recent literature is summarised in Fig.…”

Section: Pathophysiology Of Mis-c and Link With Covid-19mentioning

confidence: 99%

“…Viral infection stimulates the neutrophils to form neutrophil extracellular traps (NETs) and trap the virus triggering uncontrolled inflammation and thrombosis with elevated d -dimer or fibrinogen as seen among severe COVID-19 and MIS-C patients [ 27 ]. Viral antigen expression on infected cells and formation of anti-spike IgG immune complexes also activate inflammation leading to acute respiratory distress syndrome and multiple organ failure [ 23 ].…”

Section: Pathophysiology Of Mis-c and Link With Covid-19mentioning

confidence: 99%

See 2 more Smart Citations

Emerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection: a Systematic Review with Meta-analysis

Sood

Sharma

Sood

et al. 2021

SN Compr. Clin. Med.

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With the increased spread of severe acute respiratory syndrome coronavirus 2 infection, more patients with multisystem inflammatory syndrome in children (MIS-C) are being reported worldwide. This systematic review with meta-analysis aims to analyse the clinical features, proposed pathogenesis and current treatment options for effective management of children with this novel entity. Electronic databases (Medline, Google Scholar, WHO, CDC, UK National Health Service, LitCovid, and other databases with unpublished preprints) were extensively searched, and all articles on MIS-C published from January 1, 2020, to October 10, 2020, were retrieved. English language studies were included. This systematic review analysed 17 studies with 992 MIS-C patients from low-income and middle-income countries (LMICs) and developed countries (France, the UK, Italy, Spain, Chile and the US CDC data). Fever (95%) was the most common clinical manifestation followed by gastrointestinal (78%), cardiovascular (75.5%), and respiratory system (55.3%) involvement. Laboratory or epidemiologic evidence of inflammation and SARS-CoV-2 infection was present. Though the exact pathogenesis remains elusive, virus-induced post-infective immune dysregulation appears to play a predominant role. Features resembling Kawasaki disease, toxic shock syndrome or macrophage activation syndrome were present; 49% had shock; 32% had myocarditis; 18% had coronary vessel abnormalities and 9% had congestive cardiac failure. Sixty-three percent of the patients were admitted in paediatric intensive care unit (PICU); 63% received intravenous immunoglobulin, 58% received corticosteroids and 19% received alternate agents like tocilizumab; there were 22 (2.2%) deaths. Only 9/144 children in LMICs received tocilizumab that was significantly less than children in developed countries (p < 0.0001). This systematic review delineates and summarises recently published data on MIS-C from LMICs and developed countries. Although most needed PICU admission and received treatment with IVIG and steroids, most of the patients survived. Significantly fewer patients in developing countries received tocilizumab therapy than those in developed countries. It is crucial for clinician to recognise MIS-C, to differentiate it from other defined inflammatory conditions and initiate early treatment. Further studies are needed for long-term prognosis, especially relating to cardiac complications of MIS-C. Keywords COVID-19. Hemophagocytic lympho-histiocytosis. Kawasaki disease. SARS-CoV-2. Macrophage activation syndrome. Multisystem inflammatory syndrome in children (MIS-C). Toxic shock syndrome This article is part of the Topical Collection on Covid-19

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Section: Pathophysiology Of Mis-c and Link With Covid-19mentioning

confidence: 99%

Section: Pathophysiology Of Mis-c and Link With Covid-19mentioning

confidence: 99%

Section: Pathophysiology Of Mis-c and Link With Covid-19mentioning

confidence: 99%

See 1 more Smart Citation

Emerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection: a Systematic Review with Meta-analysis

Sood

Sharma

Sood

et al. 2021

SN Compr. Clin. Med.

View full text Add to dashboard Cite

show abstract

“…Disease progression with onset of respiratory failure requiring mechanical ventilation, signs of shock or multi-organ failure. This would appear to be a post-immunological reaction caused by non-neutralizing IgG antibody and worsened by a cytokine storm that causes generalized inflammation that resembles an atypical Kawasaki's disease or a toxic shock syndrome (29).…”

Section: Criticalmentioning

confidence: 99%

COVID-19 Pneumonia in Children: From Etiology to Management

et al. 2020

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COVID-19 is less serious in children than in adults. However, respiratory management dominates the clinical picture of hospitalized COVID-19 even in children. In some case series, deterioration of the clinical picture wherein dyspnea, cyanosis, and the onset of acute respiratory distress syndrome (ARDS) emerged ~8–10 days after the onset of SARS-CoV-2 infection, which could rapidly progress to multiple organ failure and death. This review aimed to evaluate the characteristics of COVID-19 pneumonia in pediatric populations, beginning from its etiology and pathological mechanisms and closing with its clinical management.

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“…Also, another group of 8 children with Kawasaki disease was reported in May 2020 in London, 7 of which were demonstrated to be infected by SARS-COV-2 (60). This condition has been named pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) (61). In recent studies on the Kawasaki disease, a significant increase in IL-17 and TH17 proportions is reported in patients, and the TH17 proportions have been demonstrated to be significantly up-regulated in immunoglobulin-resistant patients (62,63).…”

Section: Cluementioning

confidence: 99%