Review and future directions for PIMS-TS (MIS-C)

Roarty, Cathal; Waterfield, Thomas

doi:10.1136/archdischild-2021-323143

Cited by 17 publications

(13 citation statements)

References 18 publications

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“…The male-to-female ratio among PIMS-all and KD cases was comparable, with a higher number of male cases (1.8:1 vs. 1.7:1; Table 1 ). This also has been reported in other cohorts from other countries 7 – 11 , 16 , 18 . In our cohort, only one in four PIMS cases and one in five KD cases had a concomitant disease.…”

Section: Discussionsupporting

confidence: 88%

“…Most of the CAAs have resolved within six months following the acute PIMS phase 28,29 . However, fatigue and exercise intolerance were reported among up to 50% of PIMS cases upon six-month-follow-up 18,29 . This suggests that a structured follow-up is particularly warranted for PIMS and KD patients.…”

Section: Discussionmentioning

confidence: 99%

“…1). This pattern is well-known in PIMS and typically occurs two to eight weeks following a COVID-19 surge 12,[17][18][19] . Beginning in May 2021, the reporting of KD cases to our registry decreased; reporting of KD cases has continued to remain low since then, although the reason for this lower-level reporting is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease

Hufnagel

Doenhardt²,

Diffloth³

et al. 2023

Sci Rep

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The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4–11] vs. 3 [IQR 1–4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae—mainly cardiovascular—were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease

Hufnagel

Doenhardt²,

Diffloth³

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Our understanding of the pathogenesis of this syndrome is evolving but remains limited. Whereas genetic predisposition to developing severe MIS-C has been demonstrated ( 19 ), the true triggers for the severe inflammatory response seen in otherwise healthy individuals with MIS-C and characterized by increased plasma cytokine levels including IL-6, IL-8, IFNγ, IL-17, TNFα, and IL-10 and the multilineage immune cell activation remain unknown ( 20 – 24 ). A specific immunopathologic signature and association with HLA alleles were identified recently that may pave the way for the development of more specific biomarkers ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…The dynamic nature of this syndrome presents a further challenge to the physician. In the literature, several cases were reported to present with incomplete criteria initially but to later develop typical findings including cardiac involvement ( 16 , 19 ). This has led us to hospitalize patients when the diagnosis of MIS-C was highly suspected, to provide close monitoring and rapid intervention when needed.…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

et al. 2023

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IntroductionReports of multisystem inflammatory syndrome in children (MIS-C), following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, have been increasing worldwide, with an incidence varying significantly across studies based on the definition used for the diagnosis. At our tertiary medical center in Lebanon, we encountered several cases that presented a diagnostic challenge because they mimicked MIS-C but did not meet the US Centers for Disease Control and Prevention (CDC) definition. We decided to review these cases and describe their features in comparison with cases that met the CDC criteria of MIS-C and those that had an alternative diagnosis.MethodsThis is a retrospective chart review of subjects aged <19 years old admitted to the American University of Beirut Medical Center (AUBMC) between March 1, 2020, and May 31, 2021, with suspected or confirmed MIS-C, following documented COVID-19 infection, with sufficient or insufficient criteria for diagnosis. Subjects were classified into 3 groups: “MIS-C”, “Near MIS-C” and “Alternative Diagnosis”.ResultsA total number of 29 subjects were included in our cohort. Fever was present in all subjects. In the MIS-C group, evidence for cardiovascular system involvement was the most common feature followed by the mucocutaneous and gastrointestinal systems. In the “Near MIS-C” and “Alternative Diagnosis” group, gastrointestinal symptoms were the most common with only one patient with cardiac abnormalities and none with coagulopathy. Subjects with typical MIS-C presentation had higher inflammatory markers when compared to subjects in the other groups. Almost all the subjects had positive IgG for SARS-CoV-2. Of the 29 subjects, the Royal College of Paediatrics and Child Health (RCPCH) case definition would have identified all suspected cases without an alternative diagnosis as MIS-C, whereas the World Health Organization (WHO) and the CDC definitions would have excluded 6 and 10 subjects, respectively.ConclusionMIS-C presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria. Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions.

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SARS-CoV-2 associated disease burden in children and adolescents

Elling

2023

Monatsschr Kinderheilkd

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Review and future directions for PIMS-TS (MIS-C)

Cited by 17 publications

References 18 publications

A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease

A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

SARS-CoV-2 associated disease burden in children and adolescents

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