Syndrome resembling Kawasaki disease in COVID-19 asymptomatic children

Rehman, Suriya; Majeed, Tariq; Ansari, Mohammad Azam; Al-Suhaimi, Ebtesam A.

doi:10.1016/j.jiph.2020.08.003

Cited by 33 publications

(25 citation statements)

References 13 publications

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“…Predominantly in children and recently found few cases in adults, the SARS-COV-2 has resulted in a hyperinflammatory state called multisystem inflammatory syndrome (MIS), which was later divided into MIS in Children (MIS-C) and MIS in adults (MIS-A). The disease resembled acute rheumatic fever, toxic shock syndrome and Kawasaki disease that was misdiagnosed in the beginning (169)(170)(171); however, later, it was found to be a post-infectious state of the SARS-COV-2 primarily following 4-6 weeks after infection. In general, the syndrome may present with a combination of fever, abdominal pain, dermatologic manifestations, diarrhea, nausea, and organ failure (170).…”

Section: -H) Pediatric Long Covidmentioning

confidence: 99%

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

Akbarialiabad¹,

Taghrir²,

Abdollahi³

et al. 2021

Preprint

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Introduction: Despite more than one year passed since the first cases of SARS-CoV-2 were reported, there is still no consensus on the definition and clinical management of post-acute-COVID-19. The condition has heterogeneously been named as Chronic COVID syndrome, Post COVID-19 Syndrome, post-acute sequela of SARS-CoV-2 (PASC), and the more familiar long COVID. Method: In order to capture all relevant published studies, we undertook a multi-step search with no language restriction. The following four-step search strategy was utilized: First, a preliminary (limited) search was conducted on January 20, 2021, in Google Scholar and PubMed to identify the appropriate keywords. Then, on January 30, 2021, we adopted a search strategy of electronic databases from Cochrane Library, PsycINFO, PubMed, Embase, Scopus, and Web of sciences, using those keywords. Then, after duplicate removal, we screened all titles, abstracts, and full texts. This resulted in 66 eligible studies. Subsequently, after a forward and backward search of their references and citations an additional 54 publications were found, resulting in a total of 120 publications that formed the basis of the present analysis. The titles, abstracts, and full-texts of non-English articles were translated using Google Translate for further evaluation. We conducted our scoping review based on the PRISMA-ScR Checklist.Results: We found only one randomized clinical trial in our search. Of the 67 original studies, 22 were cohort and 28 were cross-sectional studies totaling 74.6% of the original studies. Of the total of 120 publications, 59 (49.1%) focused on signs and symptoms, 28 (23.3%) were focused on management, and 13 (10.8%) focused on pathophysiology. Ten (9%) publications focused on imaging studies. Ninety-one percent of the original investigations came from high and upper-middle-income countries, highlighting the scarcity of reports originating from low-income and lower-middle-income countries.Conclusion: The predominant symptoms among those with the so-called “Long COVID” were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness. The ambiguity and controversies in its definition have impaired proper recognition and management of those requiring additional support following the resolution of the acute phase of this infection. This has resulted in long-standing distress for the patients and their families. Our findings highlight the need for a multidisciplinary approach, support, and rehabilitation for these patients in terms of long-term mental and physical health.

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Section: -H) Pediatric Long Covidmentioning

confidence: 99%

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

Akbarialiabad¹,

Taghrir²,

Abdollahi³

et al. 2021

Preprint

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“…This is supported by the association of SARS-CoV-2 infection with cardiac complications and long-term follow-up studies of SARS-CoV-1 [39] and pneumonia [40] suggesting increased CVD risk. Interestingly, children infected with SARS-CoV-2 have been reported to have a syndrome resembling Kawasaki disease [50], which has subsequently been named as multisystem inflammatory syndrome in children (MIS-C) and has been reviewed in detail elsewhere [51][52][53][54][55]. Briefly, MIS-C often develops 4-6 weeks after SARS-CoV-2 infection and exhibits multisystem involvement with clinical features, including fever, a hyperinflammatory state, cutaneous manifestations, abdominal pain, diarrhea, vomiting, and organ dysfunction [52].…”

Section: Cardiovascular Manifestationsmentioning

confidence: 99%

COVID-19: from an acute to chronic disease? Potential long-term health consequences

Higgins

Sohaei

Diamandis

et al. 2020

Critical Reviews in Clinical Laboratory Sciences

315

206

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Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite pulmonary impairments being the most prevalent, extra-pulmonary manifestations of COVID-19 are abundant. Confirmed COVID-19 cases have now surpassed 57.8 million worldwide as of 22 November 2020. With estimated case fatality rates (number of deaths from COVID-19 divided by number of confirmed COVID-19 cases) varying between 1 and 7%, there will be a large population of recovered COVID-19 patients that may acquire a multitude of long-term health consequences. While the multi-organ manifestations of COVID-19 are now welldocumented, the potential long-term implications of these manifestations remain to be uncovered. In this review, we turn to previous similar coronaviruses (i.e. SARS-CoV-1 and Middle East respiratory syndrome coronavirus [MERS-CoV]) in combination with known health implications of SARS-CoV-2 infection to predict potential long-term effects of COVID-19, including pulmonary, cardiovascular, hematologic, renal, central nervous system, gastrointestinal, and psychosocial manifestations, in addition to the well-known post-intensive care syndrome. It is necessary to monitor COVID-19 patients after discharge to understand the breadth and severity of long-term effects. This can be accomplished by repurposing or initiating large cohort studies to not only focus on the long-term consequences of SARS-CoV-2 infection, but also on acquired immune function as well as ethno-racial group and household income disparities in COVID-19 cases and hospitalizations. The future for COVID-19 survivors remains uncertain, and if this virus circulates among us for years to come, long-term effects may accumulate exponentially.

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“… 35 Additionally, a delayed-onset inflammatory vasculitis with features akin to Kawasaki shock syndrome has been reported in children whose primary disease was asymptomatic or minimally symptomatic. 36 37 Much remains unknown about the mechanisms responsible for the dramatic variations in disease presentation and long-term sequalae. However, since the first reported cases emerged in 2019, the infectious disease and immunology communities have gained some insight into correlates of severe disease and mortality.…”

Section: Clinical Course and Inflammatory Pathology Of Sars-cov-2 Infmentioning

confidence: 99%

IL-6 modulation for COVID-19: the right patients at the right time?

Ascierto

Wei

2021

J Immunother Cancer

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The ongoing pandemic caused by the novel coronavirus SARS-CoV-2 has disrupted the global economy and strained healthcare systems to their limits. After the virus first emerged in late 2019, the first intervention that demonstrated significant reductions in mortality for severe COVID-19 in large-scale trials was corticosteroids. Additional options that may reduce the burden on the healthcare system by reducing the number of patients requiring intensive care unit support are desperately needed, yet no therapy has conclusively established benefit in randomized studies for the management of moderate or mild cases of disease. Severe COVID-19 disease is characterized by a respiratory distress syndrome accompanied by elevated levels of several systemic cytokines, in a profile that shares several features with known inflammatory pathologies such as hemophagocytic lymphohistiocytosis and cytokine release syndrome secondary to chimeric antigen receptor (CAR) T cell therapy. Based on these observations, modulation of inflammatory cytokines, particularly interleukin (IL)-6, was proposed as a strategy to mitigate severe disease. Despite encouraging recoveries with anti-IL-6 agents, especially tocilizumab from single-arm studies, early randomized trials returned mixed results in terms of clinical benefit with these interventions. Later, larger trials such as RECOVERY and REMAP-CAP, however, are establishing anti-IL-6 in combination with steroids as a potential option for hypoxic patients with evidence of hyperinflammation. We propose that a positive feedback loop primarily mediated by macrophages and monocytes initiates the inflammatory cascade in severe COVID-19, and thus optimal benefit with anti-IL-6 therapies may require intervention during a finite window of opportunity at the outset of hyperinflammation but before fulminant disease causes irreversible tissue damage—as defined clinically by C reactive protein levels higher than 75 mg/L.

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Syndrome resembling Kawasaki disease in COVID-19 asymptomatic children

Cited by 33 publications

References 13 publications

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

COVID-19: from an acute to chronic disease? Potential long-term health consequences

IL-6 modulation for COVID-19: the right patients at the right time?

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