Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children

Rowley, Anne H.

doi:10.1038/s41577-020-0367-5

Cited by 327 publications

(398 citation statements)

References 10 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%

“…MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have some similar clinical features to Kawasaki, including fever, dilation of conjunctival blood vessels, rash and redness of the oropharynx [4]. However, MIS-C affects older children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Some clinical features of MIS-C overlap KD symptoms, including fever, dilation of conjunctival blood vessels, rash, and redness of the oropharynx. 74 , 75 While patients can simultaneously meet both MIS-C and KD diagnosis criteria (OCS2), clinical and epidemiological features distinguish both diseases.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, MIS-C laboratory findings include leukopenia and extremely elevated levels of ventricular natriuretic peptide, while these alterations are not found in KD’s patients. 74 Coronary aneurysms are a typical finding of KD, while reports of this presentation are rare in MIS-C. 69 , 74 Previousl epidemiological reports suggest that the mean age of children with KD is 2 years, with few reports beyond late childhood, while MIS-C can affect older children and adolescents. 69 Data implies that Asian children are more prone to have KD, and African children are more susceptible to MIS-C. 62 , 63 , 74 …”

Section: Resultsmentioning

confidence: 99%

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Pousa¹,

Mendonça²,

Oliveira³

et al. 2021

Jornal de Pediatria

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Objective The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children. Source of data An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as “Novel coronavirus” or “Novel coronavirus 2019” or “2019 nCoV” or “COVID-19” or “SARS-CoV-2” were searched on PubMed database, associated either with age filters or generic pediatric terms. Summary of findings A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non-pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki-like disease were also described. Conclusions Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease.

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“…Another anomaly, published in The Journal of the American Medical Associations most recent report: “Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City”, suggests that MIS-C cases seem to lack elevated tumor necrosis factor-alpha (TNF-α) and interleukin-13 (IL-13), normally found in acute pulmonary COVID-19 infections [ 5 ]. Further associations are likely still yet to be discovered as this pandemic progresses; however, the finding of leukopenia also seems to be prevalent [ 18 ]. And in our case, white blood cell (WBC) values were within normal limits, while other inflammatory markers including LDH and CRP protein were significantly elevated.…”

Section: Discussionmentioning

confidence: 99%

A Case of Multisystem Inflammatory Syndrome in Children Mimicking Acute Appendicitis in a COVID-19 Pandemic Area

Jackson¹,

Chavarria²,

Hacking³

2020

Cureus

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The outbreak of the novel coronavirus (2019-nCoV) began in Wuhan, China and spread rapidly throughout the world. As of now, there have been numerous reports demonstrating clinical, radiological and pathological findings in adults. In children, the disease has essentially been seen as mild and self-limiting. However, more recently, children have been presenting with findings reminiscent of Kawasaki’s disease. And secondary to this, the benign nature of COVID-19 disease in children is beginning to be challenged. This phenomenon is now referred to as multisystem inflammatory syndrome in children (MIS-C). Further understanding the clinical course in MIS-C and its temporal association with coronavirus disease 2019 will be paramount for treatment and public health decision making. This correspondence describes a case of MIS-C with gastrointestinal manifestations mimicking acute appendicitis in a child presenting from a COVID-19 endemic area.

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Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children

Cited by 327 publications

References 10 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

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

A Case of Multisystem Inflammatory Syndrome in Children Mimicking Acute Appendicitis in a COVID-19 Pandemic Area

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