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Rheumatology (Oxford) ; 60(10): 4530-4537, 2021 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33493353

RESUMEN

OBJECTIVE: To better define the clinical distinctions between the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related paediatric inflammatory multisystem syndrome (PIMS) and Kawasaki disease (KD). METHODS: We compared three groups of patients: group 1, cases from our national historic KD database (KD-HIS), before the SARS-CoV-2 pandemic; group 2, patients with KD admitted to an intensive care unit (KD-ICU) from both our original cohort and the literature, before the SARS-CoV-2 pandemic; and group 3, patients with PIMS from the literature. RESULTS: KD-HIS included 425 patients [male:female ratio 1.3, mean age 2.8 years (s.d. 2.4)], KD-ICU 176 patients [male:female ratio 1.3, mean age 3.5 years (s.d. 3.1)] and PIMS 404 patients [male:female ratio 1.4, mean age 8.8 years (s.d. 3.7)]. As compared with KD-HIS patients, KD-ICU and PIMS patients had a higher proportion of cardiac failure, digestive and neurological signs. KD-ICU and PIMS patients also had a lower frequency of typical KD-mucocutaneous signs, lower platelet count, higher CRP and lower sodium level. As compared with KD-HIS and KD-ICU patients, PIMS patients were older and more frequently had myocarditis; they also had fewer coronary abnormalities and lower sodium levels. Unresponsiveness to IVIG was more frequent in KD-ICU than KD-HIS and PIMS patients. CONCLUSION: On clinical grounds, KD-HIS, KD-ICU and PIMS might belong to a common spectrum of non-specific pathogen-triggered hyperinflammatory states. The causes of increasing inflammation severity within the three entities and the different effects on the heart remain to be determined.


Asunto(s)
COVID-19/fisiopatología , Enfermedad Coronaria/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Síndrome Mucocutáneo Linfonodular/fisiopatología , Miocarditis/fisiopatología , Derrame Pericárdico/fisiopatología , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/fisiopatología , Adolescente , Aspirina/uso terapéutico , Proteína C-Reactiva/metabolismo , COVID-19/sangre , COVID-19/terapia , Estudios de Casos y Controles , Niño , Preescolar , Enfermedades del Sistema Digestivo/fisiopatología , Femenino , Francia , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Masculino , Síndrome Mucocutáneo Linfonodular/sangre , Síndrome Mucocutáneo Linfonodular/terapia , Miocarditis/sangre , Enfermedades del Sistema Nervioso/fisiopatología , Fenotipo , Inhibidores de Agregación Plaquetaria/uso terapéutico , Recuento de Plaquetas , Sodio/sangre , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Síndrome de Respuesta Inflamatoria Sistémica/terapia
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