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1.
Med Sci Monit ; 27: e933369, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34075014

RESUMO

In early 2020, at the beginning of the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare cases were reported in children and adolescents of multisystem inflammatory syndrome in children (MIS-C). MIS-C is characterized by fever, systemic inflammation, and multiorgan dysfunction and usually presents late in SARS-CoV-2 infection. Since May 2020, the Centers for Disease Control and Prevention (CDC) has recorded all reported cases of COVID-19 and MIS-C in children and adolescents in the USA. In April 2021, the American College of Rheumatology (ACR) revised its clinical guidelines for diagnosing and managing hyperinflammation and MIS-C. There are several challenges ahead for preventing, diagnosing, and managing MIS-C, particularly following the rapid emergence of new strains of SARS-CoV-2. This Editorial aims to present an update on the current status of the clinical presentation, diagnosis, and management of MIS-C and includes some updates from population studies and clinical guidelines.


Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Adolescente , Teste para COVID-19 , Criança , Gerenciamento Clínico , Humanos , SARS-CoV-2/isolamento & purificação
2.
Ital J Pediatr ; 47(1): 120, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078429

RESUMO

BACKGROUND: Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. CASE PRESENTATION: We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. CONCLUSION: Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.


Assuntos
COVID-19/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Biomarcadores/sangue , COVID-19/terapia , Criança , Evolução Fatal , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica , Síndrome de Resposta Inflamatória Sistêmica/terapia
3.
BMJ Open ; 11(6): e041024, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135028

RESUMO

OBJECTIVE: To compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis. DESIGN: A prospective cross-sectional multicentre study. SETTING: Two EDs at two European clinical teaching hospitals in the Netherlands. PARTICIPANTS: 760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included. METHODS: SIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA-, not treated according to protocol (reference group); (2) SIRS+, qSOFA-, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS-, qSOFA+, not treated according to protocol; (5) SIRS-, qSOFA+, treated according to protocol. PRIMARY AND SECONDARY OUTCOME MEASURES: To prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission. RESULTS: 98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% (95% CI 37.4% to 45.2%) and 48.1% (95% CI 37.4% to 58.9%), respectively. HRs were 0.79 (95% CI 0.40 to 1.56, p=0.500), 3.42 (95% CI 1.82 to 6.44, p<0.001), 18.94 (95% CI 2.48 to 144.89, p=0.005) and 4.97 (95% CI 1.44 to 17.16, p=0.011) for groups 2-5, respectively. CONCLUSION: qSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study shows that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED. TRIAL REGISTRATION NUMBER: NL8315.


Assuntos
Escores de Disfunção Orgânica , Sepse , Estudos Transversais , Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Humanos , Países Baixos/epidemiologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
5.
Clin Dermatol ; 39(1): 163-168, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33972046

RESUMO

As of May 2020, an emerging immune-mediated syndrome mainly affecting children has been detected primarily in Europe and the United States. The incidence of this syndrome appears to mirror the initial infectious assault, with a delay of several weeks. This syndrome has been termed "multisystem inflammatory syndrome in children" (MIS-C) and is observed in association with the coronavirus disease 2019 (COVID-19). The phenotypes of presentation include several characteristic features, including prolonged fever, skin eruption, neck stiffness, and gastrointestinal manifestations with pronounced abdominal pain. Shock and organ dysfunction on presentation are frequent but inconsistent, whereas respiratory distress is typically and notably absent. We have reviewed recently published data aiming to better understand MIS-C, with a focus on its mucocutaneous manifestations.


Assuntos
COVID-19/complicações , COVID-19/diagnóstico , Dermatopatias/virologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , Criança , Pré-Escolar , Conjuntivite Viral/virologia , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido , Doenças da Boca/virologia , Mucosa Bucal , Síndrome de Linfonodos Mucocutâneos/diagnóstico , SARS-CoV-2
6.
Circ J ; 85(6): 948-952, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-33980782

RESUMO

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare syndrome temporally related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares similarities with Kawasaki disease, but left ventricular dysfunction is more common in MIS-C.Methods and Results:This study reports the case of a 16-year-old Japanese male patient with MIS-C. Although the initial presentation was severe with circulatory and respiratory failure, the patient recovered completely. Endomyocardial biopsy showed active myocarditis with fibrosis. Immunoglobulin treatment was useful for recovery. CONCLUSIONS: This is the first reported case of MIS-C in Japan. Cardiologists should be aware of MIS-C, a new disease, occurring during the global SARS-CoV-2 pandemic.


Assuntos
COVID-19/imunologia , Insuficiência Cardíaca/imunologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Doença Aguda , Adolescente , COVID-19/diagnóstico , COVID-19/terapia , Diagnóstico Diferencial , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Masculino , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Resultado do Tratamento
7.
Pan Afr Med J ; 38: 174, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995781

RESUMO

Since late April 2020, a syndrome now termed Multisystem Inflammatory Syndrome in Children (MIS-C) has been seen in children and adolescents in association with COVID-19 infection. The definition of MIS-C involves fever, organ dysfunction and laboratory confirmation of inflammation in the context of laboratory or epidemiological evidence of SARS-CoV-2 infection in a patient under 21 years of age. Notably, cases are now being identified in adults termed Multisystem Inflammatory syndrome in Adults (MIS-A). Few cases have been reported in sub-Saharan Africa. We report a case of a young African male presenting with a maculopapular rash, persistent fever, elevation in inflammatory markers and a sudden, significant deterioration in cardiac function resulting in cardiogenic shock. The patient responded to intravenous steroids, intravenous immunoglobulin and background inotropic support. The recognition of this disease entity proves even more crucial now amidst the ongoing global wave of COVID-19 infection. It is paramount to identify these patients early, leading to prompt treatment avoiding further morbidity and mortality.


Assuntos
COVID-19/diagnóstico , Choque Cardiogênico/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , África ao Sul do Saara , COVID-19/fisiopatologia , COVID-19/terapia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Masculino , Choque Cardiogênico/virologia , Esteroides/administração & dosagem , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/terapia
8.
Am J Nurs ; 121(5): 26-37, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33872261

RESUMO

ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic has impacted the health of children worldwide. Although overall mortality from COVID-19 in children remains low, an associated multisystem inflammatory disorder has emerged. The disorder has been recognized and named multisystem inflammatory syndrome in children (MIS-C) by the World Health Organization and the Centers for Disease Control and Prevention. This comprehensive review describes the epidemiology, pathophysiology, signs and symptoms, other potential diagnoses, and treatments relevant to MIS-C. The review also includes patient and family education and anticipatory guidance, and discusses nursing implications for nurses working in various roles and settings, including direct care, research, and public health.


Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , COVID-19/enfermagem , Criança , Proteção da Criança/estatística & dados numéricos , Humanos , Síndrome de Resposta Inflamatória Sistêmica/enfermagem
9.
Pediatr Infect Dis J ; 40(7): 601-605, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33872279

RESUMO

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been identified in infants <12 months old. Clinical characteristics and follow-up data of MIS-C in infants have not been well described. We sought to describe the clinical course, laboratory findings, therapeutics and outcomes among infants diagnosed with MIS-C. METHODS: Infants of age <12 months with MIS-C were identified by reports to the CDC's MIS-C national surveillance system. Data were obtained on clinical signs and symptoms, complications, treatment, laboratory and imaging findings, and diagnostic SARS-CoV-2 testing. Jurisdictions that reported 2 or more infants were approached to participate in evaluation of outcomes of MIS-C. RESULTS: Eighty-five infants with MIS-C were identified and 83 (97.6%) tested positive for SARS-CoV-2 infection; median age was 7.7 months. Rash (62.4%), diarrhea (55.3%) and vomiting (55.3%) were the most common signs and symptoms reported. Other clinical findings included hypotension (21.2%), pneumonia (21.2%) and coronary artery dilatation or aneurysm (13.9%). Laboratory abnormalities included elevated C-reactive protein, ferritin, d-dimer and fibrinogen. Twenty-three infants had follow-up data; 3 of the 14 patients who received a follow-up echocardiogram had cardiac abnormalities during or after hospitalization. Nine infants had elevated inflammatory markers up to 98 days postdischarge. One infant (1.2%) died after experiencing multisystem organ failure secondary to MIS-C. CONCLUSIONS: Infants appear to have a milder course of MIS-C than older children with resolution of their illness after hospital discharge. The full clinical picture of MIS-C across the pediatric age spectrum is evolving.


Assuntos
COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Teste para COVID-19/estatística & dados numéricos , Monitoramento Epidemiológico , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Estados Unidos/epidemiologia
10.
Medwave ; 21(2): e8142, 2021 03 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33905406

RESUMO

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 is a potentially severe and rare condition that still needs a better understanding to guide its management. Reports worldwide, and especially in Latin America, are still scarce. This report presents ten cases of pediatric inflammatory multisystem syndrome temporally associated with COVID-19 in children between 2 and 12 years old treated in a Peruvian hospital, diagnosed using the Centers for Disease Control and Prevention criteria. Severe acute respiratory syndrome coronavirus 2 was detected through serological tests (immunoglobulin M or G). Most had gastrointestinal symptoms. Therapeutics consisted mainly of intravenous immunoglobulin, corticosteroids, ivermectin, hydroxychloroquine, digoxin, and antibiotic therapy. Three patients underwent mechanical ventilation; no mortality occurred in this case series. In conclusion, the manifestations presented here are similar to those reported in the literature. A timely diagnosis is necessary for proper management.


Assuntos
COVID-19/terapia , Hospitalização , Síndrome de Resposta Inflamatória Sistêmica/terapia , COVID-19/diagnóstico , COVID-19/fisiopatologia , Teste para COVID-19 , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Peru , Respiração Artificial , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia
11.
Orv Hetil ; 162(17): 652-667, 2021 04 10.
Artigo em Húngaro | MEDLINE | ID: mdl-33838024

RESUMO

Összefoglaló. A SARS-CoV-2-fertozés ritka gyermekkori szövodménye a sokszervi gyulladás, angol terminológiával paediatric inflammatory multisystem syndrome (PIMS). Két vagy több szerv érintettségével járó, súlyos tünetekkel induló betegségrol van szó, amelynek tünetei átfedést mutatnak a Kawasaki-betegséggel, a toxikus sokk szindrómával és a makrofágaktivációs szindrómával. A PIMS-betegek intenzív terápiás osztályon vagy intenzív terápiás háttérrel rendelkezo intézményben kezelendok, ahol biztosítottak a kardiológiai ellátás feltételei is. A szükséges immunterápia a klinikai prezentációtól függ. A jelen közleményben a szerzok a releváns nemzetközi irodalom áttekintését követoen ajánlást tesznek a PIMS diagnosztikai és terápiás algoritmusára. Orv Hetil. 2021; 162(17): 652-667. Summary. Pediatric inflammatory multisystem syndrome (PIMS) is a rare complication of SARS-CoV-2 infection in children. PIMS is a severe condition, involving two or more organ systems. The symptoms overlap with Kawasaki disease, toxic shock syndrome and macrophage activation syndrome. PIMS patients should be treated in an intensive care unit or in an institution with an intensive care background, where cardiological care is also provided. The required specific immunotherapy depends on the clinical presentation. In this paper, after reviewing the relevant international literature, the authors make a recommendation for the diagnostic and therapeutic algorithm for PIMS. Orv Hetil. 2021; 162(17): 652-667.


Assuntos
COVID-19 , Síndrome de Resposta Inflamatória Sistêmica , Algoritmos , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/terapia , COVID-19/virologia , Criança , Cuidados Críticos , Humanos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Síndrome de Resposta Inflamatória Sistêmica/virologia
12.
Reumatismo ; 73(1): 48-53, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874647

RESUMO

Since the coronavirus disease 2019 (COVID-19) outbreak started, children have been considered marginally involved compared to adults, with a quite significant percentage of asymptomatic carriers. Very recently, an overwhelming inflammatory activation, which shares clinical similarities with Kawasaki disease (KD), has been described in children exposed to COVID-19. We report three KD-like cases that occurred during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a highly affected area of Northern Italy. The clinical presentation was characterized by the presence of unremitting fever, diarrhea and elevated inflammatory markers. Case #1 and Case #2 occurred one week apart and shared other clinical features: laboratory tests confirmed COVID-19 exposure and high inflammatory activation with myocardial involvement. Case #3 followed a more typical pattern for KD. Interestingly, this patient showed lower levels of procalcitonin, C-reactive protein, D-dimers, and ferritin compared to the other two cases, whereas platelet count was higher. We hypothesize that SARS-CoV-2 might act in children as a trigger, either inducing a classical KD phenotype or causing a systemic inflammatory response leading to a severe KD-like phenotype, eventually characterized by myocardial impairment. We think that bringing these cases and their differences to the attention of the rheumatology community during the COVID-19 pandemic will be beneficial in order to highlight the importance of early diagnosis and to increase awareness of this new phenomenon.


Assuntos
COVID-19/complicações , Síndrome de Linfonodos Mucocutâneos/etiologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , COVID-19/diagnóstico , COVID-19/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Estudos Retrospectivos , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
14.
Rheumatol Int ; 41(6): 1037-1044, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33864498

RESUMO

Multisystem Inflammatory Syndrome in Children (MIS-C) recently reported in a minority of children affected by SARS-CoV-2, mimics Kawasaki disease (KD), a medium vessel vasculitis of unknown cause. In contrast to acute COVID-19 infection, which is usually mild in children, 68% of patients with MIS-C will need intensive care unit. Myocarditis and coronary artery ectasia/aneurysm are included between the main cardiovascular complications in MIS-C. Therefore, close clinical assessment is need it both at diagnosis and during follow-up. Echocardiography is the cornerstone modality for myocardial function and coronary artery evaluation in the acute phase. Cardiovascular magnetic resonance (CMR) detects diffuse myocardial inflammation including oedema/fibrosis, myocardial perfusion and coronary arteries anatomy during the convalescence and in adolescents, where echocardiography may provide inadequate images. Brain involvement in MIS-C is less frequent compared to cardiovascular disease. However, it is not unusual and should be monitored by clinical evaluation and brain magnetic resonance (MRI), as we still do not know its effect in brain development. Brain MRI in MIS-C shows T2-hyperintense lesions associated with restricted diffusion and bilateral thalamic lesions. To conclude, MIS-C is a multisystem disease affecting many vital organs, such as heart and brain. Clinical awareness, application of innovative, high technology imaging modalities and advanced treatment protocols including supportive and anti-inflammatory medication will help physicians to prevent the dreadful complications of MIS-C.


Assuntos
Encéfalo/diagnóstico por imagem , COVID-19/diagnóstico , Coração/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , COVID-19/fisiopatologia , Criança , Pré-Escolar , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Neuroimagem , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia
15.
Int J Infect Dis ; 106: 405-408, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33864915

RESUMO

OBJECTIVES: Multi-system inflammatory syndrome in children (MIS-C) is a post-viral inflammatory vasculopathy of children and adolescents following Covid-19 infection. Since the incidence of SARS-CoV-infections has been increasing in Germany since October 2020, we observe an increasing number of children presenting with MIS-C. DESIGN: We present detailed clinical characteristics of a cohort of nine children with MIS-C admitted to a tertiary PICU at the University Hospital of Cologne between March 2020 and February 2021. RESULTS: The clinical sings and symptoms are largely in line with recent reports. All but one patient had positive SARS-CoV-2 antibodies. Latency form infection to MIS-C was 4-6 weeks. Two children presented with unusual findings: A girl had encephalomyelitis and a boy developed MIS-C side to side with acute leukemia. CONCLUSION: MIS-C has been increasing in Germany paralell to SARS-CoV-2 infections. Rarely, unuasual findings may be associated with MIS-C.


Assuntos
COVID-19/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Anormalidades Múltiplas , Adolescente , COVID-19/complicações , COVID-19/terapia , Criança , Estudos de Coortes , Feminino , Doenças Genéticas Ligadas ao Cromossomo X/complicações , Alemanha , Hospitalização , Humanos , Eritrodermia Ictiosiforme Congênita/complicações , Lactente , Deformidades Congênitas dos Membros/complicações , Masculino , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/terapia
16.
BMJ Case Rep ; 14(4)2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849879

RESUMO

We report COVID-19 multisystemic inflammatory syndrome in an adult patient with an atypical presentation (mild abdominal pain) and a negative (repeated) reverse transcriptase-PCR, in the absence of lung involvement on lung ultrasound. In this case, focused cardiac ultrasound revealed signs of myopericarditis and enabled us to focus on the problem that was putting our patient in a perilous situation, with a quick, non-time-consuming and easy-to-access technique. Serology test was performed and SARS-CoV-2 infection was confirmed more than a week after admission to the coronary unit. As the patient had a general good appearance, the potential implications of missing this diagnosis could have been fatal.


Assuntos
COVID-19/diagnóstico , Miocardite/diagnóstico por imagem , Pericardite/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/virologia , Dor Abdominal , Adulto , COVID-19/complicações , Teste Sorológico para COVID-19 , Ecocardiografia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Miocardite/virologia , Pericardite/virologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Ultrassonografia
17.
BMC Pediatr ; 21(1): 181, 2021 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865340

RESUMO

BACKGROUND: Early diagnostic indicators and the identification of possible progression to severe or critical COVID-19 in children are unknown. To investigate the immune characteristics of early SARS-CoV-2 infection in children and possible key prognostic factors for early identification of critical COVID-19, a retrospective study including 121 children with COVID-19 was conducted. Peripheral blood lymphocyte subset counts, T cell-derived cytokine concentrations, inflammatory factor concentrations, and routine blood counts were analyzed statistically at the initial presentation. RESULTS: The T lymphocyte subset and natural killer cell counts decreased with increasing disease severity. Group III (critical cases) had a higher Th/Tc ratio than groups I and II (common and severe cases); group I had a higher B cell count than groups II and III. IL-6, IL-10, IFN-γ, SAA, and procalcitonin levels increased with increasing disease severity. Hemoglobin concentration, and RBC and eosinophil counts decreased with increasing disease severity. Groups II and III had significantly lower lymphocyte counts than group I. T, Th, Tc, IL-6, IL-10, RBC, and hemoglobin had relatively high contribution and area under the curve values. CONCLUSIONS: Decreased T, Th, Tc, RBC, hemoglobin and increased IL-6 and IL-10 in early SARS-CoV-2 infection in children are valuable indices for early diagnosis of severe disease. The significantly reduced Th and Tc cells and significantly increased IL-6, IL-10, ferritin, procalcitonin, and SAA at this stage in children with critical COVID-19 may be closely associated with the systemic cytokine storm caused by immune dysregulation.


Assuntos
COVID-19/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , Linfócitos B/citologia , Criança , Pré-Escolar , Síndrome da Liberação de Citocina/virologia , Citocinas/sangue , Feminino , Humanos , Imunidade , Lactente , Células Matadoras Naturais/citologia , Contagem de Linfócitos , Masculino , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Subpopulações de Linfócitos T/citologia
18.
BMJ Case Rep ; 14(4)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846193

RESUMO

Since the emergence of SARS-CoV-2, clinicians have been challenged with a wide spectrum of disease severity. One of the serious complications associated with the virus is multisystem inflammatory syndrome in children (MIS-C). It is characterised by inflammation leading to organ damage, in the setting of positive SARS-CoV-2 infection. MIS-C is thought to be a postviral reaction where most children are negative on PCR testing but are positive for SARS-CoV-2 antibodies. The Centers for Disease Control and Prevention recently defined the same phenomenon occurring in adults as multisystem inflammatory syndrome in adults (MIS-A) and emphasised on the use of antibody testing in this population. Here we describe an adult woman with an exposure to SARS-CoV-2 who presented with unexplained organ failure and shock. Positive antibody testing was the only clue to the diagnosis of MIS-A. We stress the importance of SARS-CoV-2 antibody detection in order to identify these cases.


Assuntos
COVID-19/complicações , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adulto , Anticorpos Antivirais , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , Teste Sorológico para COVID-19 , Diagnóstico Diferencial , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/virologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico
20.
BMC Pediatr ; 21(1): 144, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33765980

RESUMO

BACKGROUND: Emergence of 2019-nCoV attracted global attention and WHO declared COVID-19 a public health emergency of international concern. Therefore we aimed to explore the severity and atypical manifestations of COVID-19 among children. METHODS: This is an observational cohort study conducted on 398 children with confirmed COVID-19 by using real-time reverse transcriptase polymerase chain reaction assay for detection of 2019-nCoV nucleic acid during the period from March to November 2020. Patients were subdivided regarding the severity of COVID-19 presentation into Group I (Non-severe COVID-19) was admitted into wards and Group II (Severe COVID-19) admitted into the PICU. RESULTS: Non- severe cases were 295cases (74.1%) and 103cases (25.9%) of severe cases. There was a significant difference between age groups of the affected children (P < 0.001) with a median (0-15 years). Boys (52%) are more affected than girls (48%) with significant differences (P < 0.001). 68.6%of confirmed cases had contact history to family members infected with COVID-19. 41.7% of severe patients needed mechanical ventilation. Death of 20.4% of severe cases. In COVID-19 patients, fever, headache, fatigue and shock were the most prominent presentations (95, 60.3, 57.8, and 21.8% respectively). 3.5% of children were manifested with atypical presentations; 1.25% manifested by pictures of acute pancreatitis, 1.25% presented by manifestations of deep venous thrombosis and 1.0% had multisystem inflammatory syndrome (MIS-C). Multivariate regression analysis showed that COVID-19 severity in children was significantly higher among children with higher levels of D-dimer, hypoxia, shock and mechanical ventilation. CONCLUSION: Most children had a non-severe type of COVID-19 and children with severe type had higher levels of D-dimer, hypoxia, shock and mechanical ventilation.


Assuntos
COVID-19/complicações , Pancreatite/complicações , Pediatria , Síndrome de Resposta Inflamatória Sistêmica/complicações , Doença Aguda , Adolescente , COVID-19/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pancreatite/diagnóstico , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
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