scholarly journals Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis—A Critical Review of Its Pathogenesis and Treatment

2020 ◽  
Vol 8 ◽  
Author(s):  
Jeremy C. McMurray ◽  
Joseph W. May ◽  
Madeleine W. Cunningham ◽  
Olcay Y. Jones
Keyword(s):  
Kawasaki Disease ◽  
Critical Review ◽  
Acute Rheumatic Fever ◽  
Systemic Vasculitis ◽  
Viral Myocarditis ◽  
Current Treatment ◽  
Clinical Perspective ◽  
Treatment Regimens ◽  
Inflammatory Syndrome ◽  
Post Infectious

MIS-C is a newly defined post-viral myocarditis and inflammatory vasculopathy of children following COVID-19 infection. This review summarizes the literature on diagnosis, parameters of disease severity, and current treatment regimens. The clinical perspective was analyzed in light of potential immunopathogenesis and compared to other post-infectious and inflammatory illnesses of children affecting the heart. In this paradigm, the evidence supports the importance of endothelial injury and activation of the IL-1 pathway as a common determinant among MIS-C, Kawasaki disease, and Acute Rheumatic fever.

scholarly journals Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during the COVID-19 Pandemic

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Reza Shahriarirad ◽  
Anahita Sanaei Dashti ◽  
Shabnam Hajiani Ghotbabadi
Keyword(s):  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Organ Damage ◽  
Laboratory Evaluation ◽  
Number Of Children ◽  
Reactive Protein ◽  
Public Crisis ◽  
Exact Etiology ◽  
Novel Coronavirus ◽  
Inflammatory Syndrome

Background. Although Kawasaki disease (KD) is the most common self-limited systemic vasculitis in pediatrics, the exact etiology of the disease, its association with other diseases, and pathogens is still unknown. In order to achieve a better understanding and management of the disease, documentation and reporting of atypical cases is justified, particularly with the growing number of children with inflammatory syndrome with clinical features simulating KD during the COVID-19 pandemic. Here, we present a case of an atypical case of KD presenting as multisystem inflammatory syndrome (MIS) during the COVID-19 pandemic. Case Presentation. The patient is a 7-year-old girl who developed fever (39°C) and erythematous multiform rash on the abdomen and along with erythema and edema on the extremities. Laboratory evaluation revealed neutrophilia and lymphopenia along with elevated C-reactive protein, erythrocyte sedimentation rate, troponin, lactate dehydrogenase, ferritin, and D-dimer. Although the patient did not fulfill the KD criteria, based on approved guidelines and approaches regarding atypical KD and multisystem inflammatory syndrome in children (MIS-C) during the COVID-19 pandemic, intravenous immunoglobulin along with aspirin was administered for the patients. The patient’s symptoms resolved with an uneventful postdischarge course. Conclusion. Early diagnosis and treatment of patients meeting full or partial criteria for KD are critical to preventing end-organ damage and other long-term complications, especially during times of public crisis and global health emergencies, such as the novel coronavirus pandemic.

scholarly journals The Trilogy of SARS-CoV-2 in Pediatrics (Part 2): Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 26 (4) ◽  
pp. 318-338
Author(s):  
Van L. Tran ◽  
Sarah Parsons ◽  
Andrew Nuibe
Keyword(s):  
Kawasaki Disease ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Febrile Illness ◽  
Current Treatment ◽  
Published Data ◽  
Treatment Considerations ◽  
Cardiac Manifestations ◽  
Effectiveness Studies ◽  
Inflammatory Syndrome

Multisystem Inflammatory Syndrome in Children (MIS-C) was first recognized as a novel illness in 2020 with manifestations similar to other hyperinflammatory syndromes, such as Kawasaki disease or macrophage activation syndrome. Severity varies from a self-limited febrile illness to shock requiring inotropes and mechanical ventilation. Gastrointestinal symptoms and persistent fevers are the most common clinical symptoms, with the addition of cardiac manifestations inclusive of ventricular dysfunction and coronary artery aneurysms. With no controlled trials or comparative effectiveness studies evaluating treatment of MIS-C to date, current treatment with immunomodulatory agents has mainly been derived from previous experience treating Kawasaki disease. This article provides a comprehensive review summarizing published data for the evaluation and management of MIS-C, with a focus on pharmacotherapy treatment considerations.

scholarly journals Kawasaki-like syndrome in children from Greater Poland during the first wave of COVID-19 pandemic

2020 ◽  
Vol 16 (4) ◽  
pp. 396-403
Author(s):  
Katarzyna Mazur-Melewska ◽  
◽  
Anna Mania ◽  
Paweł Małecki ◽  
Iwona Klimecka ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Developed Countries ◽  
Kawasaki Syndrome ◽  
Incomplete Kawasaki Disease ◽  
Viral Aetiology ◽  
History Of ◽  
The Mean ◽  
Artery Disease ◽  
Inflammatory Syndrome

Kawasaki disease is an acute disease caused by systemic vasculitis, which predominantly affects children younger than 5 years of age. It is the leading cause of acquired coronary artery disease in childhood in developed countries. Currently, in the era of COVID-19, an increased number of cases, most likely related to SARS-CoV-2, are being observed. Our study aimed to describe the incidence and course of Kawasaki-like syndrome in patients admitted to the Polish department of infectious diseases during the first wave of COVID-19 pandemic. We identified 6 children with Kawasaki disease within almost 6 weeks of the pandemic. Medical history of 3 children showed contact with a person suspected of SARS-CoV-2 infection. One patient had confirmed SARS-CoV-2 serology (a female patient who lived in the epidemic centre). We did not confirm any bacterial or viral aetiology in 3 patients. Conclusions: Based on the conducted analysis comparing the number of cases during the “spring wave” of SARS-CoV-2 pandemic compared to previous years, an increased incidence of Kawasaki syndrome among children from the Greater Poland was found, similar to that reported by doctors from various European countries. The mean age of patients with Kawasaki disease was higher than previously reported. Analysis of clinical forms in our patients showed the entire spectrum from incomplete Kawasaki disease to full blown Kawasaki disease shock syndrome and multisystem inflammatory syndrome in children. The risk assessment of immunoglobulin resistance using the Kobayashi and Egami scores had no predictive value in patients with Kawasaki disease during the COVID-19 period.

scholarly journals Current Treatment Guidelines of SARS-CoV-2 Related Multisystem Inflammatory Syndrome in Children: A Literature Review and Expert Opinion

2021 ◽  
Vol 11 (01) ◽  
pp. e133-e140
Author(s):  
Alireza Ghodsi ◽  
Mehrdad Sarabi ◽  
Abdolreza Malek ◽  
Ali Khakshour
Keyword(s):  
Kawasaki Disease ◽  
Treatment Guidelines ◽  
Clinical Manifestations ◽  
Current Treatment ◽  
Current Management ◽  
Management Guidelines ◽  
Current Review ◽  
Systemic Disorder ◽  
Clinical Questions ◽  
Inflammatory Syndrome

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a systemic disorder that seems to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since April 2020, there have been multiple reports about children with this new condition worldwide, including Europe, Asia, Latin America, and North America. The symptoms of this syndrome mimic the clinical manifestations of Kawasaki disease; therefore, the treatment of Kawasaki disease, as well as supportive care, was the management of choice in children with MIS-C in the early days of recognizing it. It is important to precisely ascertain the risk of COVID-19 infection and its severity in children and to acknowledge the management of this syndrome, with reliable data from cohorts, trials, and experts' opinions. In the current review, we summarize the current management guidelines for MIS-C and present our own protocol to answer some clinical questions regarding MIS-C management during the COVID-19 pandemic.

scholarly journals Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253625
Author(s):  
Shazia S. Mohsin ◽  
Qalab Abbas ◽  
Devyani Chowdhary ◽  
Farah Khalid ◽  
Abdul Sattar Sheikh ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Viral Myocarditis ◽  
Intravenous Immunoglobulins ◽  
Left Ventricular ◽  
World Health ◽  
Fulminant Myocarditis ◽  
Severe Left Ventricular Dysfunction ◽  
Inflammatory Syndrome

Objectives To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts. Methods All children (1 month– 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C. Results Thirty children with median age of 24 (interquartile range (IQR)1–192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis. Conclusions Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes.

Infectious Croup: A Critical Review

1986 ◽  
Vol 95 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Reginald Baugh ◽  
Bennie B. Gilmore
Keyword(s):  
Medical Care ◽  
Critical Review ◽  
Current Treatment ◽  
Clinical Entity ◽  
Frequent Occurrence ◽  
Medical Care System ◽  
Treatment Methods ◽  
Treatment Regimens ◽  
Bacterial Tracheitis ◽  
Successful Prevention

Infectious croup is a viral or bacterial syndrome characterized by a barking cough, hoarseness, and stridor. Three separate conditions will be discussed: laryngotracheobronchitis, spasmotic croup, and bacterial tracheitis. Each clinical entity will be defined and its treatment reviewed. Current treatment regimens for infectious croup involve various combinations of mist therapy, racemic epinephrine, corticosteroids, and syrup of ipecac. Tradition, rather than science, appears to be the basis of many of these treatments. Despite the frequent occurrence of infectious croup, no treatment has proved consistently successful. Prevention and better treatment methods are the keys for reducing the high cost of infectious croup to the medical care system.

THE ROLE OF BRACHYTHERAPY IN TREATMENT FOR ESOPHAGEAL CANCER

2017 ◽  
Vol 63 (4) ◽  
pp. 660-665
Author(s):  
Yelena Tyuryaeva
Keyword(s):  
Esophageal Cancer ◽  
Critical Review ◽  
Palliative Treatment ◽  
Combined Treatment ◽  
Neoadjuvant Treatment ◽  
Early Esophageal Cancer ◽  
Separate Section ◽  
Treatment Regimens ◽  
Contradictory Data

The article is devoted to various aspects of the use of intraluminal brachytherapy (IB) in treatment for esophageal cancer (EC). A critical review of the use of IB as a component of combined radiotherapy/chemoradiotherapy in neoadjuvant treatment regimens, for definitive CRT, as well as in palliative treatment of non-operable tumors of this localization is given. The contradictory data on the effectiveness of brachytherapy with locally distributed, inoperable EC are summarized. A separate section relates to the prospects for incorporating brachytherapy into combined treatment of early esophageal cancer. Carried out analysis testifies to the necessity of standardization of summary and daily doses of irradiation depending on the indications to the IB.

COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

2021 ◽  
pp. 1-3
Author(s):  
Lesya G. Tomlinson ◽  
Mitchell I. Cohen ◽  
Rebecca E. Levorson ◽  
Megan B. Tzeng
Keyword(s):  
Inflammatory Process ◽  
Myocardial Dysfunction ◽  
Sinus Node ◽  
Qtc Prolongation ◽  
Mild Disease ◽  
Abnormal Immune Response ◽  
Idioventricular Rhythm ◽  
Inflammatory Syndrome ◽  
Electrocardiographic Abnormalities ◽  
Post Infectious

Abstract SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.

scholarly journals Vasculitis: From Target Molecules to Novel Therapeutic Approaches

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 757
Author(s):  
Sang-Wan Chung
Keyword(s):  
Systemic Vasculitis ◽  
Alkylating Agents ◽  
Large Vessel Vasculitis ◽  
Large Vessel ◽  
Biologic Therapies ◽  
Therapeutic Approaches ◽  
Novel Treatments ◽  
Treatment Regimens ◽  
Immune Mediated ◽  
Target Molecules

Systemic vasculitis is a group of diverse diseases characterized by immune-mediated inflammation of blood vessels. Current treatments for vasculitis, such as glucocorticoids and alkylating agents, are associated with significant side effects. In addition, the management of both small and large vessel vasculitis is challenging due to a lack of robust markers of disease activity. Recent research has advanced our understanding of the pathogenesis of both small and large vessel vasculitis, and this has led to the development of novel biologic therapies capable of targeting key cytokine and cellular effectors of the inflammatory cascade. It is anticipated that these novel treatments will lead to more effective and less toxic treatment regimens for patients with systemic vasculitis.

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