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  1. Article ; Online: Clinical features, diagnosis, and outcomes of multisystem inflammatory syndrome in children associated with coronavirus disease 2019.

    Kwak, Ji Hee / Lee, Soo-Young / Choi, Jong-Woon

    Clinical and experimental pediatrics

    2020  Volume 64, Issue 2, Page(s) 68–75

    Abstract: ... multisystem syndrome temporally associated with COVID-19, or COVID-19-associated multisystem inflammatory ... The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome ... to that of cytokine storm syndrome. MIS-C shows clinical features similar to KD, but differences between them exist ...

    Abstract The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading worldwide since December 2019. Hundreds of cases of children and adolescents with Kawasaki disease (KD)-like hyperinflammatory illness have been reported in Europe and the United States during the peak of the COVID-19 pandemic with or without shock and cardiac dysfunction. These patients tested positive for the polymerase chain reaction or antibody test for SARS-CoV-2 or had a history of recent exposure to COVID-19. Clinicians managing such patients coined new terms for this new illness, such as COVID-19-associated hyperinflammatory response syndrome, pediatric inflammatory multisystem syndrome temporally associated with COVID-19, or COVID-19-associated multisystem inflammatory syndrome in children (MIS-C). The pathogenesis of MIS-C is unclear; however, it appears similar to that of cytokine storm syndrome. MIS-C shows clinical features similar to KD, but differences between them exist with respect to age, sex, and racial distributions and proportions of patients with shock or cardiac dysfunction. Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), interleukin-1 receptor antagonist (anakinra), or monoclonal antibody to tumor necrosis factor (infliximab) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy. The prognosis of MIS-C seemed favorable without sequelae in most patients despite a reported mortality rate of approximately 1.5%.
    Language English
    Publishing date 2020-12-30
    Publishing country Korea (South)
    Document type Journal Article
    ISSN 2713-4148
    ISSN (online) 2713-4148
    DOI 10.3345/cep.2020.01900
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical Features of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in Indonesia.

    Putri, Nina Dwi / Prawira, Yogi / Tartila, Tartila / Jasin, Madeleine Ramdhani / Puspitasari, Henny Adriani / Puspaningtyas, Niken Wahyu / Indawati, Wahyuni / Karyanti, Mulya Rahma / Setyanto, Darmawan Budi / Prayitno, Ari / Yuniar, Irene / Alatas, Fatima Safira / Hidayati, Eka Laksmi / Muhaimin, Riski / Prawitasari, Titis / Soebadi, Amanda / Muktiarti, Dina / Primacakti, Fitri / Rahmadhany, Anisa /
    Octavius, Gilbert Sterling / Djer, Mulyadi M / Hendarto, Aryono / Dewi, Rismala / Kaswandani, Nastiti / Pudjiadi, Antonius Hocky

    Journal of tropical pediatrics

    2022  Volume 68, Issue 3

    Abstract: Background: While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is ... the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive ... Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between ...

    Abstract Background: While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia.
    Methods: This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021.
    Results: The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors.
    Conclusions: Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.
    MeSH term(s) COVID-19/complications ; COVID-19/epidemiology ; Child ; Cross-Sectional Studies ; Humans ; Indonesia/epidemiology ; Male ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/therapy
    Language English
    Publishing date 2022-04-09
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 800065-7
    ISSN 1465-3664 ; 0449-3281 ; 0142-6338
    ISSN (online) 1465-3664
    ISSN 0449-3281 ; 0142-6338
    DOI 10.1093/tropej/fmac025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2.

    Whittaker, Elizabeth / Bamford, Alasdair / Kenny, Julia / Kaforou, Myrsini / Jones, Christine E / Shah, Priyen / Ramnarayan, Padmanabhan / Fraisse, Alain / Miller, Owen / Davies, Patrick / Kucera, Filip / Brierley, Joe / McDougall, Marilyn / Carter, Michael / Tremoulet, Adriana / Shimizu, Chisato / Herberg, Jethro / Burns, Jane C / Lyall, Hermione /
    Levin, Michael

    JAMA

    2020  Volume 324, Issue 3, Page(s) 259–269

    Abstract: ... multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ... of children with an unusual syndrome of fever and inflammation.: Objectives: To describe the clinical and ... with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had ...

    Abstract Importance: In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation.
    Objectives: To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders.
    Design, setting, and participants: Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019.
    Exposures: Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization.
    Main outcomes and measures: Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders.
    Results: Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively).
    Conclusions and relevance: In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.
    MeSH term(s) Adolescent ; Betacoronavirus ; COVID-19 ; Child ; Child, Preschool ; Coronavirus Infections/complications ; England ; Female ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome/physiopathology ; Pandemics ; Pneumonia, Viral/complications ; SARS-CoV-2 ; Symptom Assessment ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/physiopathology
    Keywords covid19
    Language English
    Publishing date 2020-06-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2020.10369
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study.

    Swann, Olivia V / Holden, Karl A / Turtle, Lance / Pollock, Louisa / Fairfield, Cameron J / Drake, Thomas M / Seth, Sohan / Egan, Conor / Hardwick, Hayley E / Halpin, Sophie / Girvan, Michelle / Donohue, Chloe / Pritchard, Mark / Patel, Latifa B / Ladhani, Shamez / Sigfrid, Louise / Sinha, Ian P / Olliaro, Piero L / Nguyen-Van-Tam, Jonathan S /
    Horby, Peter W / Merson, Laura / Carson, Gail / Dunning, Jake / Openshaw, Peter J M / Baillie, J Kenneth / Harrison, Ewen M / Docherty, Annemarie B / Semple, Malcolm G

    BMJ (Clinical research ed.)

    2020  Volume 370, Page(s) m3249

    Abstract: ... inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19 ... Objective: To characterise the clinical features of children and young people admitted ... definition. Children meeting the MIS-C criteria have different demographic and clinical features depending ...

    Abstract Objective: To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C).
    Design: Prospective observational cohort study with rapid data gathering and near real time analysis.
    Setting: 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020).
    Participants: 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2.
    Main outcome measures: Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C.
    Results: Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1)
    Conclusions: Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive).
    Study registration: ISRCTN66726260.
    MeSH term(s) Adolescent ; Age Factors ; Betacoronavirus ; COVID-19 ; Child ; Child, Preschool ; Cohort Studies ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Critical Care ; Female ; Hospital Mortality ; Hospitalization/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Respiration, Artificial ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/therapy ; United Kingdom ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-08-27
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.m3249
    Database MEDical Literature Analysis and Retrieval System OnLINE

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