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Article: Anti-SARS-CoV-2 Vaccination and PIMS-TS-Friends or Foe? Case Reports and Literature Review.

Opoka-Winiarska, Violetta / Morawska-Michalska, Izabela / Mertowska, Paulina / Gosik, Krzysztof / Kądziołka, Olga / Grywalska, Ewelina

Vaccines

2024 Volume 12, Issue 3

Abstract: Pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), also known as a multisystem inflammatory syndrome in children (MIS-C), is diagnosed in children who develop an inadequate inflammatory response after ... ...

Abstract	Pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), also known as a multisystem inflammatory syndrome in children (MIS-C), is diagnosed in children who develop an inadequate inflammatory response after exposure to the SARS-CoV-2 virus. The pathogenesis of the abnormal response of the immune system to a previous SARS-COV-2 infection has not been explained. Similarly, the safety and effectiveness of COVID-19 vaccinations in this group of patients have become the subject of clinical discussion. Presenting experiences from many centers aims to answer this question. We present 4 cases of patients who suffered from PIMS-TS. Three of them were safely vaccinated against COVID-19 after illness. One patient developed PIMS-TS temporarily associated with COVID-19 vaccination. We also collected and discussed data from other centers.
Language	English
Publishing date	2024-03-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines12030278
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: DOCK8

Opoka-Winiarska, Violetta / Winiarska, Natalia / Lejman, Monika / Gdak, Małgorzata / Gosik, Krzysztof / Lewandowski, Filip / Niedźwiedzka-Rystwej, Paulina / Grywalska, Ewelina

International journal of molecular sciences

2024 Volume 25, Issue 4

Abstract: This study investigated the association between autoimmunity and immunodeficiency in pediatric patients, focusing on the case of a 15-year-old female diagnosed with juvenile idiopathic arthritis (JIA) and secondary Sjögren's syndrome. The patient ... ...

Abstract	This study investigated the association between autoimmunity and immunodeficiency in pediatric patients, focusing on the case of a 15-year-old female diagnosed with juvenile idiopathic arthritis (JIA) and secondary Sjögren's syndrome. The patient presented with a variety of symptoms, including joint pain, bronchial asthma, leukopenia, and skin lesions. Genetic testing revealed a de novo mutation in the
MeSH term(s)	Adolescent ; Child ; Female ; Humans ; Arthritis, Juvenile/complications ; Arthritis, Juvenile/genetics ; Guanine Nucleotide Exchange Factors/genetics ; Immunologic Deficiency Syndromes ; Mutation ; Quality of Life ; Sjogren's Syndrome/complications ; Sjogren's Syndrome/genetics
Chemical Substances	DOCK8 protein, human ; Guanine Nucleotide Exchange Factors
Language	English
Publishing date	2024-02-13
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms25042259
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Article: Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

Krawiec, Paulina / Opoka-Winiarska, Violetta / Pac-Kożuchowska, Elżbieta

Journal of clinical medicine

2022 Volume 11, Issue 10

Abstract: Background: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. ... ...

Abstract	Background: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. Gastrointestinal manifestations are prominent in children with PIMS-TS/MIS-C. Thus, it is challenging to differentiate this condition from an exacerbation of inflammatory bowel disease (IBD). We aimed to present the clinical characteristics, and diagnostic and therapeutic difficulties in patients with overlapping IBD and PIMS-TS/MIS-C; Methods: We reviewed medical records of children hospitalized due to overlapping IBD and PIMS-TS/MIS-C in a single pediatric hospital from December 2020 to December 2021; Results: There were four children with overlapping IBD flare and PIMS-TS/MIS-C. In three cases, IBD recognition preceded PIMS-TS/MIS-C onset and PIMS-TS/MIS-C occurred during anti-inflammatory therapy of IBD. All children presented with gastrointestinal symptoms at PIMS-TS/MIS-C onset. All patients received IVIG and ASA treatment. In three children there was a need to use steroids to resolve PIMS-TS/MIS-C symptoms. One child was vaccinated against COVID-19; Conclusions: SARS-CoV-2 infection may affect patients with underlying inflammatory conditions such as IBD, inducing systemic symptoms of PIMS-TS/MIS-C, and probably triggering IBD after PIMS-TS/MIS-C. The resemblance of clinical presentations is the main source of diagnostic and therapeutic challenges in PIMS-TS/MIS-C in patients with underlying IBD.
Language	English
Publishing date	2022-05-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11102765
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Article ; Online: PIMS-TS, the New Paediatric Systemic Inflammatory Disease Related to Previous Exposure to SARS-CoV-2 Infection-"Rheumatic Fever" of the 21st Century?

Opoka-Winiarska, Violetta / Grywalska, Ewelina / Roliński, Jacek

International journal of molecular sciences

2021 Volume 22, Issue 9

Abstract: Paediatric inflammatory multisystem syndrome temporally associated ... ...

Abstract	Paediatric inflammatory multisystem syndrome temporally associated with
MeSH term(s)	COVID-19/complications ; COVID-19/drug therapy ; COVID-19/etiology ; COVID-19/pathology ; COVID-19/virology ; COVID-19 Vaccines/immunology ; Cytokines/metabolism ; Glucocorticoids/therapeutic use ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Rheumatic Fever/microbiology ; Rheumatic Fever/pathology ; SARS-CoV-2/isolation & purification ; SARS-CoV-2/pathogenicity ; Streptococcus pyogenes/pathogenicity ; Systemic Inflammatory Response Syndrome/drug therapy ; Systemic Inflammatory Response Syndrome/etiology ; Systemic Inflammatory Response Syndrome/pathology
Chemical Substances	COVID-19 Vaccines ; Cytokines ; Glucocorticoids ; Immunoglobulins, Intravenous
Language	English
Publishing date	2021-04-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms22094488
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Article: Safety of the COVID-19 vaccination in children with juvenile idiopathic arthritis-A observational study from two pediatric rheumatology centres in Poland.

Opoka-Winiarska, Violetta / Lipinska, Joanna / Michalak, Arkadiusz / Burzyński, Jacek / Kądziołka, Olga / Smolewska, Elżbieta

Frontiers in pediatrics

2023 Volume 11, Page(s) 1103763

Abstract: Introduction: The safety of COVID-19 vaccines in children with juvenile idiopathic arthritis (JIA) is the concern of patients and their parents and doctors in the current pandemic reality. The main objective of the study was to evaluate the safety of ... ...

Abstract	Introduction: The safety of COVID-19 vaccines in children with juvenile idiopathic arthritis (JIA) is the concern of patients and their parents and doctors in the current pandemic reality. The main objective of the study was to evaluate the safety of COVID-19 vaccine in patients with JIA. Method: A cohort study based on short clinical follow-up of 43 children with JIA was conducted in the years 2021-2022 in two centres of paediatric rheumatology in Poland. All patients received mRNA COVID-19 vaccine. The patients' data were collected using appropriate validated questionnaire. Disease activity was evaluated using Juvenile Arthritis Disease Activity Score 27-joint count (JADAS-27). Results: Ten (22.7%) children had COVID-19 infection before getting COVID-19 vaccine. After first dose of COVID-19 vaccine 25/43 (58.1%) patients presented typical adverse events: arm pain or oedema at the application side or weakness. Also, twenty five (58.1%) children had side effects after second dose of this vaccine, however the spectrum of the symptoms was wider (additionally: headache, fever, lymphadenopathy, arrhythmia). Thirteen out of 43 (30.2%) patients had active disease before and 8/43 (18.6%) after COVID-19 vaccination, while the degree of JADAS-27 activity was higher in the study group before COVID-19 vaccination ( Conclusions: Our study found out that children and adolescents with JIA with remission without treatment or on the long-term treatment-cDMARDs or even bDMARDs, can be safely vaccinated for COVID-19. Moreover, the study found that COVID-19 vaccination does not interfere with the JIA treatment and does not exacerbate symptoms of the disease and that vaccination protected against developing COVID-19 in children with JIA even on treatment.
Language	English
Publishing date	2023-03-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2023.1103763
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Article ; Online: Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

Paulina Krawiec / Violetta Opoka-Winiarska / Elżbieta Pac-Kożuchowska

Journal of Clinical Medicine, Vol 11, Iss 2765, p

2022 Volume 2765

Abstract	Background: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. Gastrointestinal manifestations are prominent in children with PIMS-TS/MIS-C. Thus, it is challenging to differentiate this condition from an exacerbation of inflammatory bowel disease (IBD). We aimed to present the clinical characteristics, and diagnostic and therapeutic difficulties in patients with overlapping IBD and PIMS-TS/MIS-C; Methods: We reviewed medical records of children hospitalized due to overlapping IBD and PIMS-TS/MIS-C in a single pediatric hospital from December 2020 to December 2021; Results: There were four children with overlapping IBD flare and PIMS-TS/MIS-C. In three cases, IBD recognition preceded PIMS-TS/MIS-C onset and PIMS-TS/MIS-C occurred during anti-inflammatory therapy of IBD. All children presented with gastrointestinal symptoms at PIMS-TS/MIS-C onset. All patients received IVIG and ASA treatment. In three children there was a need to use steroids to resolve PIMS-TS/MIS-C symptoms. One child was vaccinated against COVID-19; Conclusions: SARS-CoV-2 infection may affect patients with underlying inflammatory conditions such as IBD, inducing systemic symptoms of PIMS-TS/MIS-C, and probably triggering IBD after PIMS-TS/MIS-C. The resemblance of clinical presentations is the main source of diagnostic and therapeutic challenges in PIMS-TS/MIS-C in patients with underlying IBD.
Keywords	SARS-CoV-2 ; COVID-19 ; PIMS-TS ; MIS-C ; Crohn’s disease ; ulcerative colitis ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Could hemophagocytic lymphohistiocytosis be the core issue of severe COVID-19 cases?

Opoka-Winiarska, Violetta / Grywalska, Ewelina / Roliński, Jacek

BMC medicine

2020 Volume 18, Issue 1, Page(s) 214

Abstract: Background: COVID-19, a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly presents as fever, cough, dyspnea, and myalgia or fatigue. Although the majority of patients with COVID-19 have mild symptoms, some are ... ...

Abstract	Background: COVID-19, a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly presents as fever, cough, dyspnea, and myalgia or fatigue. Although the majority of patients with COVID-19 have mild symptoms, some are more prone to serious outcomes, including pneumonia, acute respiratory distress syndrome (ARDS), and even death. Hemophagocytic lymphohistiocytosis (HLH) is a severe, life-threatening inflammatory syndrome associated with intense cytokine release (also known as a "cytokine storm"). Similar to COVID-19, HLH is characterized by aggressive course leading to multi-organ failure. Main text: The purpose of this review article is to draw attention to the possibility of the complication of HLH in patients with the severe course of COVID-19. Indeed, some of the clinical characteristics observed in the more severe cases of COVID-19 are reminiscent of secondary HLH (which can be triggered by infections, malignancies, rheumatological diseases, or autoimmune/immunodeficiency conditions). The pathogenesis of SARS-CoV-2 infection also suggests that HLH or a similar hyperinflammatory syndrome is the cause of the severe course of the infection. Conclusion: The pathogenesis and clinical symptoms of severe COVID-19 indicate that an increased inflammatory response corresponding to HLH is occurring. Therefore, patients with severe COVID-19 should be screened for hyperinflammation using standard laboratory tests to identify those for whom immunosuppressive therapy may improve outcomes.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/therapy ; Cytokine Release Syndrome/virology ; Humans ; Lymphohistiocytosis, Hemophagocytic/diagnosis ; Lymphohistiocytosis, Hemophagocytic/therapy ; Lymphohistiocytosis, Hemophagocytic/virology ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/therapy ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	1741-7015
ISSN (online)	1741-7015
DOI	10.1186/s12916-020-01682-y
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Differential diagnosis in children with musculoskeletal pain in Emergency Department

Małgorzata Drozd / Adrianna Gorecka / Bartłomiej Zaremba / Violetta Opoka-Winiarska

Journal of Education, Health and Sport, Vol 12, Iss

2022 Volume 11

Abstract: Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare ... ...

Abstract	Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare system, we also evaluated the impact of pandemic on type of musculoskeletal symptoms. Study design: A retrospective cross-sectional study was conducted by statistical analysis of data of patients with non-traumatic musculoskeletal pain registered in HED between January 2018 and December 2020. Data of patients referred and not referred to hospital ward and admitted to HED before and during COVID-19 pandemic have been compared. Results: Majority of patients presented acute, non-trauma related, single-site pain, usually localized in the hip, the knee and the spine. 21,49% of patients were referred to a hospital ward, usually rheumatological, neurological or orthopedic. Final diagnoses in almost ¾ patients belong to the group of musculoskeletal system and connective tissue disorders. During the pandemic significantly less patients with musculoskeletal pain reported to our HED. The duration of symptoms before admission was not significantly longer than in previous years, but the problem in children and the impact of the pandemic on the musculoskeletal system in children is complex. Conclusions: Our study provides detailed information on patterns of pediatric musculoskeletal consultations in HED. A positive history of trauma preceding musculoskeletal pain in a child may only be accidentally related to the final cause. Musculoskeletal pain can be also a symptom of a lot of various systemic conditions, not only diseases of the musculoskeletal system. The still ongoing COVID-19 pandemic may require changes in the organization of the HED. We believe that the presented results can help in organizing and planning care in pediatric HEDs, develop diagnostic algorithms and training for HED staff.
Keywords	musculoskeletal pain ; childhood ; emergency department ; COVID-19 ; Education ; L ; Sports ; GV557-1198.995 ; Medicine ; R
Subject code	616
Language	English
Publishing date	2022-10-01T00:00:00Z
Publisher	Kazimierz Wielki University
Document type	Article ; Online
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Article ; Online: PIMS-TS, the New Paediatric Systemic Inflammatory Disease Related to Previous Exposure to SARS-CoV-2 Infection—“Rheumatic Fever” of the 21st Century?

Violetta Opoka-Winiarska / Ewelina Grywalska / Jacek Roliński

International Journal of Molecular Sciences, Vol 22, Iss 4488, p

2021 Volume 4488

Abstract: Paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ) (PIMS-TS) is a new systemic inflammatory disease that mainly affects children. Its course in many features resembles ... ...

Abstract	Paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ) (PIMS-TS) is a new systemic inflammatory disease that mainly affects children. Its course in many features resembles that of acute rheumatic fever (ARF). Therefore, it is interesting that the experiences with ARF can be used in the management of patients with PIMS-TS. The aim of the article is to analyse the current data on PIMS-TS in relation to ARF. PIMS-TS and ARF are associated with an abnormal immune response to specific pathogens ( SARS-CoV-2 and group A streptococcus , respectively). The main symptoms of both diseases are fever and cardiac involvement. Current therapy for PIMS-TS is based on anti-inflammatory treatment: intravenous immunoglobulin (first-line), intravenous glucocorticoids (second-line), or biological therapy (third-line; including interleukin [IL]-1 antagonists, IL-6 receptor blockers, and anti-tumour necrosis factor agents). Vaccination might be good prophylaxis, but the efficacy and safety of the vaccines against SARS-CoV-2 have not yet been established in children. Interesting insights may be gained by considering PIMS-TS in light of what is known of ARF due to their similar courses, but there are still many unanswered questions surrounding this disease and its pathogenesis.
Keywords	COVID-19 ; paediatric inflammatory multisystemic syndrome (PIMS) ; rheumatic fever ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: The Impact of Epstein-Barr Virus Infection on Juvenile Idiopathic Arthritis Activity and Patient's Response to Treatment.

Opoka-Winiarska, Violetta / Grywalska, Ewelina / Sobiesiak, Aleksandra / Roliński, Jacek

Journal of clinical medicine

2020 Volume 9, Issue 11

Abstract: This study aimed to investigate the relationship between Epstein-Barr virus (EBV) infection and the onset of juvenile idiopathic arthritis (JIA), disease activity, and response to treatment. The study included 44 children with JIA, 23 children with ... ...

Abstract	This study aimed to investigate the relationship between Epstein-Barr virus (EBV) infection and the onset of juvenile idiopathic arthritis (JIA), disease activity, and response to treatment. The study included 44 children with JIA, 23 children with different types of arthritis, and 44 controls. We measured EBV infection markers, including the EBV DNA load and the concentration of antibodies to viral antigens, at disease onset, before treatment. Six months after JIA diagnosis and the initiation of treatment patients with anti-viral capsid antigen IgG had a higher disease activity and worse response to treatment than patients without previous infection. After six months of treatment, the probability of disease inactivity in children without a history of EBV infection was almost 6.5 times greater than in a child with a history of infection. Furthermore, the probability of a better response after six months of treatment in a child with a history of EBV infection was more than five times smaller than in a child without infection. A past EBV infection can have a negative effect on achieving disease remission and may be associated with a worse response to treatment. Our results do not indicate the need for routine assessment of EBV infection markers in patients with JIA.
Language	English
Publishing date	2020-10-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm9113453
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