Clinical characteristics and outcomes of Multisystem Inflammatory Syndrome in Children (MIS-C): A national multicenter cohort in Saudi Arabia

Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 in a solid organ transplant recipient.

Weight excess association with severity in children and adolescents with COVID-19: A systematic review.

US public health resources for coronavirus disease 2019 that are relevant to allergy-immunology

uch remains uncertain about the pathophysiology of the various clinical presentations of coronavirus disease 2019 (COVID-19).Severe infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) most often manifests with a pulmonary syndrome that evolves from viral pneumonia to an inflammatory mediated acute respiratory distress syndrome.Two less common clinical presentations of COVID-19 include multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19 cardiovascular syndrome (ACovCS) in adults.These 2 syndromes are being reported as distinct entities, but they have several overlapping clinical features, which suggests that these conditions may be attributable to related pathophysiology in 2 different age groups.The incidence of severe COVID-19 in children is lower than in adults; however, MIS-C has been recognized worldwide during the past few months, challenging the paradigm that children are not severely affected by SARS-CoV-2.By definition, MIS-C only occurs in individuals younger than 21 years of age, but to our knowledge there has been no effort to explain why a firm dichotomous age threshold is appropriate.Case series 1,2 have described children with fever, abdominal pain, and mucocutaneous disease (rash, conjunctivitis, oral lesions), and many develop coronary artery dilation, similar to Kawasaki disease.Although both syndromes are associated with elevated inflammatory markers, there are several features that distinguish MIS-C from Kawasaki disease.A large proportion of children with MIS-C present with cardiac complications including elevated troponin, cardiogenic shock, and reduced biventricular function; in contrast, such cardiac complications are rare in Kawasaki disease.Nearly half of the reported patients with MIS-C are older than 10 years old, yet the median age for Kawasaki disease is 2 years old.Additionally, thrombocytopenia is more common in MIS-C, whereas thrombocytosis is typically seen in Kawasaki disease.Why some children develop MIS-C is presently unknown.Many children with MIS-C have no history of a symptomatic respiratory infection and test negative for SARS-CoV-2 by polymerase chain reaction, but have developed SARS-CoV-2-specific IgG antibodies, suggesting the initial infection occurred at least 2 weeks before the development of MIS-C.Epidemiological studies have demonstrated that higher regional incidences of MIS-C are associated with the larger COVID-19 outbreaks in Italy, the United Kingdom, and New York City; and regional peaks in MIS-C diagnoses occur approximately 4 weeks after COVID-19 diagnoses peak. 3These observations have led to the hypothesis that MIS-C is attributable to a postinfectious inflammatory state that occurs several weeks after a primary infection with SARS-CoV-2.Cardiovascular complications associated with SARS-CoV-2 infection have also been recognized in adults. 4There is a range of diverse cardiac manifestations from acute coronary syndrome to a viral myocarditis-like syndrome, which we

COVID-19 vasculitis and novel vasculitis mimics.

Arterial abnormalities identified in kidneys transplanted into children during the COVID-19 pandemic.

Complexities of the COVID-19 vaccine and multisystem inflammatory syndrome in children.

Coronavirus disease 2019, multisystem inflammatory syndrome in children, apolipoprotein E4, and race

Multisystem Inflammatory Syndrome in Children in Association With COVID-19.

Epidemiologic trends in Kawasaki disease during coronavirus disease-19 in Singapore

To compare clinical characteristics and outcomes of children admitted to the PICU for severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. The secondary objective was to identify explanatory factors associated with outcome of critical illness defined by a composite index of in-hospital mortality and organ system support requirement. Retrospective cohort study. Thirty-eight PICUs within the Viral Infection and Respiratory Illness Universal Study registry from March 2020 to January 2021. Children less than 18 years with severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. Of 394 patients, 171 (43.4%) had multisystem inflammatory syndrome in children. Children with multisystem inflammatory syndrome in children were more likely younger (2-12 yr vs adolescents; p < 0.01), Black (35.6% vs 21.9%; p < 0.01), present with fever/abdominal pain than cough/dyspnea (p < 0.01), and less likely to have comorbidities (33.3% vs 61.9%; p < 0.01) compared with those without multisystem inflammatory syndrome in children. Inflammatory marker levels, use of inotropes/vasopressors, corticosteroids, and anticoagulants were higher in multisystem inflammatory syndrome in children patients (p < 0.01). Overall mortality was 3.8% (15/394), with no difference in the two groups. Diagnosis of multisystem inflammatory syndrome in children was associated with longer duration of hospitalization as compared to nonmultisystem inflammatory syndrome in children (7.5 d[interquartile range, 5-11] vs 5.3 d [interquartile range, 3-11 d]; p < 0.01). Critical illness occurred in 164 patients (41.6%) and was more common in patients with multisystem inflammatory syndrome in children compared with those without (55.6% vs 30.9%; p < 0.01). Multivariable analysis failed to show an association between critical illness and age, race, sex, greater than or equal to three signs and symptoms, or greater than or equal to two comorbidities among the multisystem inflammatory syndrome in children cohort. Among nonmultisystem inflammatory syndrome in children patients, the presence of greater than or equal to two comorbidities was associated with greater odds of critical illness (odds ratio 2.95 [95% CI, 1.61-5.40]; p < 0.01). This study delineates significant clinically relevant differences in presentation, explanatory factors, and outcomes among children admitted to PICU with severe acute respiratory syndrome coronavirus 2-related illness stratified by multisystem inflammatory syndrome in children.

IntroductionA rare but serious condition often requiring intensive care, multisystem inflammatory syndrome in children (MIS-C) is characterized by hyperinflammatory shock related to the SARS-CoV-2 pandemic. This resource teaches residents, pediatric emergency medicine fellows, and advanced practice providers who care for children to recognize and manage MIS-C and associated sequelae while applying the basic principles of pediatric resuscitation.MethodsThe simulation case was based on a real patient who presented to the emergency department with fever, rash, and cardiogenic shock. We designed the scenario to be used with a high-fidelity school-age mannequin in an emergency center resuscitation room or simulation lab. The case took 25 minutes to run, followed by a 15- to 20-minute debrief session. Personnel required for the case included a simulation technician, case instructor, emergency department nurse, parent, and consultant. Learners had to recognize the syndrome and treat the resultant shock and arrhythmia with a combination of vasopressors, antiarrhythmics, and defibrillation. Afterward, learners participated in a formal debriefing session and completed a written evaluation.ResultsTwenty-five learners (six pediatric emergency medicine fellows, 12 residents, and seven advanced practice providers) participated in the scenario over a 3-month period. The written evaluation was completed by 20 of the 25 participants; all 20 felt their confidence, comfort, and knowledge regarding the topic had increased, with an average score of 5 (strongly agree) on a 5-point Likert scale.DiscussionThis simulation case offers an effective experience for learners to become comfortable and confident in recognizing and managing MIS-C.

COVID-19-Related Multisystem Inflammatory Syndrome in Children Affects Left Ventricular Function and Global Strain Compared with Kawasaki Disease

COVID-19 herd immunity by immunisation: are children in the herd?