Abstract
SARS-CoV-2 infection in children can trigger cardiovascular manifestations potentially requiring an intensive treatment and defining a new entity named Multisystem Inflammatory Syndrome in Children (MIS-C), whose features partially overlap with Kawasaki Disease (KD). A cross-sectional study including all diagnoses of MIS-C and KD from April 2020 to May 2021 in our metropolitan area was conducted evaluating clinical, laboratory (including immunological response, cytokines, and markers of myocardial damage), and cardiac (coronary and non-coronary) features at onset of the diseases. Evolution of ventricular dysfunction, valve regurgitations, and coronary lesions was documented. The severity of the disease was also considered based on the need for inotropic support and ICU admission. Twenty-four MIS-C were diagnosed (14 boys, median age 82 months): 13/24 cases (54.17%) presented left ventricular dysfunction, 12/24 (50%) required inotropic support, and 10/24 (41.67%) developed coronary anomalies (CALs). All patients received steroids and IVIG at a median time of 5 days (IQR1:4, IQR3:6.5) from onset of fever and heart function normalized 6 days (IQR1: 5, IQR3: 7) after therapy, while CALs persisted in one. One patient (12.5%) required infliximab because of refractory disease and still presented CALs 18 days after therapy. During the same study period, 15 KD were diagnosed: none had ventricular dysfunction, while 7/15 (46.67%) developed CALs. Three out of 15 patients (20%) still presented CALs 46 days from onset. Compared to KD, MIS-C pts have significantly higher IL8 and similar lymphocytes subpopulations. Despite a more severe presentation and initial cardiac findings compared to KD, the myocardial injury in MIS-C has a rapid response to immunomodulatory treatment (median time 6 days), in terms of ventricular function, valve regurgitations, and troponin. Incidence of CALs is similar at onset, but it tends to regress in most of the cases of MIS-C differently than in KD where CALs persist in up to 40% in the subacute stage after treatment.
Highlights
COVID-19 pandemic has severely affected 2020, rapidly becoming a challenging global health issue.SARS-CoV-2 is the causative pathogen of the COVID-19 pandemic and belongs to the beta-coronaviruses group
Since both Kawasaki Disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) are systemic vasculitides sharingofclinical, ber 2020, when the alpha variantwe the cytokine according to the post-acute nature of the most of the and lymphocyteexpected, subsets could define a peculiar pattern useful fordisease, distinguishing the MIS-C p naso-pharyngeal swabs were negative for SARS-CoV-2 on admission, so viral typ two diseases
The different cytokines profile of MIS-C compared to KD suggests a role of IL-8 in the pathogenesis of the disease by inducing endothelial dysfunction
Summary
SARS-CoV-2 is the causative pathogen of the COVID-19 pandemic and belongs to the beta-coronaviruses group. The positive-sense single-stranded RNA virus has an enveloped capsid that expresses the spike protein, which is a critical protein involved in its pathogenesis [1]. Despite firstly considered as an adult condition [5,6], growing evidence has led to describing a new syndrome developing 3–6 weeks following SARS-CoV-2 infection and sharing clinical features with Kawasaki Disease (KD) [7,8,9], which is named Multisystem. Different diagnostic criteria have been released by scientific societies [11,12,13], all agreeing that MIS-C is to be intended as an infectious-related autoimmunity syndrome unleashed by SARS-CoV-2 occasionally leading to dramatic clinical patterns
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