Narrative Review Article: Radiographic Findings in COVID-19 and MIS-C in Children

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

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

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

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

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

COVID-19 vasculitis and novel vasculitis mimics.

COVID-19 in Immunocompromised Children and Adolescents.

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

There is limited understanding of the viral antibody fingerprint following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children. Herein, SARS-CoV-2 proteome-wide immunoprofiling of children with mild/moderate or severe coronavirus disease 2019 (COVID-19) versus multisystem inflammatory syndrome in children versus hospitalized control patients revealed differential cytokine responses, IgM/IgG/IgA epitope diversity, antibody binding and avidity. Apart from spike and nucleocapsid, IgG/IgA recognized epitopes in nonstructural protein (NSP) 2, NSP3, NSP12-NSP14 and open reading frame (ORF) 3a-ORF9. Peptides representing epitopes in NSP12, ORF3a and ORF8 demonstrated SARS-CoV-2 serodiagnosis. Antibody-binding kinetics with 24 SARS-CoV-2 proteins revealed antibody parameters that distinguish children with mild/moderate versus severe COVID-19 or multisystem inflammatory syndrome in children. Antibody avidity to prefusion spike correlated with decreased illness severity and served as a clinical disease indicator. The fusion peptide and heptad repeat 2 region induced SARS-CoV-2-neutralizing antibodies in rabbits. Thus, we identified SARS-CoV-2 antibody signatures in children associated with disease severity and delineate promising serodiagnostic and virus neutralization targets. These findings might guide the design of serodiagnostic assays, prognostic algorithms, therapeutics and vaccines in this important but understudied population.

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

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

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

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