Abstract
The understanding of SARS-CoV-2 related syndromes in the pediatric population needs to grow worldwide. In its severe presentation, COVID-19 is a systemic disease characterized by hyperinflammation, cytokine storm and increased myocardial injury markers. Cardiac involvement in seen in 20-30% of hospitalized adult patients and accounts for about 40% of deaths. An intriguing aspect of the COVID-19 is the fact that most children and adolescents have mild or asymptomatic forms of the disease, perhaps related to a lower expression of virus [...]
Highlights
Population so Far?Hospital Evangélico de Cachoeiro de Itapemirim,[1] Cachoeiro de Itapemirim, ES – Brazil Faculdade de Medicina da Universidade de São Paulo,[2] São Paulo, SP – Brazil Fundação Técnico Educacional Souza Marques,[3] Rio de Janeiro, RJ – Brazil Editorial referring to the article: Kawasaki-like disease, a new phenotype in SARS–CoV-2?
The understanding of SARS-CoV-2 related syndromes in the pediatric population needs to grow worldwide
2 it is known that 40% of individuals under the age of 18 exposed to the virus get infected and that only 20-30% of children and adolescents infected with SARS-Cov-2 have symptoms
Summary
Hospital Evangélico de Cachoeiro de Itapemirim,[1] Cachoeiro de Itapemirim, ES – Brazil Faculdade de Medicina da Universidade de São Paulo,[2] São Paulo, SP – Brazil Fundação Técnico Educacional Souza Marques,[3] Rio de Janeiro, RJ – Brazil Editorial referring to the article: Kawasaki-like disease, a new phenotype in SARS–CoV-2?. Clinical manifestations of this combination are: 1- febrile syndrome: characterized by persistent fever, mild change in inflammatory markers and indirect signs of organ dysfunction; 2- Classic MIS-C: important change in inflammatory markers, multisystem involvement and severe cardiac involvement with shock and cardiovascular dysfunction; 3- Kawasaki-like disease: cutaneous-mucosal involvement with milder cardiac involvement (American Heart Association criteria for complete or incomplete Kawasaki disease); 4- COVID-19 simile: major respiratory involvement (acute respiratory distress syndrome). A higher frequency of gastrointestinal manifestations (abdominal pain, mesenteric lymphadenopathy, vomiting, diarrhea, and in some cases an acute abdomen requiring exploratory surgery), lymphopenia, elevation of inflammatory markers and myocardial injury (C-reactive protein, interleukins, procalcitonin, D-dimer, N-terminal prohormone of brain natriuretic peptide [NT-proBNP], troponin, lactate, transaminases, etc.), cardiovascular manifestations such as myocarditis, valvulitis, left and/or right ventricular dysfunction, changes in the coronary artery and pericardium, hemodynamic instability, shock and greater need for intensive care support compared to classic Kawasaki. Elevation of NT-proBNP occurred in 73% and left ventricular dysfunction with LVEF < 55% in 33%
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