Journal of Child

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Review


DOI :10.26650/jchild.2021.1.881325   IUP :10.26650/jchild.2021.1.881325    Full Text (PDF)

Multisystem Inflammatory Syndrome in Children

Yıldız Ekemen Keleş, Dilek Yılmaz Çiftdoğan

An outbreak of pneumonia of unknown origin occurred in China in December 2019. The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was named Coronavirus disease 2019 (COVID- 19). COVID-19, which is seen less frequently in children than adults, is known to have milder symptoms. However, at the end of April 2020 in Europe, it was observed that some children with SARS-CoV-2 infections developed fever, abdominal pain, shock, myocardial insufficiency, and the need for intensive care. This new disease has been called Multisystem Inflammatory Syndrome in Children (MIS-C). Although the pathogenesis of MIS-C is unclear, it progresses with signs of multi-organ involvement as a result of uncontrolled inflammation of the immune system and even causes death. Therefore, the diagnosis and treatment of patients with MIS-C should be managed quickly. In this review, the pathophysiology, clinical and laboratory findings, diagnostic methods, and treatment regimens of MIS-C were discussed.

Keywords: COVID-19, child, SARS-CoV-2, multisystem inflammatory syndrome, diagnose, treatment
DOI :10.26650/jchild.2021.1.881325   IUP :10.26650/jchild.2021.1.881325    Full Text (PDF)

Çocuklarda Çoklu Sistemik İnflamatuvar Sendrom

Yıldız Ekemen Keleş, Dilek Yılmaz Çiftdoğan

2019 yılı Aralık ayında Çin’de nedeni bilinmeyen pnömoni salgını meydana geldi ve ciddi akut solunum yetmezliği sendromu koronavirüs 2’nin (SARSCoV- 2) neden olduğu hastalığa Koronavirüs hastalığı 2019 (COVID-19) adı verildi. Koronavirüs hastalığı 2019 çocuklarda erişkinlere kıyasla daha az sıklıkla görülmekte ve daha hafif bulgularla seyrettiği bilinmektedir. Fakat Avrupa’da Nisan 2020’nin sonlarında SARS-CoV-2 enfeksiyonu geçiren bazı çocuklarda ateş, karın ağrısı, şok, miyokardiyal yetmezlik ve yoğun bakımı ihtiyacı geliştiği görülmüştür. Bu yeni hastalığa Çoklu Sistemik İnflamatuvar Sendrom (MIS-C) adı verilmiştir. MIS-C’in patogenezi net olmamakla birlikte immün sistemin kontrolsüz inflamasyonu sonucunda çoklu organ tutulumuna ait bulgularla seyretmekte ve hatta ölüme neden olmaktadır. Bu nedenle MIS-C’li hastaların tanı ve tedavilerinin hızlıca yönetilmesi gerekmektedir. Bu derlemede MIS-C hastalığının patofizyolojisi, klinik ve laboratuvar bulguları, tanı yöntemleri ve tedavi rejimleri irdelenmiştir.

Keywords: COVID-19, çocuk, SARS-CoV-2, çoklu sistemik inflamatuvar sendrom, tanı, tedavi

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References

  • 1. World Health Organization (WHO). WHO Director-General's opening remarks at the media briefing on COVID-19 -- 11 March 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-COVID-19---11-march-2020 (Accessed on May 01, 2020). google scholar
  • 2. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020;145(6):e20200702. doi 10.1542/peds.2020-0702. google scholar
  • 3. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet. 2020;395(10239):1771-8. doi: 10.1016/S0140-6736(20)31103-X. google scholar
  • 4. Viner RM, Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic. The Lancet. 2020;395(10239):1741-3. DOI10.1016/S0140-6736(20)31129-6. google scholar
  • 5. Center for Disease Control and Prevention, Center for Preparedness and Response: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19), Clinician Outreach and Communication (COCA) Webinar-19 May 2020. Available at: https://emergency.cdc.gov/coca/calls/2020/callinfo_051920.asp?deliveryName=USCDC_1052- DM28623. google scholar
  • 6. Pediatric Intensive Care Society. PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease. April 27, 2020. Available at https://picsociety.uk/wpcontent/uploads/2020/04/PICS-statement-re-novel-KD-C19- presentation-v2-27042020.pdf. google scholar
  • 7. Perez-Toledo M, Faustini SE, Jossi SE, Shields AM, Kanthimathinathan HK, Allen JD, et al. Serology confirms SARS-CoV-2 infection in PCR-negative children presenting with Paediatric Inflammatory Multi-System Syndrome. MedRxiv. 2020. doi: 10.1101/2020.06.05.20123117. google scholar
  • 8. Weisberg SP, Connors T, Zhu Y, Baldwin M, Lin W-H, Wontakal S, et al. Antibody responses to SARS-CoV2 are distinct in children with MIS-C compared to adults with COVID-19. medRxiv. 2020. doi: 10.1101/2020.07.12.20151068. Preprint. google scholar
  • 9. Brodin P. Why is COVID-19 so mild in children? Acta Paediatr. 2020 Jun;109(6):1082-1083. doi: 10.1111/apa.15271. Epub 2020 Apr 15. PMID: 32212348. google scholar
  • 10. Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020;581(7809):465-9. doi: 10.1038/s41586-020-2196-x. google scholar
  • 11. Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell. 2020;183(4):968-81. e7. doi: 10.1016/j.cell.2020.09.016. google scholar
  • 12. Hamming I, Timens W, Bulthuis M, Lely A, Navis Gv, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The Journal of Pathology: Rev Med Microbiol. 2004;203(2):631-7. doi: 10.1002/path.1570. google scholar
  • 13. Kuba K, Imai Y, Rao S, Jiang C, Penninger JM. Lessons from SARS: control of acute lung failure by the SARS receptor ACE2. J mol med. 2006;84(10):814-20. doi: 10.1007/s00109-006-0094-9. google scholar
  • 14. Chang L-Y, Lu C-Y, Shao P-L, Lee P-I, Lin M-T, Fan T-Y, et al. Viral infections associated with Kawasaki disease. J Formos Med Assoc. 2014;113(3):148-54. doi: 10.1016/j.jfma.2013.12.008. google scholar
  • 15. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2. doi: 10.1016/S2213-2600(20)30076-X. google scholar
  • 16. Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. 2020. doi: 10.1161/cırculatıonaha.120.048360. google scholar
  • 17. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem inflammatory syndrome in US children and adolescents. N Engl J Med. 2020;383(4):334-46. doi: 10.1056/NEJMoa2021680. google scholar
  • 18. Carlin RF, Fischer AM, Pitkowsky Z, Abel D, Sewell TB, Landau EG, et al. Discriminating MIS-C Requiring Treatment from Common Febrile Conditions in Outpatient Settings. J Pediatr. 2020. doi: 10.1016/j.jpeds.2020.10.013. google scholar
  • 19. Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383(4):347-58. doi: 10.1056/NEJMoa2021756. google scholar
  • 20. Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. bmj. 2020;369. doi: 10.1136/bmj.m2094. google scholar
  • 21. Lishman J, Kohler C, De Vos C, Van Der Zalm MM, Itana J, Redfern A, et al. Acute Appendicitis in Multisystem Inflammatory Syndrome in Children With COVID-19. Pediatr Infect Dis J. 2020;39(12):e472-e3. doi: 10.1097/INF.0000000000002900. google scholar
  • 22. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS‐C) Associated with SARS‐CoV‐2 and Hyperinflammation in COVID‐19. Version 2. Arthritis Rheumatol. 2020. doi: 10.1002/art.41616. google scholar
  • 23. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. Jama. 2020. doi: 10.1001/jama.2020.10369. google scholar
  • 24. Mamishi S, Movahedi Z, Mohammadi M, Ziaee V, Khodabandeh M, Abdolsalehi MR, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiol Infec. 2020;148. doi: 10.1017/S095026882000196X. google scholar
  • 25. Türkiye Cumhuriyeti COVID-19 Çocuk Hasta yönetimi ve Tedavi Rehberi.https://covid19bilgi.saglik.gov.tr/depo/rehberler/covid-19-rehberi/COVID-19_REHBERI_COCUK_HASTA_YONETIMI_VE_TEDAVI.pdf. google scholar
  • 26. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet. 2020. doi: 10.1016/S0140-6736(20)31103-X. google scholar
  • 27. Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, et al. COVID-19–associated multisystem inflammatory syndrome in children—United States, March–July 2020. Morbidity and Mortality Weekly Report. 2020;69(32):1074. doi: 10.15585/mmwr.mm6932e2. google scholar
  • 28. Capone CA, Subramony A, Sweberg T, Schneider J, Shah S, Rubin L, et al. Characteristics, cardiac involvement, and outcomes of multisystem inflammatory syndrome of childhood associated with severe acute respiratory syndrome coronavirus 2 infection. J pediatr. 2020;224:141-5. doi: 10.1016/j.jpeds.2020.06.044. google scholar
  • 29. Moraleda C, Serna-Pascual M, Soriano-Arandes A, Simó S, Epalza C, Santos M, et al. Multi-inflammatory syndrome in children related to SARS-CoV-2 in Spain. Clin Infec Dis. 2020. doi: 10.1093/cid/ciaa1042. google scholar
  • 30. Shulman S. Pediatric COVID-associated Multi-system Inflammatory Syndrome (PMIS)[Editorial]. J Pediat Inf Disc Soc. 2020. doi: 10.1093/jpids/piaa062. google scholar
  • 31. Lin K-H, Chang S-S, Yu C-W, Lin S-C, Liu S-C, Chao H-y, et al. Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis. BMJ open. 2015;5(4):e006703. doi: 10.1136/bmjopen-2014-006703. google scholar
  • 32. Rowley AH. Multisystem inflammatory syndrome in children and Kawasaki disease: two different illnesses with overlapping clinical features. The Journal of Pediatrics. 2020;224:129-32. doi: 10.1016/j.jpeds.2020.06.057. google scholar
  • 33. Rowley AH, Shulman ST. The epidemiology and pathogenesis of Kawasaki disease. Front Pediatr. 2018;6:374. doi: 10.3389/fped.2018.00374. google scholar
  • 34. Gatterre P, Oualha M, Dupic L, Iserin F, Bodemer C, Lesage F, et al. Kawasaki disease: an unexpected etiology of shock and multiple organ dysfunction syndrome. Intensive Care Med. 2012;38(5):872-8. doi: 10.1007/s00134-012-2473-8. google scholar
  • 35. Li Y, Luo C, Li W, Xu Z, Zeng C, Bi S, et al. Structure-based preliminary analysis of immunity and virulence of SARS coronavirus. Viral Immunol. 2004;17(4):528-34. doi: 10.1089/vim.2004.17.528. google scholar
  • 36. Gaensbauer JT, Birkholz M, Smit MA, Garcia R, Todd JK. Epidemiology and clinical relevance of toxic shock syndrome in US children. Pediatr Infect Dis J. 2018;37(12):1223-6. doi: 10.1097/INF.0000000000002002. google scholar
  • 37. Lin Y-J, Cheng M-C, Lo M-H, Chien S-J. Early differentiation of Kawasaki disease shock syndrome and toxic shock syndrome in a pediatric intensive care unit. Pediatr infect Dis J. 2015;34(11):1163-7. doi: 10.1097/INF.0000000000000852. google scholar
  • 38. Grom AA, Horne A, De Benedetti F. Macrophage activation syndrome in the era of biologic therapy. Nat Rev Rheumatol. 2016;12(5):259-68. doi: 10.1038/nrrheum.2015.179. google scholar
  • 39. Chesshyre E, Ramanan AV, Roderick MR. Hemophagocytic lymphohistiocytosis and infections: An update. Pediatr infect Dis J.2019;38(3):e54-e6. doi: 10.1097/INF.0000000000002248. google scholar
  • 40. Schram AM, Campigotto F, Mullally A, Fogerty A, Massarotti E, Neuberg D, et al. Marked hyperferritinemia does not predict for HLH in the adult population. Blood. 2015;125(10):1548-52. doi: 10.1182/blood-2014-10-602607. google scholar
  • 41. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1. Arthritis Rheumatol. 2020;72(11):1791-805. doi: 10.1002/art.41454. google scholar
  • 42. Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J. 2020;39(11):e340-e6. doi: 10.1097/INF.0000000000002888. google scholar
  • 43. Capra R, De Rossi N, Mattioli F, Romanelli G, Scarpazza C, Sormani MP, et al. Impact of low dose tocilizumab on mortality rate in patients with COVID-19 related pneumonia. Eur J Intern Med. 2020;76:31-5. doi: 10.1016/j.ejim.2020.05.009. google scholar
  • 44. Cheung EW, Zachariah P, Gorelik M, Boneparth A, Kernie SG, Orange JS, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. Jama. 2020;324(3):294-6. doi: 10.1001/jama.2020.10374. google scholar

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APA

Ekemen Keleş, Y., & Yılmaz Çiftdoğan, D. (2021). Multisystem Inflammatory Syndrome in Children. Journal of Child, 21(1), 74-82. https://doi.org/10.26650/jchild.2021.1.881325


AMA

Ekemen Keleş Y, Yılmaz Çiftdoğan D. Multisystem Inflammatory Syndrome in Children. Journal of Child. 2021;21(1):74-82. https://doi.org/10.26650/jchild.2021.1.881325


ABNT

Ekemen Keleş, Y.; Yılmaz Çiftdoğan, D. Multisystem Inflammatory Syndrome in Children. Journal of Child, [Publisher Location], v. 21, n. 1, p. 74-82, 2021.


Chicago: Author-Date Style

Ekemen Keleş, Yıldız, and Dilek Yılmaz Çiftdoğan. 2021. “Multisystem Inflammatory Syndrome in Children.” Journal of Child 21, no. 1: 74-82. https://doi.org/10.26650/jchild.2021.1.881325


Chicago: Humanities Style

Ekemen Keleş, Yıldız, and Dilek Yılmaz Çiftdoğan. “Multisystem Inflammatory Syndrome in Children.” Journal of Child 21, no. 1 (Nov. 2024): 74-82. https://doi.org/10.26650/jchild.2021.1.881325


Harvard: Australian Style

Ekemen Keleş, Y & Yılmaz Çiftdoğan, D 2021, 'Multisystem Inflammatory Syndrome in Children', Journal of Child, vol. 21, no. 1, pp. 74-82, viewed 15 Nov. 2024, https://doi.org/10.26650/jchild.2021.1.881325


Harvard: Author-Date Style

Ekemen Keleş, Y. and Yılmaz Çiftdoğan, D. (2021) ‘Multisystem Inflammatory Syndrome in Children’, Journal of Child, 21(1), pp. 74-82. https://doi.org/10.26650/jchild.2021.1.881325 (15 Nov. 2024).


MLA

Ekemen Keleş, Yıldız, and Dilek Yılmaz Çiftdoğan. “Multisystem Inflammatory Syndrome in Children.” Journal of Child, vol. 21, no. 1, 2021, pp. 74-82. [Database Container], https://doi.org/10.26650/jchild.2021.1.881325


Vancouver

Ekemen Keleş Y, Yılmaz Çiftdoğan D. Multisystem Inflammatory Syndrome in Children. Journal of Child [Internet]. 15 Nov. 2024 [cited 15 Nov. 2024];21(1):74-82. Available from: https://doi.org/10.26650/jchild.2021.1.881325 doi: 10.26650/jchild.2021.1.881325


ISNAD

Ekemen Keleş, Yıldız - Yılmaz Çiftdoğan, Dilek. “Multisystem Inflammatory Syndrome in Children”. Journal of Child 21/1 (Nov. 2024): 74-82. https://doi.org/10.26650/jchild.2021.1.881325



TIMELINE


Submitted16.02.2021
Accepted07.03.2021
Published Online17.05.2021

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