Peculiarities of the course of multisystem inflammatory syndrome associated with COVID-19 in children: from literature review to own clinical observations

Authors

  • L.V. Pypa National Pirogov Memorial Medical University, Vinnytsya, Ukraine, Ukraine
  • N.V. Piljujko National Pirogov Memorial Medical University, Vinnytsya, Ukraine, Ukraine
  • I.V. Odarchuk National Pirogov Memorial Medical University, Vinnytsya, Ukraine, Ukraine
  • A.V. Filyk National Pirogov Memorial Medical University, Vinnytsya, Ukraine, Ukraine
  • N.O. Zymak-Zakutnja Municipal Enterprise “Khmelnytskyi City Children’s Hospital” Khmelnytskyi City Council, Khmelnytskyi, Ukraine, Ukraine
  • N.O. Kabachynska Municipal Enterprise “Khmelnytskyi City Children’s Hospital” Khmelnytskyi City Council, Khmelnytskyi, Ukraine, Ukraine
  • I.E. Gurnitska Municipal Enterprise “Khmelnytskyi City Children’s Hospital” Khmelnytskyi City Council, Khmelnytskyi, Ukraine, Ukraine
  • V.S. Lysyk Municipal Enterprise “Khmelnytskyi City Children’s Hospital” Khmelnytskyi City Council, Khmelnytskyi, Ukraine, Ukraine
  • Z.I. Kovtun Municipal Enterprise “Khmelnytskyi City Children’s Hospital” Khmelnytskyi City Council, Khmelnytskyi, Ukraine, Ukraine
  • K.V. Jakymyshyna Municipal Enterprise “Khmelnytskyi City Children’s Hospital” Khmelnytskyi City Council, Khmelnytskyi, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2312-413X.9.3.2021.236228

Keywords:

children, SARS-CoV-2, COVID-19, MIS-C, Kawasaki disease, hyperinflammatory syndrome

Abstract

Current data suggest that during the global pandemic of COVID-19 children are less affected than adults and most of them are asymptomatic or with mild symptoms. However, recently, cases of pediatric patients who have developed severe inflammatory syndrome temporally related to SARS-CoV-2 have been reported both in the USA and Europe. These reports, although sharing features with other pediatric syndromes such as Kawasaki disease (KD), Kawasaki disease shock syndrome, macrophage activated syndrome, and toxic shock syndrome, seem to outline a novel entity syndrome, characterized by cytokine storm with elevated inflammatory markers and typical clinical finding. Clinical characteristics are greater median age than KD, higher frequency of cardiac involvement and gastrointestinal symptoms, lower frequency of coronary anomalies. We report a summary of the current evidence about clinical features, pathogenesis, therapy strategies, and outcome of this novel syndrome.

References

Dong Y., Mo X., Hu Y. et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020. 145(6). e20200702. doi: 10.1542/peds.2020-0702 [PubMed] [Google Scholar].

Li W., Moore M.J., Vasilieva N. et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003. 426(6965). 450-454 [PMC free article] [PubMed] [Google Scholar].

Castagnoli R., Votto M., Licari A. et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020 April. doi: 10.1001/jamapediatrics.2020.1467. Online ahead of print [PubMed] [Google Scholar].

Koné-Paut I., Cimaz R. Is it Kawasaki shock syndrome, Kawasaki-like disease or pediatric inflammatory multisystem disease? The importance of semantic in the era of COVID-19 pandemic. RMD Open. 2020. 6. e001333 [PMC free article] [PubMed] [Google Scholar].

Verdoni L., Mazza A., Gervasoni A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicenter of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020. 395(10239). 1771-1778 [PMC free article] [PubMed] [Google Scholar].

Jones V.G., Mills M., Suarez D. et al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hosp. Pediatr. 2020. 10. 537-540 [PubMed] [Google Scholar].

Riphagen S., Gomez X., Gonzalez-Martinez C., Wilkinson N., Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020. 23. 395(10237). 1607-1608 [PMC free article] [PubMed] [Google Scholar].

Belhadjer Z., Méot M., Bajolle F. et al. Acute heart failure in multisystem inflammatory syndrome children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. 2020 doi.org/10.1161/CIRCULATIONAHA.120.048360 Online ahead of print [PubMed] [Google Scholar].

Licciardi F., Pruccoli G., Denina M. et al. SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome: a novel COVID phenotype in children. Pediatrics. 2020. May 21. e20201711. doi: 10.1542/peds.2020-1711 [PubMed] [Google Scholar].

Toubiana J., Poirault C., Corsia A., Bajolle F., Fourgeaud J., Angoulvant F. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020 Jun. 369. doi: 10.1136/bmj.m2094 [PMC free article] [PubMed] [Google Scholar].

Makino N., Nakamura Y., Yashiro M. et al. Descriptive epidemiology of Kawasaki disease in Japan, 2011–2012: from the results of the 22nd nationwide survey. J. Epidemiol. 2015. 25. 239-245 [PMC free article] [PubMed] [Google Scholar].

Esper F., Shapiro E.D., Weibel C., Ferguson D., Landry M.L., Kahn J.S. Association between a novel human coronavirus and Kawasaki disease. J. Infect. Dis. 2005. 191. 499-502 [PMC free article] [PubMed] [Google Scholar].

Ebihara T., Endo R., Ma X., Ishiguro N., Kikuta H. Lack of association between New Haven coronavirus and Kawasaki disease. J. Infect. Dis. 2005. 192. 351-352 [PMC free article] [PubMed] [Google Scholar].

Shirato K., Imada Y., Kawase M., Nakagaki K., Matsuyama S., Taguchi F. Possible involvement of infection with human coronavirus 229E, but not NL63, in Kawasaki disease. J. Med. Virol. 2014. 86. 2146-2153 [PMC free article] [PubMed] [Google Scholar].

Ravelli A., Minoia F., Davì S. et al. Classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann. Rheum. Dis. 2016. 75. 481-489 [PubMed] [Google Scholar].

Kanegaye J.T., Wilder M.S., Molkara D. Recognition of a Kawasaki disease shock syndrome. Pediatrics. 2009. 123. e783-e789 [PMC free article] [PubMed] [Google Scholar].

Chuang Y.-Y., Huang Y.-C., Lin T.-Y. Toxic Shock Syndrome in Children. Pediatric Drugs. 2005. 7(1). 11-25 [PubMed] [Google Scholar].

Royal College of Paediatrics and Child Health (RCPCH) Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. May 2020. https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf. July 30, 2020 [Google Scholar].

Centers for Disease Control and Prevention: Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C). 14 May 2020. https://www.cdc.gov/mis-c/hcp/. July 30, 2020 [Google Scholar].

Istituito Superiore di Sanità. Indicazioni ad interim su malattia di Kawasaki e sindrome infiammatoria acuta multisistemica in età pediatrica e adolescienziale nell’attuale scenario emergenziale da infezione Sars-CoV-2. 2020, Rapporto ISS COVID-19 n. 29/2020 [Google Scholar].

Ramcharan T., Nolan O., Lai C.Y. et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital. Pediatr. Cardiol. 2020 Jun. 1-11. doi: 10.1007/s00246-020-02391-2. Online ahead of print [PMC free article] [PubMed] [Google Scholar].

Belot A., Antona D., Renolleau S. et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Euro Surveill. 2020 Jun. 25(22). 2001010. doi: 10.2807/1560-7917.ES.2020.25.22.2001010 [PMC free article] [PubMed] [Google Scholar].

Pouletty M., Borocco C., Ouldali N. et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicenter cohort. Ann. Rheum. Dis. 2020 Aug. 79(8). 999-1006 [PMC free article] [PubMed] [Google Scholar].

Chiotos K., Bassiri H., Behrens E.M. et al. Multisystem Inflammatory Syndrome in Children During The Coronavirus 2019 Pandemic: A Case Series. J. Pediatric Infect. Dis. Soc. 2020 Jul 13. 9(3). 393-398 [PMC free article] [PubMed] [Google Scholar].

Henderson L.A., Canna S.W., Schulert G.S. On the alert for cytokine storm: immunopathology in COVID-19. Arthritis Rheumatol. 2020 Jul. 72(7). 1059-1063 [PMC free article] [PubMed] [Google Scholar].

Molloy E.J., Bearer C.F. COVID-19 in children and altered inflammatory responses. Pediatr. Res. 2020. doi: 10.1038/s41390-020-0881-y. Рublished online April 3 [PubMed] [Google Scholar].

Roncati L., Ligabue G., Fabbiani L., Malagoli C. Type 3 hypersensitivity in COVID-19 vasculitis. Clin. Immunol. 2020. 217 [PMC free article] [PubMed] [Google Scholar].

Huang C., Wang Y., Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020. 395. 497-506. doi: 10.1016/S0140-6736(20)301835 [PMC free article] [PubMed] [Google Scholar].

Nakra N.A., Blumberg D.A., Herrera-Guerra A., Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed management. Children. 2020. 7. 69 [PMC free article] [PubMed] [Google Scholar].

The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19 — preliminary report. N. Engl. J. Med. DOI: 10.1056/NEJMoa2021436 [PMC free article] [PubMed] [Google Scholar].

Wang M., Cao R., Zhang L., Yang X., Liu J., Xu M., Shi Z., Hu Z., Zhong W., Xiao G. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020. 30. 269-271 [PMC free article] [PubMed] [Google Scholar].

Wang Y., Zhang D., Du G., Du R., Zhao J., Jin Y., Fu S., Gao L., Cheng Z., Lu Q. et al. Remdesivir in adults with severe COVID-19: A randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020. 395. 1569-1578 [PMC free article] [PubMed] [Google Scholar].

Feldstein L.R., Rose E.B., Horwitz S.M. et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N. Engl. J. Med. 2020 Jul 23. 383(4). 334-346 [PMC free article] [PubMed] [Google Scholar].

Lami F., Scalabrini I., Lucaccioni L., Iughetti L. The perfect storm: Current evidence on pediatric inflammatory multisystem disease during SARS-CoV-2 pandemic. Acta Biomed. 2020. 91(3). e2020034 [PMC free article] [PubMed] [Google Scholar].

Marchesi A., Tarissi de Jacobis I., Rigante D. Kawasaki disease: guidelines of the Italian Society of Pediatrics, part I — definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase. Ital. J. Pediatr. 2018. 44. 102 [PMC free article] [PubMed] [Google Scholar].

Published

2021-07-13

Issue

Section

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