Discriminating Multisystem Inflammatory Syndrome in Children Requiring Treatment from Common Febrile Conditions in Outpatient Settings

Carlin, Rebecca F.; Fischer, Avital; Pitkowsky, Zachary; Abel, Dori; Sewell, Taylor B.; Landau, E; Caddle, Steve; Robbins-Milne, Laura; Boneparth, Alexis; Milner, Josh; Cheung, Eva W.; Zachariah, Philip; Stockwell, Melissa S.; Anderson, Brett R.; Gorelik, Mark

doi:10.1016/j.jpeds.2020.10.013

Cited by 44 publications

(55 citation statements)

References 16 publications

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“…One study compared MIS-C patients with control patients presenting with febrile illnesses from other common outpatient conditions [ 42 ]. Between these groups, MIS-C patients reported higher temperatures (40 °C vs 38.9 °C), increased frequency of abdominal pain (odds ratio [OR]: 12.5), neck pain (OR: 536.5), conjunctivitis (OR: 31.3), oral mucosal irritation (OR: 11.8), extremity swelling or rash (OR: 99.9), and generalized rash (OR: 7.4) [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…The mainstay of treatment for MIS-C is immunomodulation in those with shock, cardiac involvement, or severe disease manifestations requiring intensive care unit admission [ 1 , 4 , [6] , [7] , [8] , 10 , 40 , 42 , 59 , 60 ]. While there are no prospective studies to date, expert recommendations using data extrapolated from KD advise intravenous immunoglobulin (IVIG) as first-line therapy in doses of 2 g/kg administered every 8–12 h [ 1 , 4 , [6] , [7] , [8] , 10 , 40 , 42 , [59] , [60] , [61] ]. Recent retrospective data have also suggested a potential benefit of early initiation of corticosteroids (prednisolone 2 mg/kg/day given intravenous or oral in 3 divided doses for 10 days), particularly in critically ill children and those on multiple vasoactive medications [ 1 , 4 , 7 , 20 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children with COVID-19

Gottlieb

Bridwell

Ravera

et al. 2021

The American Journal of Emergency Medicine

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Background Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19. Objective The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting. Discussion MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit. Conclusion MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children with COVID-19

Gottlieb

Bridwell

Ravera

et al. 2021

The American Journal of Emergency Medicine

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“…Fever is a key manifestation of MIS-C, with affected children presenting with significantly higher temperatures and longer fever duration than children with other routine pediatric illnesses (25). Thus, children with unremitting fever, an epidemiologic link to SARS-CoV-2, and suggestive clinical symptoms should be considered "under investigation" for MIS-C, while alternative diagnoses that could explain the patient's clinical presentation are also explored (Figure 1).…”

Section: Moderate To Highmentioning

confidence: 99%

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 2

Henderson

Canna

Friedman

et al. 2021

Arthritis & Rheumatology

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365

522

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Objective. To provide guidance on the management of Multisystem Inflammatory Syndrome in Children (MIS-C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Recommendations are also provided for children with hyperinflammation during coronavirus disease 2019 (COVID-19), the acute, infectious phase of SARS-CoV-2 infection. Methods. The Task Force was composed of 9 pediatric rheumatologists and 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS-C and hyperinflammation in COVID-19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved anonymous voting and webinar discussion. A 9-point scale was used to determine the appropriateness of each statement (median scores of 1-3 for inappropriate, 4-6 for uncertain, and 7-9 for appropriate). Consensus was rated as low, moderate, or high based on dispersion of the votes. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, which were prespecified before voting. Results. The first version of the guidance was approved in June 2020, and consisted of 40 final guidance statements accompanied by a flow diagram depicting the diagnostic pathway for MIS-C. The document was revised in November 2020, and a new flow diagram with recommendations for initial immunomodulatory treatment of MIS-C was added. Conclusion. Our understanding of SARS-CoV-2-related syndromes in the pediatric population continues to evolve. This guidance document reflects currently available evidence coupled with expert opinion, and will be revised as further evidence becomes available. Due to the rapidly expanding information and evolving evidence related to COVID-19, which may lead to modification of some guidance statements over time, it is anticipated that updated versions of this article will be published, with the version number included in the title. Readers should ensure that they are consulting the most current version. Guidance developed and/or endorsed by the American College of Rheumatology (ACR) is intended to inform particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to this guidance to be voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. Guidance statements are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidance developed or endorsed by the ACR is subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.

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“…At the same time, myocardial injury outside Kawasaki syndromes has been reported in pediatric patients infected with SARS-CoV-2, and a recent case report describes reversible myocardial injury associated with COVID-19 in an infant. All these show that COVID-19 screening should be performed in children with myocardial injury in an inflammatory context [ 49 , 50 ].…”

Section: Cvd and Covid-19 In Childrenmentioning

confidence: 99%

Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity

Buicu

Benedek

Buicu

et al. 2021

JCM

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COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant “cytokine storm”, which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation also plays a major role in the clinical evolution of COVID-19 patients. Pre-existing inflammatory conditions, such as those associated with chronic coronary diseases, type 2 diabetes mellitus or obesity, may be associated with worse clinical outcomes in the context of COVID-19 disease. These comorbidities are reported as powerful predictors of poor outcomes and death following COVID-19 disease. Moreover, in the context of chronic coronary syndrome, the cytokine storm triggered by SARS-CoV-2 infection may favor vulnerabilization and rupture of a silent atheromatous plaque, with consequent acute coronary syndrome, leading to a sudden deterioration of the clinical condition of the patient. This review aims to present the current status of knowledge regarding the link between COVID-19 mortality, systemic inflammation and several major diseases associated with poor outcomes, such as cardiovascular diseases, diabetes and obesity.

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Discriminating Multisystem Inflammatory Syndrome in Children Requiring Treatment from Common Febrile Conditions in Outpatient Settings

Cited by 44 publications

References 16 publications

Multisystem inflammatory syndrome in children with COVID-19

Multisystem inflammatory syndrome in children with COVID-19

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 2

Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity

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