A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

Haşlak, Fatih; Günalp, Aybüke; Kasapçopur, Özgür

doi:10.1097/bor.0000000000000910

Cited by 13 publications

(13 citation statements)

References 123 publications

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“…IVIG treatment, reported as the first-line therapy for all clinical severity levels of the disease,[ 29 ] was applied to 96.6% of our patients. In the literature, the use of IVIG treatment varies between 71 and 100%.…”

Section: Discussionmentioning

confidence: 99%

The evaluation of the burden of multisystem inflammatory syndrome in children on health economics

Balkarlı,

Kıymet,

Böncüoğlu

et al. 2023

Arch Rheumatol

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Objectives: This study aimed to evaluate the diagnostic tests and treatments applied in patients with multisystem inflammatory syndrome in children (MIS-C) and to determine the effect of the disease on health costs. Patients and methods: This retrospective cohort study included 59 MIS-C patients (40 males, 19 females; mean age: 7.7±4.2 years; range, 4 months to 16.5 years) who were admitted and treated between April 1, 2020, and November 1, 2021. Demographic and clinical features with hospital costs and length of stay were retrospectively reviewed from the medical files and computerized system of the hospital. Direct medical care costs of items were calculated with the hospital perspective using a combination of microcosting technique (resource-based accounting method) and hospital list data. Cases were classified as mild, moderate, or severe, and the patients were divided into two groups: the mild group and the moderate-severe group. Classification was determined by the vasoactive inotropic score (VIS), degree of respiratory support, and evidence of organ damage. Results: The mean age of the cases in the mild group was 6.5±3.7 years, and the mean age of the cases in the moderate-severe group was 9.2±4.3 years. Of 59 patients, 19 (32.2%) were followed up in the pediatric intensive care unit. The median duration of hospitalization in the hospital was 8 (interquartile range: 7-12) days. The total cost of the patients hospitalized with the diagnosis of MIS-C during the study period was 849,242.93$, and the mean cost per patient was 14,393.94±9,631.92$. In the distribution of the total cost of hospitalization according to expenses, the highest rate was pharmacy and blood products (51.99%) and IVIG costs (43.99%). While the mean total cost per person was 13,682.87±8,799.63$ in mild cases, it was 16,433.82±9,440.02$ in moderate-severe cases, and no statistically significant relationship was found between the two groups (p>0.05). There was no difference in the mean cost per patient between the cases with and without heart, lung, kidney, or neurologic involvement and advanced respiratory support (p>0.05). There was a strong positive correlation between the total costs and age (r=0.883, n=59, p<0.0001), with increased amount of costs with increased age. Conclusion: In the study, no statistically significant correlation was found between the total cost of per person in the mild group and the moderate-severe group (p>0.05). This finding may be due to the wide use of IVIG in MIS-C treatment, in addition to low transfer rates to pediatric intensive care units due to high-flow nasal cannula usage.

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Section: Discussionmentioning

confidence: 99%

The evaluation of the burden of multisystem inflammatory syndrome in children on health economics

Balkarlı,

Kıymet,

Böncüoğlu

et al. 2023

Arch Rheumatol

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“…Pediatricians have faced the challenge of differentiating MIS-C patients from classical Kawasaki disease (KD). 5 , 6 Kawasaki disease is diagnosed primarily through clinical criteria. Classic (typical) KD is diagnosed when a child has a fever persisting for at least 5 days, along with the presence of 4 out of 5 specific findings: bilateral conjunctival injection (redness of the whites of the eyes), oral mucosal changes (cracked and red lips, strawberry tongue, etc.…”

Section: Introductionmentioning

confidence: 99%

Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic

Şener,

Batu,

Akca

et al. 2024

Turkish Archives of Pediatrics

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Objective: We aimed to delineate the distinctive characteristics that aid in distinguishing between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with KD-like manifestations during the pandemic. Materials and Methods: We evaluated KD patients and MIS-C patients with KD-like symptoms admitted during the pandemic (between January 2021 and December 2022). Results: Thirty-three MIS-C patients and 15 KD patients were included. Kawasaki disease patients were younger than MIS-C patients (3.4 vs. 7.6 years). Rash ( P = .044, 100% vs. 75.7%), oral mucosal changes ( P = .044, 100% vs. 75.7%), and cervical lymphadenopathy ( P = .001, 93.3% vs. 42.4%) were more common in KD. Multisystem inflammatory syndrome in children: patients had more hypotension ( P = .002, 45.4% vs. 0), gastrointestinal ( P < .001, 72.7% vs. 13.3%), and respiratory symptoms ( P = .044, 24.2% vs. 0). Multisystem inflammatory syndrome in children patients also had low lymphocyte and thrombocyte counts and elevated levels of d -dimer, ferritin, and cardiac parameters, unlike KD patients. Multisystem inflammatory syndrome in children patients exhibited a notable reduction in left ventricular systolic function in echocardiography. Another significant difference with regard to management was the anakinra treatment, which was prescribed for MIS-C patients. Conclusion: Although MIS-C patients might display a clinical resemblance to KD, several features could help differentiate between MIS-C and classical KD. Specific clinical (hypotension, gastrointestinal, and respiratory symptoms) and laboratory (low lymphocyte and thrombocyte counts with higher C-reactive protein, ferritin, d -dimer, and cardiac parameters) features are characteristic of MIS-C. In addition, divergence in management strategies is evident between the 2 diseases, as biologic drugs were more prevalently employed in MIS-C patients than in classical KD patients.

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“…The demographic features of the patients revealed an age range between 7 and 10 years ( 8 , 9 ), depending on the study, with a male predominance. The pathogenic mechanism of MIS-C remains unclear; the most accepted theory describes the primary role of a cytokine storm and the action of the adaptive immunity after SARS-CoV-2 infection ( 10 , 11 ). Additionally, certain intrinsic susceptibility factors in the host have been described and the evidence of molecular mimicry was also presented for the disease pathogenesis ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…The role of pro-inflammation after acute SARS-CoV-2 infection in poor prognosis and complications has been described in the literature ( 10 , 14 ). A set of persistent symptoms occurring after documented SARS-CoV2 infection, defined as post-COVID syndrome (or long COVID), has been described in adults and the pediatric population ( 15 ), not only among those patients who were hospitalized with severe symptoms but also among those who were asymptomatic or with only mild symptoms.…”

Section: Introductionmentioning

confidence: 99%

Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience

et al. 2023

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BackgroundA severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C.MethodsWe enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis.ResultsEndo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted.ConclusionsThe severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.

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A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

Cited by 13 publications

References 123 publications

The evaluation of the burden of multisystem inflammatory syndrome in children on health economics

The evaluation of the burden of multisystem inflammatory syndrome in children on health economics

Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic

Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience

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