Patterns of myocardial involvement in children during COVID-19 pandemic: Early experience from northern Italy

Ferrero, Paolo; Piazza, Isabelle; Bonino, Cecilia; Ciuffreda, Matteo

doi:10.4103/apc.apc_77_20

Cited by 10 publications

(17 citation statements)

References 11 publications

(9 reference statements)

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“…Fever was documented in nearly all patients (922/928; 99.4%) [ 11 – 17 , 23 , 24 , 30 – 85 ], commonly during at least 5 days (258/928; 27.0%). The majority (598/699; 85.6%) presented gastrointestinal symptoms, mostly abdominal pain (315/539; 58.4%), vomiting (306/532; 57.5%), and diarrhea (268/532; 50.4%) [ 11 – 14 , 16 , 24 , 26 , 30 – 37 , 39 , 40 , 43 – 45 , 47 , 49 – 52 , 54 – 77 , 79 , 80 , 82 , 84 – 86 ]. Cardiovascular manifestations were found in 79.3% of patients (307/387) [ 11 – 17 , 24 , 30 – 37 , 39 – 41 , 44 – 49 , 51 – 86 ].…”

Section: Resultsmentioning

confidence: 99%

“…Pericardial effusion was frequently found (114/511; 22.3%). Half of cases (295/587; 50.3%) showed respiratory symptoms, including upper respiratory tract symptoms (95/397; 23.9%), dyspnea (101/378; 26.7%) and (multiple) radiological infiltrates (114/321; 35.5%) [ 14 , 15 , 23 , 33 , 35 , 37 , 38 , 40 , 44 , 45 , 47 , 52 , 59 , 60 , 66 , 68 , 71 , 73 , 77 , 82 ]. Thirteen cases (1.4%) revealed thrombotic complications [ 11 , 13 , 16 , 17 , 74 , 78 ], including 2 splenic infarctions [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…A quarter of patients (130/557; 23.3%) fulfilled criteria for complete KD [ 12 , 13 , 15 , 30 , 35 , 37 , 41 , 45 , 46 , 50 , 53 , 56 , 59 , 61 , 63 , 64 , 68 , 69 , 72 , 73 , 77 , 79 , 81 , 83 , 85 , 86 ] (criteria in Supplementary information 1 ). A similar proportion (99/411; 24.1%) fulfilled 2 or 3 of the KD criteria in combination with prolonged fever, resembling incomplete KD [ 11 – 13 , 32 , 36 , 39 , 44 , 47 , 48 , 52 , 54 , 57 , 61 – 63 , 65 – 69 , 77 , 79 , 81 , 83 ]. Polymorphous exanthema (466/849; 54.9%) and non-purulent conjunctivitis (423/849; 49.8%) occurred the most.…”

Section: Resultsmentioning

confidence: 99%

“…Polymorphous exanthema (466/849; 54.9%) and non-purulent conjunctivitis (423/849; 49.8%) occurred the most. Although shock was frequently reported in single cases (103/138; 74.6%), shock only presented in half of single cases with complete KD (11/24; 45.8%) [ 12 , 30 , 35 , 41 , 45 , 46 , 53 , 68 , 69 , 72 , 77 ].…”

Section: Resultsmentioning

confidence: 99%

“…Increased inflammatory markers were frequently documented (Fig. 4 ) [ 11 , 12 , 24 , 30 – 57 , 60 , 62 , 64 , 66 – 73 , 75 – 77 , 80 , 84 ], including C-reactive protein (CRP; median 249 mg/l [IQR 173–322] in single cases), ferritin (910 μg/l [457–1521]), and interleukin-6 (244.5 pg/ml [107–379]). Notably, patients exhibited substantially higher inflammation compared to historical KD [ 15 , 64 ] or non-PIMS-TS/MIS(-C) [ 23 ] cohorts.…”

Section: Resultsmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

2021

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An association between a novel pediatric hyperinflammatory condition and SARS-CoV-2 was recently published and termed pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome (in children) (MIS(-C)). We performed a systematic review and describe the epidemiological, clinical, and prognostic characteristics of 953 PIMS-TS/MIS(-C) cases in 68 records. Additionally, we studied the sensitivity of different case definitions that are currently applied. PIMS-TS/MIS(-C) presents at a median age of 8 years. Epidemiological enrichment for males (58.9%) and ethnic minorities (37.0% Black) is present. Apart from obesity (25.3%), comorbidities are rare. PIMS-TS/MIS(-C) is characterized by fever (99.4%), gastrointestinal (85.6%) and cardiocirculatory manifestations (79.3%), and increased inflammatory biomarkers. Nevertheless, 50.3% present respiratory symptoms as well. Over half of patients (56.3%) present with shock. The majority of the patients (73.3%) need intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%. Despite severe disease, mortality is rather low (1.9%). Of the currently used case definitions, the WHO definition is preferred, as it is more precise, while encompassing most cases. Conclusion : PIMS-TS/MIS(-C) is a severe, heterogeneous disease with epidemiological enrichment for males, adolescents, and racial and ethnic minorities. However, mortality rate is low and short-term outcome favorable. Long-term follow-up of chronic complications and additional clinical research to elucidate the underlying pathogenesis is crucial. What is Known: • A novel pediatric inflammatory syndrome with multisystem involvement has been described in association with SARS-CoV-2. • To date, the scattered reporting of cases and use of different case definitions provides insufficient insight in the full clinical spectrum, epidemiological and immunological features, and prognosis. What is New: • This systematic review illustrates the heterogeneous spectrum of PIMS-TS/MIS(-C) and its epidemiological enrichment for males, adolescents, and racial and ethnic minorities. • Despite its severe presentation, overall short-term outcome is good. • The WHO MIS definition is preferred, as it is more precise, while encompassing most cases. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-021-03993-5.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

2021

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Kawasaki-like disease in children with COVID-19

et al. 2020

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Children with Coronavirus disease 2019 (COVID-19) are being reported to have manifestations of hyperinflammatory states and/or Kawasaki-like disease. In this study, we investigated children with typical and atypical Kawasaki disease (KD) likely to be associated with COVID-19. We have reported four children with Kawasaki-like disease probably associated with COVID-19. The clinical features were consistent with incomplete KD in three patients. SARS-CoV-2 RT-PCR was positive in one and the serology was positive in one patient with negative RT-PCR. Corticosteroids, anakinra, intravenous immunoglobulin (IVIG), and acetylsalicylic acid were used in the treatment. Three patients recovered after the treatment while one patient died. The literature review revealed 36 articles describing 320 children with Kawasaki-like disease associated with COVID-19. SARS-CoV-2 RT-PCR was negative in 120 (65.5%) of 183 patients while the serology was positive in 130 (83.8%) of 155 patients. The therapeutic options have included IVIG, acetylsalicylic acid, tocilizumab, anakinra, enoxaparin, and methylprednisolone. Pediatric COVID-19 cases may present with atypical/incomplete Kawasaki-like disease. Thus, pediatricians need to be aware of such atypical presentations resembling KD for early diagnosis of COVID-19.

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Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Campbell

2021

Curr Cardiol Rep

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Purpose of Review To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Recent Findings Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred. Summary Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.

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Patterns of myocardial involvement in children during COVID-19 pandemic: Early experience from northern Italy

Cited by 10 publications

References 11 publications

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

Kawasaki-like disease in children with COVID-19

Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

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