Pediatric Case of Severe COVID-19 With Shock and Multisystem Inflammation

Nguyen, David C; Haydar, Hanan; Pace, Emily A.; Zhang, Xiaochun Susan; Dobbs, Katherine R.

doi:10.7759/cureus.8915

Cited by 16 publications

(24 citation statements)

References 16 publications

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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%

“…Although white blood cell counts were frequently increased (12,800/μl [9150–20,075]), lymphocytopenia was common (831.5/μl [510–1157.5]) [ 12 , 24 , 30 – 36 , 39 – 41 , 43 – 46 , 48 – 50 , 52 – 57 , 60 , 62 , 67 – 73 , 75 , 77 , 80 , 84 ], contrasting with historical KD cohorts [ 15 , 64 ] (median lymphocytes 2800–3080/μl) or non-PIMS-TS/MIS(-C) (median 2100/μl) [ 23 ]. Most PIMS-TS/MIS(-C) presented reduced to normal thrombocytes (platelets below 150,000/μl in 44/104; 42.3%) [ 11 , 12 , 24 , 30 , 32 – 36 , 38 , 40 , 41 , 43 – 46 , 48 , 50 , 52 – 56 , 62 , 66 – 68 , 70 , 71 , 77 , 80 , 84 ]. Thrombocytosis (platelets above 450,000/μl), a typical KD sign and a laboratory criterium for incomplete KD [ 87 ], occurred in only 5/104 (4.8%).…”

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%

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

2021

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“… N.A. MIS-C, shock IVIg, ASA Recovered [ 232 ] 1 (confirmed) F 10y MIS-C, shock None Recovered [ 233 ] 1 (confirmed) F 5y MIS-C, shock IVIg, ASA Recovered [ 234 ] 3 (all confirmed) 1 M 2 F 8.3y MIS-C, shock 2 IVIg, 3 glucocorticoids, 1 TCZ Recovered [ 235 ] 10 (8 confirmed) 10 M 6 F 9.2y MIS-C, 10 shock 5 IVIg, 10 glucocorticoids, 2 anakinra Recovered 4 Coronary artery abnormalities [ 236 ] 6 (all confirmed) 2 M 4 F 6y MIS-C, 5 shock 6 IVIg, 6 glucocorticoids Recovered [ 237 ] 12 (all confirmed) 9 M 3 F 8y MIS-C N.A. Recovered 2 Coronary artery abnormalities [ 238 ] 15 (all confirmed) 9 M 6 F 11.5y MIS-C 12 IVIg, 3 glucocorticoids, 9 TCZ, 2 anakinra, 2 ASA 1 Death …”

Section: Resultsmentioning

confidence: 99%

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

Novelli

Motta

Santis

et al. 2021

Journal of Autoimmunity

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“…Levels of many cytokines have been found to be increased in severe, critically ill and fatal cases 14,22,156,166,171 . Of note, there are emerging reports of a rare systemic inflammatory condition in children, resembling typical or atypical Kawasaki disease, presently named Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS‐CoV‐2 infection (PIMS‐TS), toxic shock syndromes, bacterial sepsis and macrophage activation syndromes (http://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19) 77,106,107,111,114,203,209‐229 of whom some but not all test positive for COVID‐19. The clinical characteristics of PIMS‐TS include cardiac disease sometimes including coronary artery aneurysms, the need for intensive care and inotrope, and additional treatments.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus global pandemic: An overview of current findings among pediatric patients

Perikleous

Tsalkidis

Bush

et al. 2020

Pediatric Pulmonology

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Background The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. Aim To assess the characteristics of COVID‐19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. Search Strategy An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS‐CoV‐2, COVID‐19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. Results The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. Conclusions Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS‐CoV‐2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.

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Pediatric Case of Severe COVID-19 With Shock and Multisystem Inflammation

Cited by 16 publications

References 16 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

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

Coronavirus global pandemic: An overview of current findings among pediatric patients

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