Sixteen Weeks Later: Expanding the Risk Period for Multisystem Inflammatory Syndrome in Children

Cirks, Blake; Rowe, Samantha J; Jiang, Sarah; Brooks, Robert; Mulreany, Michael; Hoffner, Wendy; Jones, Olcay Y.; Hickey, Patrick W.

doi:10.1093/jpids/piab007

Cited by 29 publications

(27 citation statements)

References 12 publications

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“…However, it is now well known that the disease does not have a single phenotype and that various symptoms and system involvements may accompany the disease [ 3 ]. Furthermore, patients presenting several months after a documented COVID-19 illness or after contact with a person having COVID-19 were reported [ 4 ]. The spectrum of the disease has become a subject of increasing interest, as patients with MIS-C express a phenotype similar to many diseases, such as Kawasaki disease (KD), macrophage-activating syndrome (MAS), and septic shock.…”

Section: Introductionmentioning

confidence: 99%

The Multifaceted Presentation of the Multisystem Inflammatory Syndrome in Children: Data from a Cluster Analysis

Sönmez

Çağlayan

Yener

et al. 2022

JCM

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Background: The aim of this study was to evaluate the outcomes of patients with the multisystem inflammatory syndrome in children (MIS-C) according to phenotypes of disease and define the prognostic factors for the severe course. Methods: This cross-sectional study included 293 patients with MIS-C from seven pediatric rheumatology centers. A two-step cluster analysis was performed to define the spectrum of disease and their outcomes were compared between each group. Results: Four subgroups were identified as follows: cluster I, predominantly Kawasaki-like features (n = 100); cluster II, predominantly MAS-like features (n = 34); cluster III, predominantly LV dysfunction (n = 47); cluster IV, other presentations (n = 112). The duration of fever was longer in cluster II and the length of hospitalization was longer in both clusters II and III. Laboratory findings revealed lower lymphocyte and platelet counts and higher acute phase reactants (APRs) in cluster II, while patients in cluster IV showed less inflammation with lower APRs. The resolution of abnormal laboratory findings was longer in clusters II and III, while it was shortest in cluster IV. Seven patients died. Among them, four belonged to cluster II, while three were labeled as cluster III. Patients with severe course had higher levels of neutrophil–lymphocyte ratio, mean platelet volume, procalcitonin, ferritin, interleukin-6, fibrinogen, D-Dimer, BNP, and troponin-I, and lower levels of lymphocyte and platelet counts. Conclusion: As shown, MIS-C is not a single disease presenting with various clinical features and outcomes. Understanding the disease spectrum will provide individualized management.

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Section: Introductionmentioning

confidence: 99%

The Multifaceted Presentation of the Multisystem Inflammatory Syndrome in Children: Data from a Cluster Analysis

Sönmez

Çağlayan

Yener

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Multisystem inflammatory syndrome (MIS) is an uncommon condition that could worsen the outcome in COVID-19 patients. However, there is a post-COVID-19-MIS established in the literature; it usually manifests four to six weeks after the acute phase of the infection, but there is literature exposing the risk period up to sixteen weeks [ 3 , 4 ]. In April 2020, this syndrome was recognized in the United Kingdom (UK) and named Pediatric Inflammatory Multisystem Syndrome ( i.e., Multisystem Inflammatory Syndrome in Children - MIS-C) [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

Reversible Autoimmune Cardiomyopathy Secondary to a Vaccine-Induced Multisystem Inflammatory Syndrome

Neme¹,

Martinez²,

Noboa³

et al. 2022

Cureus

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The Dominican government started an early booster protocol, including a heterogeneous vaccination sequence needed based on availability. We report a case of a 25-year-old male who presented with jaundice, and vomiting for 6 days, associated with maculopapular rash (Mucocutaneous features), elevated pro-B-type natriuretic peptide (pro-BNP), erythrocyte sedimentation rate (ESR), transaminitis (> 1000 U/L), thrombocytopenia, echocardiogram evidenced stigmata of heart failure after his third dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. He was started on steroids and immunoglobulin therapy for multisystemic organ failure syndrome. A significant improvement was noticed, then was discharge; in the post-discharge clinic, he was asymptomatic, inflammatory markers improved, and the echocardiogram showed a recovered ejection fraction. An accurate anamnesis, including a proper chronologic gathering of the events, is essential to recognize a vaccine-multisystem inflammatory syndrome; its prompt assessment and therapy would directly improve the outcome.

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“…The clinical picture of this syndrome can evolve in two directions: in young children with symptoms similar to Kawasaki disease, toxic shock syndrome, or macrophage activation syndrome, and in older children, it predominates in septic shock syndrome [ 16 , 17 , 19 ]. The onset of manifestations occurs 2 to 6 weeks after acute infection with the SARS-CoV-2 virus; in a few cases, it has been found to appear after 6 weeks after the infection [ 20 ]. The symptoms and signs are diverse, and patients who have mild forms at first presentation may develop severe forms of the disease within a few days [ 21 , 22 ].…”

Section: Sars-cov-2 Infectionmentioning

confidence: 99%

Immune Responses to Some Viral Infections That Have a High Evolutionary Potential—A Case Report with Literature Review

Sur

Moldovan

Mocanu

et al. 2022

Life

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Viral infections are a key issue in modern medicine. SARS-CoV-2 infection confirms that we are not sufficiently prepared for these unforeseen infections. The COVID-19 pandemic has cultivated a great sense of fear and distrust in patients. If viral infections, in this case, SARS-CoV-2, overlap with another infection, the symptoms are prolonged and worsened, and complications may occur. Starting from an objective clinical finding of a patient they had in follow-up and treatment, the authors present the problems of the diseases the patient suffered from. These are described as reviews so that readers can get an idea of the clinical methods of expression and the therapeutic possibilities. Therefore, this article describes Lyme disease and post-treatment Lyme disease syndrome, SARS-CoV-2 infection, and multisystem inflammatory syndrome in children (MISC-C), as the patient suffered from an incomplete form of Kawasaki disease. During the treatment for Lyme disease, the patient also contracted the influenza type A virus. Although any of these diseases could have the potential for serious evolution, our patient still went through these infections relatively well. This can be explained by the fact that the patient had a slow immune response to the aforementioned infections, which allowed him to survive these diseases relatively easily, unlike other individuals who have an exaggerated immune response or who suffer from serious immune involvement, e.g., hepatitis B with a fulminant response. The case was presented chronologically, but at the same time, all particular infection manifestations were accurately described. For these reasons, the article is presented in the form of a review, exemplified by the case itself. Of the 52 cases of MISC-C found in the Pediatrics Clinic II of Cluj-Napoca, we present the case of a male patient who presented with Lyme disease, post-treatment Lyme disease syndrome, Kawasaki disease, and MISC-C incomplete form.

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Sixteen Weeks Later: Expanding the Risk Period for Multisystem Inflammatory Syndrome in Children

Cited by 29 publications

References 12 publications

The Multifaceted Presentation of the Multisystem Inflammatory Syndrome in Children: Data from a Cluster Analysis

The Multifaceted Presentation of the Multisystem Inflammatory Syndrome in Children: Data from a Cluster Analysis

Reversible Autoimmune Cardiomyopathy Secondary to a Vaccine-Induced Multisystem Inflammatory Syndrome

Immune Responses to Some Viral Infections That Have a High Evolutionary Potential—A Case Report with Literature Review

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