Treatment of MIS-C in Children and Adolescents

Mahmoud, Sanaa; El-Kalliny, Mostafa; Kotby, Alyaa; El-Ganzoury, Mona M; Fouda, Eman; Ibrahim, Hanan

doi:10.1007/s40124-021-00259-4

Cited by 52 publications

(59 citation statements)

References 78 publications

(114 reference statements)

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“…Prognosis in MIS-C is calculated by taking into account cardiovascular complications, such as presence of ventricular dysfunction and coronary artery aneurysms (CAA). CAA occurs in 9–24% of cases with MIS-C ( 14 , 15 ). These complications have triggered recommendations for immunomodulatory treatments, including intravenous immunoglobulin (IVIG), corticosteroids, biologics, and recommendations for intensive cardiac observation.…”

Section: Clinical Characteristics and Epidemiology Of Covid-19 Kawasa...mentioning

confidence: 99%

“…These complications have triggered recommendations for immunomodulatory treatments, including intravenous immunoglobulin (IVIG), corticosteroids, biologics, and recommendations for intensive cardiac observation. The choice of IVIG treatment was mainly considered based on similarity to Kawasaki disease ( 15 ).…”

Section: Clinical Characteristics and Epidemiology Of Covid-19 Kawasa...mentioning

confidence: 99%

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Mechanisms of Immune Dysregulation in COVID-19 Are Different From SARS and MERS: A Perspective in Context of Kawasaki Disease and MIS-C

et al. 2022

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Coronaviruses have led to three major outbreaks to date-Severe Acute Respiratory Syndrome (SARS; 2002), Middle East Respiratory Syndrome (MERS; 2012) and the ongoing pandemic, Coronavirus Disease (COVID-19; 2019). Coronavirus infections are usually mild in children. However, a few children with MERS had presented with a severe phenotype in the acute phase resulting in progressive pneumonic changes with increasing oxygen dependency and acute respiratory distress requiring ventilatory support. A subset of children with a history of SARS-CoV-2 infection develops a multisystem hyper-inflammatory phenotype known as Multisystem Inflammatory Syndrome in Children (MIS-C). This syndrome occurs 4-6 weeks after infection with SARS-CoV-2 and has been reported more often from areas with high community transmission. Children with MIS-C present with high fever and often have involvement of cardiovascular, gastrointestinal and hematologic systems leading to multiorgan failure. This is accompanied by elevation of pro-inflammatory cytokines such as IL-6 and IL-10. MIS-C has several similarities with Kawasaki disease (KD) considering children with both conditions present with fever, rash, conjunctival injection, mucosal symptoms and swelling of hands and feet. For reasons that are still not clear, both KD and MIS-C were not reported during the SARS-CoV and MERS-CoV outbreaks. As SARS-CoV-2 differs from SARS-CoV by 19.5% and MERS by 50% in terms of sequence identity, differences in genomic and proteomic profiles may explain the varied disease immunopathology and host responses. Left untreated, MIS-C may lead to severe abdominal pain, ventricular dysfunction and shock. Immunological investigations reveal reduced numbers of follicular B cells, increased numbers of terminally differentiated CD4+T lymphocytes, and decreased IL-17A. There is still ambiguity about the clinical and immunologic risk factors that predispose some children to development of MIS-C while sparing others. Host-pathogen interactions in SARS, MERS and COVID-19 are likely to play a crucial role in the clinical phenotypes that manifest. This narrative review focuses on the immunological basis for development of MIS-C syndrome in the ongoing SARS-CoV-2 pandemic. To the best of our knowledge, these aspects have not been reviewed before.

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Section: Clinical Characteristics and Epidemiology Of Covid-19 Kawasa...mentioning

confidence: 99%

Section: Clinical Characteristics and Epidemiology Of Covid-19 Kawasa...mentioning

confidence: 99%

Mechanisms of Immune Dysregulation in COVID-19 Are Different From SARS and MERS: A Perspective in Context of Kawasaki Disease and MIS-C

et al. 2022

View full text Add to dashboard Cite

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“…Rarely the infection can also present with a severe inflammatory syndrome similar to those met in Kawasaki Syndrome [5]; this novel presentation was called multisystem inflammatory syndrome in children (MIS-C) and has an estimated incidence of 2 per 100,000 individuals younger than 21 years old. MIS-C was defined by WHO on the basis of fever, laboratory markers of inflammation, multisystem (≥ 2) organ involvement, and temporal relationship to severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) [6]. Nevertheless, most of the young patients had a mildly-symptomatic or completely asymptomatic infection therefore after a period of interruption of school, sport and recreational activities they needed returning to play.…”

Section: Introductionmentioning

confidence: 99%

Re-evaluation After 2 Years of COVID-19 Pandemic: Return to Play in Pediatric Population: What’s New?

et al. 2022

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An observational retrospective study was conducted on 180 young competitive athletes. These children were revaluated after a mild/moderate SARS-CoV-2 infection through 3 different kind of protocol aimed at recognizing any cardiorespiratory complications due to the infection. The aim of the present study was to evaluate the results of “return to play” Italian Protocols for readmission to competitive sport in pediatric population. All of the subjects analyzed were readmitted at competitive sport after revaluation. None of the young athletes showed cardiorespiratory compromises at first and/or second level evaluation, confirming that in young population there is low risk of hospitalization and life threatening complications after a mild/moderate infection. Italian simplified protocol for resuming sport have proved to be a valuable tool for health assessment both in adult and young athletes allowing them to resume their training in safety.

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“…At the individual level, immunologic testing for SARS-CoV-2 can allow patients to better understand their health status by identifying a previous infection [3]. For example, evidence of a previously undetected infection may be important for managing "long COVID" or multisystem inflammatory syndrome in children (MIS-C) [6,7].…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Use of COVID-19 Immunologic Test Results to Inform Decisions About Daily Activities and COVID-19 Vaccination

Jiang

Akers

Gill

et al. 2022

Preprint

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Importance: Despite widespread use of clinical diagnostic tests to assess prior exposure to SARS-CoV-2, limited evidence exists regarding how test results affect patient behaviors and decision-making. Objective: To understand the rationale behind ordering diagnostic T-cell receptor (TCR) immunosequencing for assessment of prior SARS-CoV-2 infection and evaluate how test results affect patient behaviors, including day-to-day activities and decisions about vaccination. Design: Mandatory demographic information and clinical characteristics were collected for all individuals ordering T-DetectTM COVID. Study participants completed a one-time survey that included additional questions about demographics and clinical characteristics, relevant interactions with healthcare providers, reasons for ordering diagnostic TCR immunosequencing, and the utility of test results. Setting: US participants ordering T-Detect COVID between February 2021 and March 2022. Participants: Of the 806 individuals who underwent diagnostic TCR immunosequencing, provided informed consent, and were sent the email survey, 718 completed the survey (response rate, 89.1%). At the time of receiving the test report, 25.5% of participants had been vaccinated against COVID-19, 29.7% reported a previous COVID-19 infection, and 25.6% were immunocompromised. Main Outcome(s) and Measure(s): Patient demographics and clinical characteristics were reported using descriptive statistics. Additional analyses explored trends in reported data over time and evaluated reasons for ordering diagnostic TCR immunosequencing and behaviors among participant subgroups (vaccinated or unvaccinated individuals and those with positive or negative test results). Logistic regression analysis evaluated factors that increased the likelihood of post-test vaccination. Results: Study participants ordered diagnostic TCR immunosequencing to understand their health status (55.0%) and to inform decision-making about daily activities (43.6%) and vaccination (38.3%). Most participants (92.1%) ordered diagnostic TCR immunosequencing for themselves without consulting their physician. Testing negative for prior SARS-CoV-2 infection was associated with increased likelihood of subsequent COVID-19 vaccination (31.0% vs 6.9%; median time to vaccination, 17.0 days vs 47.5 days), which was confirmed by logistic regression analysis. Conclusions and Relevance: This report presents patient-reported clinical utility of a commercial COVID-19 assay based on an immune response readout. Our findings suggest that participants used diagnostic TCR immunosequencing results to inform decisions about daily activities and COVID-19 vaccination. Trial Registration: Not applicable.

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Treatment of MIS-C in Children and Adolescents

Cited by 52 publications

References 78 publications

Mechanisms of Immune Dysregulation in COVID-19 Are Different From SARS and MERS: A Perspective in Context of Kawasaki Disease and MIS-C

Mechanisms of Immune Dysregulation in COVID-19 Are Different From SARS and MERS: A Perspective in Context of Kawasaki Disease and MIS-C

Re-evaluation After 2 Years of COVID-19 Pandemic: Return to Play in Pediatric Population: What’s New?

Self-Reported Use of COVID-19 Immunologic Test Results to Inform Decisions About Daily Activities and COVID-19 Vaccination

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