Multisystem inflammatory syndrome associated with COVID-19 in pediatric patients
DOI:
https://doi.org/10.51798/sijis.v3i2.306Keywords:
Coronavirus disease 2019-nCoV; Kawasaki disease; little boy; intravenous immunoglobulinsAbstract
Pediatric Multisystem Inflammatory Syndrome (P-MIS) linked to SARS-CoV-2 is a generalized inflammatory reaction that develops approximately 4-6 weeks after COVID-19 illness. The aim of the article was to analyze the immunopathogenesis, diagnosis and treatment of P-MIS. A systematic literature review was performed using databases such as Embase, Redalyc, LILACS, SciELO, Springer, Elsevier, EBSCO and Google Scholar and the keywords: Coronavirus disease, Kawasaki disease, child, intravenous immunoglobulins. Inclusion criteria were: full articles, published between the years 2019-2022, in English and Spanish. Of the 273 articles found, 243 articles were rejected for not meeting the established criteria, with 30 articles selected as eligible. According to the results, SIM-P is characterized by fever, myocardial injury, shock and development of coronary artery aneurysms; laboratory tests show: elevation of markers of inflammation, changes in coagulation tests, especially significant elevation of D-dimer and fibrinogen and elevation of markers of myocardial injury, troponin and natriuretic peptide. Phase 1 treatment occurs with the administration of intravenous immunoglobulin G (IVIG), corticosteroids, low molecular weight heparin in a prophylactic dose; in phase 2, treatment consists of administration of a second dose of IVIG, progressive reduction of prednisone and use of biological therapy; and, in phase 3, infliximab or tocilizumab is used. In conclusion, SIM-P has elevated inflammatory markers and multi-organ involvement, with no associated bacterial diagnosis, with evidence of infection or recent exposure to SARS-CoV-2.
References
Abdul Aleem; Abdul Bari Akbar Samad; Amy K. Slenker. (2022). Emerging Variants of SARS-CoV-2 And Novel Therapeutics Against Coronavirus (COVID-19) (statpearls). https://www.ncbi.nlm.nih.gov/books/NBK570580/
Abrams, J., Oster, M., Bryant, B., Campbell, A., & Kennedy, J. (2021). FACTORS LINKED TO SEVERE OUTCOMES IN MULTISYSTEM INFLAMMATORY YNDROME IN CHILDREN IN THE USA: a retrospective surveillance study. Lancet Child AdolescHealth, March 9, 1–10.
Aleksova, A., Gagno, G., Sinagra, G., Beltrami, A. P., Janjusevic, M., Ippolito, G., Zumla, A., Fluca, A. L., & Ferro, F. (2021). Effects of sars‐cov‐2 on cardiovascular system: The dual role of angiotensin‐converting enzyme 2 (ace2) as the virus receptor and homeostasis regulator‐review. International Journal of Molecular Sciences, 22(9), 1–14. https://doi.org/10.3390/ijms22094526
Arias, J. J. W. A. H., de la Hoz, R. E. H., & Segrera, P. L. L. (2021). What do we know about kawasaki disease and covid-19? Andes Pediatrica, 92(2), 281–287. https://doi.org/10.32641/andespediatr.v92i2.2786
Callaway, E. (2020). The coronavirus is mutating - does it matter? Nature, 585(7824), 174–177. https://doi.org/10.1038/d41586-020-02544-6
Choi, M., Aiello, E. A., Ennis, I. L., & Villa-Abrille, M. C. (2020). The RAAS and SARS-CoV-2: A riddle to solve. Hipertension y Riesgo Vascular, 37(4), 169–175. https://doi.org/10.1016/j.hipert.2020.05.005
Consiglio, C. R., Cotugno, N., Sardh, F., Pou, C., Amodio, D., Rodriguez, L., Tan, Z., Zicari, S., Ruggiero, A., Pascucci, G. R., Santilli, V., Campbell, T., Bryceson, Y., Eriksson, D., Wang, J., Marchesi, A., Lakshmikanth, T., Campana, A., Villani, A., … D’Amore, C. (2020). The immunology of multisystem inflammatory syndrome in children with COVID-19. medRxiv, January. https://doi.org/10.1101/2020.07.08.20148353
Elliott, W., Guda, M. R., Asuthkar, S., Teluguakula, N., Prasad, D. V. R., Tsung, A. J., & Velpula, K. K. (2021). PAD Inhibitors as a Potential Treatment for SARS-CoV-2 Immunothrombosis. July, 1–13.
Estrada, C. (2020). Comportamiento clínico epidemiológico de la Covid-19. Multimed [online], 24(4), 870–886. http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S1028-48182020000400870
Feldstein, L. R., Rose, E. B., Horwitz, S. M., Collins, J. P., Newhams, M. M., Son, M. B. F., Newburger, J. W., Kleinman, L. C., Heidemann, S. M., Martin, A. A., Singh, A. R., Li, S., Tarquinio, K. M., Jaggi, P., Oster, M. E., Zackai, S. P., Gillen, J., Ratner, A. J., Walsh, R. F., Randolph, A. G. (2020). Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. New England Journal of Medicine, 383(4), 334–346. https://doi.org/10.1056/nejmoa2021680
Feldstein, L. R., Tenforde, M. W., Friedman, K. G., Newhams, M., Rose, E. B., Dapul, H., Soma, V. L., Maddux, A. B., Mourani, P. M., Bowens, C., Maamari, M., Hall, M. W., Riggs, B. J., Giuliano, J. S., Singh, A. R., Li, S., Kong, M., Schuster, J. E., McLaughlin, G. E., … Randolph, A. G. (2021). Characteristics and Outcomes of US Children and Adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C) Compared with Severe Acute COVID-19. JAMA - Journal of the American Medical Association, 325(11), 1074–1087. https://doi.org/10.1001/jama.2021.2091
Harrison, A. G., Lin, T., & Wang, P. (2020). Mechanisms of SARS-CoV-2 Transmission and Pathogenesis. Trends in Immunology, 41(12), 1100–1115. https://doi.org/10.1016/j.it.2020.10.004
Hemmer, C. J., Löbermann, M., & Reisinger, E. C. (2021). COVID-19: epidemiology and mutations: An update. Radiologe, 61(10), 880–887. https://doi.org/10.1007/s00117-021-00909-0
Holstein, B. (2021). Multisystem Inflammatory Sydrome in Children. The journal for nurses practitioners practitioners, January.
Howard-Jones, A. R., Burgner, D. P., Crawford, N. W., Goeman, E., Gray, P. E., Hsu, P., Kuek, S., McMullan, B. J., Tosif, S., Wurzel, D., Bowen, A. C., Danchin, M., Koirala, A., Sharma, K., Yeoh, D. K., & Britton, P. N. (2022). COVID-19 in children. II: Pathogenesis, disease spectrum and management. Journal of Paediatrics and Child Health, 58(1), 46–53. https://doi.org/10.1111/jpc.15811
Islam, A., Ahmed, A., Naqvi, I. H., & Parveen, S. (2020). Emergence of deadly severe acute respiratory syndrome coronavirus-2 during 2019–2020. VirusDisease, 31(2), 128–136. https://doi.org/10.1007/s13337-020-00575-1
Kabeerdoss, J., Pilania, R. K., Karkhele, R., Kumar, T. S., Danda, D., & Singh, S. (2021). Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatology International, 41(1), 19–32. https://doi.org/10.1007/s00296-020-04749-4
Le, N. K., Kaman, K., Martin, H. C., Mullur, J., Stenehjem, K. K., Coomar, L., Bahar, B., Dutta, M., Izurieta, R., & Brooks, J. P. (2021). The immunologic response to severe acute respiratory syndrome coronavirus 2. Allergy and Asthma Proceedings, 42(6), 495–505. https://doi.org/10.2500/aap.2021.42.210077
Li, D. L., Davogustto, G., Soslow, J. H., Wassenaar, J. W., Parikh, A. P., Chew, J. D., Dendy, J. M., George-Durrett, K. M., Parra, D. A., Clark, D. E., & Hughes, S. G. (2022). Characteristics of COVID-19 Myocarditis With and Without Multisystem Inflammatory Syndrome. American Journal of Cardiology, 168(2), 135–141. https://doi.org/10.1016/j.amjcard.2021.12.031
Margarita, G., Romero, O., Santiesteban, V. S., Felic, G., Rodr, E., Santiesteban, B. S., Coello, M. G., Docente, G., & Ilich, V. (2019). Introducción. 23(2), 206–218.
Menon, N. M., & Srivaths, L. V. (2022). Thromboembolism in children with multisystem inflammatory syndrome: a literature review. Pediatric Research, May, 1–5. https://doi.org/10.1038/s41390-021-01873-0
Ministerio de Salud Pública. (2020). Alerta Epidemiológica por Síndrome inflamatorio multisistémico en niños y adolescentes (menores de 19 años). Revista Espanola de Salud Publica, 94, 1–4. https://doi.org/10.4321/S1135-57272020000100001
Naranjo Arango, Y. A., Farfán Cortés, A. Y. A. A., García Henao, J. P., Arango Slingsby, C., & Saldarriaga Rivera, L. M. (2021). Multisystemic inflammatory syndrome in children with COVID-19: A rheumatology perspective. Revista Colombiana de Reumatología (English Edition), 28(4), 289–299. https://doi.org/10.1016/j.rcreue.2020.09.004
Nikolopoulou, G. B., & Maltezou, H. C. (2022). COVID-19 in Children: Where do we Stand? Archives of Medical Research, 53(1), 1–8. https://doi.org/10.1016/j.arcmed.2021.07.002
OMS. (2020). Síndrome inflamatorio multisistémico en niños y adolescentes con COVID-19. Informe científico, 1–3.
OPS. (2021). Actualización Epidemiológica Enfermedad por coronavirus Tabla de Contenido. Ops, 26.
Oz, M., Ernst, D., & Kabbani, N. (2021). A comprehensive guide to the pharmacologic regulation of angiotensin convertin enzyme 2 (ACE 2), the SARS COV 2 entry receptor. Pharmacologiy and Therapeutics, 1–44.
Pal, M., Berhanu, G., Desalegn, C., & Kandi, V. (2020). Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): An Update. Cureus, 2(3). https://doi.org/10.7759/cureus.7423
Paola, A., Álvarez, L., Carolina, A., & Urdiales, S. (2021). C OVID-19. 168–172.
Papanikolaou, V., Chrysovergis, A., Ragos, V., Tsiambas, E., Katsinis, S., Manoli, A., Papouliakos, S., Roukas, D., Mastronikolis, S., Peschos, D., Batistatou, A., Kyrodimos, E., & Mastronikolis, N. (2022). From delta to Omicron: S1-RBD/S2 mutation/deletion equilibrium in SARS-CoV-2 defined variants. Gene, 814(December 2021), 146134. https://doi.org/10.1016/j.gene.2021.146134
Prata-Barbosa, A., Lima-Setta, F., Santos, G. R. dos, Lanziotti, V. S., de Castro, R. E. V., de Souza, D. C., Raymundo, C. E., de Oliveira, F. R. C., de Lima, L. F. P., Tonial, C. T., Colleti, J., Bellinat, A. P. N., Lorenzo, V. B., Zeitel, R. de S., Pulcheri, L., Costa, F. C. M. da, La Torre, F. P. F., Figueiredo, E. A. das N., Silva, T. P. da, … de Magalhães-Barbosa, M. C. (2020). Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. Jornal de Pediatria, 96(5), 582–592. https://doi.org/10.1016/j.jped.2020.07.002
Ramcharan, T., Nolan, O., Lai, C. Y., Prabhu, N., Krishnamurthy, R., Richter, A. G., Jyothish, D., Kanthimathinathan, H. K., Welch, S. B., Hackett, S., Al-Abadi, E., Scholefield, B. R., & Chikermane, A. (2020). Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatric Cardiology, 41(7), 1391–1401. https://doi.org/10.1007/s00246-020-02391-2
Rowley, A. H. (2020). Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nature Reviews Immunology, 20(8), 453–454. https://doi.org/10.1038/s41577-020-0367-5
Salinas F., Mauricio. (2020). Sobre las revisiones sistemáticas y narrativas de la literatura en Medicina. Revista chilena de enfermedades respiratorias, 36(1), 26-32. https://dx.doi.org/10.4067/S0717-73482020000100026
Sperotto, F., Friedman, K. G., Son, M. B. F., VanderPluym, C. J., Newburger, J. W., & Dionne, A. (2021). Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. European Journal of Pediatrics, 180(2), 307–322. https://doi.org/10.1007/s00431-020-03766-6
Stawicki, S., Jeanmonod, R., Miller, A., Paladino, L., Gaieski, D., Yaffee, A., De Wulf, A., Grover, J., Papadimos, T., Bloem, C., Galwankar, S., Chauhan, V., Firstenberg, M., DI Somma, S., Jeanmonod, D., Garg, S., Tucci, V., Anderson, H., Fatimah, L., … Garg, M. (2020). The 2019-2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper. Journal of Global Infectious Diseases, 12(2), 47–93. https://doi.org/10.4103/jgid.jgid_86_20
Torres, J. P., Izquierdo, G., Acuña, M., Pavez, D., & Reyes, F. (2020). Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiafgo de Chile during the SARS-CoV2 pandemic. International Journal of Infectious Disease, August.
Vogel, T. P., Top, K. A., Karatzios, C., Hilmers, D. C., Tapia, L. I., Moceri, P., Giovannini-chami, L., Wood, N., Chandler, R. E., Klein, N. P., Schlaudecker, E. P., Poli, M. C., Muscal, E., & Munoz, F. M. (2021). Multisystem inflammatory syndrome in children and adults: case definition and guidelines for data collection, analysis and presentation of immunization safety data. Feb 25, 1–14.
Wang, H., Li, X., Li, T., Zhang, S., Wang, L., Wu, X., & Liu, J. (2020). The genetic sequence, origin, and diagnosis of SARS-CoV-2. European Journal of Clinical Microbiology and Infectious Diseases, 39(9), 1629–1635. https://doi.org/10.1007/s10096-020-03899-4
Wang, L., Li, G., Yuan, C., Yang, Y., Ling, G., Zheng, J., Zhou, Y., Zhang, T., Lin, W., & Lin, Z. (2021). Progress in the diagnosis and treatment of COVID-19 in children: A review. International Journal of General Medicine, 14(November), 8097–8108. https://doi.org/10.2147/IJGM.S335888
Whittaker, E., Bamford, A., Kenny, J., Kaforou, M., Jones, C. E., Shah, P., Ramnarayan, P., Fraisse, A., Miller, O., Davies, P., Kucera, F., Brierley, J., McDougall, M., Carter, M., Tremoulet, A., Shimizu, C., Herberg, J., Burns, J. C., Lyall, H., & Levin, M. (2020). Clinical Characteristics of 58 Children with a Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2. JAMA - Journal of the American Medical Association, 324(3), 259–269. https://doi.org/10.1001/jama.2020.10369
Wong Chew, R. M., Díaz Ramírez, J. B., Vite Velázquez, X., Cortázar Maldonado, L. A., García Osorno, Z. R., Perón Medina, L. Á., Ramírez Velázquez, I. O., Vilchis, H. J., Gutiérrez Bautista, D., Mosqueda Martínez, E. E., Chávez Aguilar, J. E., Cruz Salgado, A. X., Morales Fernández, J. A., Vásquez Martínez, L. M., Valadez González, Y., Ángel Ambrocio, A. H., Bautista Carbajal, P., & García León, M. L. (2021). Caracterización genómica y variantes del virus SARS-CoV-2. Acta Médica Grupo Ángeles, 19(3), 445–456. https://doi.org/10.35366/101743
Yagnam R., F., Izquierdo C., G., Villena M., R., González M., C., & Drago T., M. (2021). Pediatric multisystemic inflammatory syndrome temporarily associated with covid-19: Clinical characteristics and management in a pediatric critical care unit. Andes Pediatrica, 92(3), 395–405. https://doi.org/10.32641/andespediatr.v92i3.3333
Zimmermann, P., & Curtis, N. (2020). Coronavirus infections in children including COVID-19: An overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatric Infectious Disease Journal, 39(5), 355–368. https://doi.org/10.1097/INF.0000000000002660
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