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COVID-19 Related Pediatric Multisystem Inflammatory Disease (MIS-C): Management and Outcome

Year 2021, Volume: 7 Issue: 2, 105 - 109, 29.05.2021
https://doi.org/10.30934/kusbed.927082

Abstract

The false impression that children have been less harmed than adults during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic was invalidated as pediatric cases resembling Kawasaki disease and toxic shock syndrome started to be reported from the United Kingdom in April 2020.
We propose that this disease, called coronavirus disease 2019 (COVID-19) related pediatric multisystem inflammatory disease (MIS-C), should be managed in hospital even if the diagnosis is uncertain.
In children who have not life-threatening disease, a comprehensive laboratory evaluation should be performed to determine whether the criteria for MIS-C are met and treatment decision should be made after this evaluation. Immunomodulatory treatment should be initiated without waiting for a definitive diagnosis in critically-ill children if the disease is suspected.
Children with MIS-C should be followed up in an institution with subspecialists of pediatric infectious diseases, pediatric rheumatology, pediatric cardiology, pediatric intensive care, and pediatric gastroenterology, if possible.
We suggest that healthcare workers entering rooms of patients with suspected COVID-19 should be cautious against airborne transmission, although this route is controversial for SARS-CoV-2.
Management primarily consists of intravenous immunoglobulin, steroids, biologicals, antithrombotic drugs, and antimicrobial agents.
Although duration of therapy is debatable, the prerequisites of discharge are restoration of cardiac function and no fever in the last 24 hours.
MIS-C has a favorable prognosis, the case fatality rate being only 1-2%.

Project Number

Yok

References

  • Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26. doi:10.1016/j.eclinm.2020.100527
  • Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2.J Am Med Assoc. 2020;324(3):259-269. doi:10.1001/jama.2020.10369
  • Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: An analysis from the pediatric cardiac critical care consortium and virtual PICU system registries. Pediatr Crit Care Med. 2014;15(6):529-537. doi:10.1097/PCC.0000000000000153
  • Lishman J, Kohler C, de Vos C, et al. Acute appendicitis in multisystem inflammatory syndrome in children with COVID-19. Pediatr Infect Dis J. 2020;39(12):e472-e473. doi:10.1097/INF.0000000000002900
  • Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Published 2021.
  • Greenhalgh T, Jimenez JL, Prather KA, Tufekci Z, Fisman D, Schooley R. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. Lancet (London, England). 2021;0(0). doi:10.1016/S0140-6736(21)00869-2
  • Zeynep AE, Öncel S, Sönmez HE. Çocuklarda COVID-19’a ikincil gelişen multisistemik inflamatuar sendrom. Acta Med Nicomedia. 2021;4(1):29-34.
  • Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology clinical guidance for pediatric patients with multisystem inflammatory syndrome in children (MIS‐C) associated with SARS‐CoV‐2 and hyperinflammation in COVID‐19. Version 2. Arthritis Rheumatol. December 2020. doi:10.1002/art.41616
  • Harwood R, Allin B, Jones CE, et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Heal. 2021;5(2):133-141. doi:10.1016/S2352-4642(20)30304-7
  • Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children.J Am Med Assoc. 2021;325(9). doi:10.1001/jama.2021.0694
  • Jonat B, Gorelik M, Boneparth A, et al. Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 in a children’s hospital in New York City. Pediatr Crit Care Med. 2020;22(3):e178-e191. doi:10.1097/PCC.0000000000002598
  • Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res. 2020;194:101-115. doi:10.1016/j.thromres.2020.06.029
  • World Health Organisation. Therapeutics and COVID-19: Living Guideline.; 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.1. Accessed April 24, 2021.
  • Rimensberger PC, Kneyber MCJ, Deep A, et al. Caring for critically ill children with suspected or proven coronavirus disease 2019 infection: recommendations by The Scientific Sections’ Collaborative of The European Society of Pediatric and Neonatal Intensive Care. Pediatr Crit Care Med. 2021;22(1):56-67. doi:10.1097/PCC.0000000000002599
  • American Academy of Pediatrics. COVID-19 Interim Guidance: Return to Sports and Physical Activity. COVID-19 Interim Guidance. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/. Published 2021. Accessed April 23, 2021.
  • Davies P. Addressing fundamental questions on MIS-C. Lancet Child Adolesc Heal. 2021;5(5):310-311. doi:10.1016/s2352-4642(21)00059-6
  • Abrams JY, Oster ME, Godfred-Cato SE, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Heal. 2021;5(5):323-331. doi:10.1016/s2352-4642(21)00050-x
  • Centers for Disease Control and Prevention (CDC). Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States | CDC. Multisystem Inflammatory Syndrome in Children (MIS-C). https://www.cdc.gov/mis-c/cases/index.html. Published 2021. Accessed April 9, 2021.
  • Başar EZ, Sönmez HE, Öncel S, Yetimakman AE, Babaoğlu A. Multisystemic inflammatory syndrome in children associated with COVID-19: a single center experience in Turkey. Turk Arch Pediatr 2021;56(3): 192-9. DOI:10.5152/TurkArchPediatr.2021.21018

COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar

Year 2021, Volume: 7 Issue: 2, 105 - 109, 29.05.2021
https://doi.org/10.30934/kusbed.927082

Abstract

Nisan 2020'de İngiltere’den Kavasaki hastalığı ve toksik şok sendromu benzeri bir klinik tablo ile sağlık kurumuna getirilen çocuk hastaların bildirilmeye başlamasıyla birlikte şiddetli akut solunum sendromu koronavirüsü 2 (SARS-CoV-2) pandemisi sırasında çocukların yetişkinlerden daha az zarar gördüğü inanışı ortadan kalkmıştır.
2019 koronavirüs hastalığı (COVID-19) ile ilişkili pediatrik multisistem inflamatuar hastalık (MIS-C) olarak adlandırılan bu klinik antitenin, tanısı şüphe düzeyinde bile olsa, hastanede tedavi edilmesini önermekteyiz.
Yaşamsal tehlikesi bulunmayan çocuklarda MIS-C ölçütlerinin karşılanıp karşılanmadığının saptanması için kapsamlı bir laboratuvar değerlendirmesi yapılmalı, tedavi kararı bu değerlendirmeden sonra verilmelidir. Klinik durumu kritik olan çocuklara ise, hastalıktan şüphelenildiği takdirde, kesin tanı koyulması beklenmeden immünomodülatör tedavi başlanmalıdır.
MIS-C’li çocuklar mümkünse çocuk enfeksiyon hastalıkları, çocuk romatolojisi, çocuk kardiyolojisi, çocuk yoğun bakım ve çocuk gastroenterolojisi yan dal uzmanlarının bulunduğu bir kurumda izlenmelidir.
Henüz tartışmalı da olsa, SARS-CoV-2’nin hava yoluyla bulaşması söz konusu olduğundan, COVID-19 şüpheli hastaların odalarına giren sağlık çalışanlarının hava yolu bulaşına karşı da tedbirli olmalarını öneriyoruz.
Tedavi başlıca intravenöz immünoglobülin, steroid, biyolojik ajan, antitrombotik tedavi ve antimikrobiyal tedaviden oluşmaktadır.
Tedavi süresi kesinlik kazanmamakla birlikte taburculuk için kardiyak işlevlerin normale dönmesi ve son 24 saatte ateş saptanmaması önkoşuldur.
MIS-C’nin prognozu çoğunlukla iyi olup, vaka fatalite hızı %1-2’dir.

Supporting Institution

Yok

Project Number

Yok

Thanks

Yazar, bu derlemede sözü edilen yerel verileri sağlamadaki katkısı için Doç. Dr. Emine Hafize SÖNMEZ’e teşekkürü bir borç bilir.

References

  • Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26. doi:10.1016/j.eclinm.2020.100527
  • Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2.J Am Med Assoc. 2020;324(3):259-269. doi:10.1001/jama.2020.10369
  • Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: An analysis from the pediatric cardiac critical care consortium and virtual PICU system registries. Pediatr Crit Care Med. 2014;15(6):529-537. doi:10.1097/PCC.0000000000000153
  • Lishman J, Kohler C, de Vos C, et al. Acute appendicitis in multisystem inflammatory syndrome in children with COVID-19. Pediatr Infect Dis J. 2020;39(12):e472-e473. doi:10.1097/INF.0000000000002900
  • Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Published 2021.
  • Greenhalgh T, Jimenez JL, Prather KA, Tufekci Z, Fisman D, Schooley R. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. Lancet (London, England). 2021;0(0). doi:10.1016/S0140-6736(21)00869-2
  • Zeynep AE, Öncel S, Sönmez HE. Çocuklarda COVID-19’a ikincil gelişen multisistemik inflamatuar sendrom. Acta Med Nicomedia. 2021;4(1):29-34.
  • Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology clinical guidance for pediatric patients with multisystem inflammatory syndrome in children (MIS‐C) associated with SARS‐CoV‐2 and hyperinflammation in COVID‐19. Version 2. Arthritis Rheumatol. December 2020. doi:10.1002/art.41616
  • Harwood R, Allin B, Jones CE, et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Heal. 2021;5(2):133-141. doi:10.1016/S2352-4642(20)30304-7
  • Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children.J Am Med Assoc. 2021;325(9). doi:10.1001/jama.2021.0694
  • Jonat B, Gorelik M, Boneparth A, et al. Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 in a children’s hospital in New York City. Pediatr Crit Care Med. 2020;22(3):e178-e191. doi:10.1097/PCC.0000000000002598
  • Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res. 2020;194:101-115. doi:10.1016/j.thromres.2020.06.029
  • World Health Organisation. Therapeutics and COVID-19: Living Guideline.; 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.1. Accessed April 24, 2021.
  • Rimensberger PC, Kneyber MCJ, Deep A, et al. Caring for critically ill children with suspected or proven coronavirus disease 2019 infection: recommendations by The Scientific Sections’ Collaborative of The European Society of Pediatric and Neonatal Intensive Care. Pediatr Crit Care Med. 2021;22(1):56-67. doi:10.1097/PCC.0000000000002599
  • American Academy of Pediatrics. COVID-19 Interim Guidance: Return to Sports and Physical Activity. COVID-19 Interim Guidance. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/. Published 2021. Accessed April 23, 2021.
  • Davies P. Addressing fundamental questions on MIS-C. Lancet Child Adolesc Heal. 2021;5(5):310-311. doi:10.1016/s2352-4642(21)00059-6
  • Abrams JY, Oster ME, Godfred-Cato SE, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Heal. 2021;5(5):323-331. doi:10.1016/s2352-4642(21)00050-x
  • Centers for Disease Control and Prevention (CDC). Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States | CDC. Multisystem Inflammatory Syndrome in Children (MIS-C). https://www.cdc.gov/mis-c/cases/index.html. Published 2021. Accessed April 9, 2021.
  • Başar EZ, Sönmez HE, Öncel S, Yetimakman AE, Babaoğlu A. Multisystemic inflammatory syndrome in children associated with COVID-19: a single center experience in Turkey. Turk Arch Pediatr 2021;56(3): 192-9. DOI:10.5152/TurkArchPediatr.2021.21018
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Paediatrics
Journal Section Review Article
Authors

Selim Öncel 0000-0002-5493-1818

Project Number Yok
Publication Date May 29, 2021
Submission Date April 24, 2021
Acceptance Date May 3, 2021
Published in Issue Year 2021 Volume: 7 Issue: 2

Cite

APA Öncel, S. (2021). COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 7(2), 105-109. https://doi.org/10.30934/kusbed.927082
AMA Öncel S. COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar. KOU Sag Bil Derg. May 2021;7(2):105-109. doi:10.30934/kusbed.927082
Chicago Öncel, Selim. “COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi Ve Sonuçlar”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 7, no. 2 (May 2021): 105-9. https://doi.org/10.30934/kusbed.927082.
EndNote Öncel S (May 1, 2021) COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 7 2 105–109.
IEEE S. Öncel, “COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar”, KOU Sag Bil Derg, vol. 7, no. 2, pp. 105–109, 2021, doi: 10.30934/kusbed.927082.
ISNAD Öncel, Selim. “COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi Ve Sonuçlar”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 7/2 (May 2021), 105-109. https://doi.org/10.30934/kusbed.927082.
JAMA Öncel S. COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar. KOU Sag Bil Derg. 2021;7:105–109.
MLA Öncel, Selim. “COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi Ve Sonuçlar”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, vol. 7, no. 2, 2021, pp. 105-9, doi:10.30934/kusbed.927082.
Vancouver Öncel S. COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar. KOU Sag Bil Derg. 2021;7(2):105-9.