Koronavirüs Hastalığı 2019 (COVID-19) Nedeniyle Miyokardit Gelişen Çocukların Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, Koronavirüs hastalığı 2019 (COVID-19) nedeniyle miyokardit gelişen hastaların verilerini paylaşmaktır.

Materyal ve metod: Nisan 2020 ile Ocak 2022 tarihleri arasında COVID-19’a bağlı miyokardit tanısı alan 50 çocuğun verileri retrospektif olarak değerlendirildi.

Bulgular: Hastaların 24’ünde (%48) multisistem inflamatuar sendrom (MIS-C) saptandı. En sık görülen yakınmalar ateş (26 hasta, %52) ve göğüs ağrısı (14 hasta, %28) idi. Sekiz hastada (%16) sistolik disfonksiyon mevcuttu. Bir hastaya kardiyak tamponad nedeniyle perikardiyosentez yapıldı. Dört hastada (%8) akut fulminan miyokardit gelişti ve yoğun bakım gereksinimi oldu. Bir hasta entübasyona ihtiyaç duydu ve sonrasında ekstübe edildi. Yirmi bir hasta (%42) yalnızca intravenöz immünoglobulin ile tedavi edildi, 8 hasta intravenöz immünoglobulin + steroid aldı. Dört hastaya (%8) intravenöz inotropik tedavi uygulandı. Yirmi bir hasta (%42) ise herhangi bir tedavi almadan sadece yatak istirahati ile iyileşti. Hiçbir hastamız kaybedilmedi.

Sonuç: Çalışmamızda, COVID-19’a bağlı miyokardit gelişen pediatrik hastaların yaklaşık yarısının yalnızca yatak istirahati ile iyileştiği görüldü. Bununla birlikte, çalışmamızın da gösterdiği gibi bazı olgularda fulminan miyokardite ilerleyebilmektedir. Bu nedenle, bu tür hastalar stabil görünseler bile yakından izlenmelidir; çünkü uygun tedavi, ihtiyaç duyan hastalara hızlıca uygulandığında mortalite büyük ölçüde önlenebilmektedir.

Anahtar Kelimeler

• Çocuklar
• Koronavirüs Hastalığı 2019 (COVID-19)
• Miyokardit
• Fulminan

Evaluation of Children Who Develop Myocarditis Due to Coronavirus Disease 2019

Öz

Background: The aim of this study is to share the data of patients who developed myocarditis due to Coronavirus disease 2019 (COVID-19).

Materials and Methods: The data of 50 children who were diagnosed with myocarditis due to Coronavirus disease 19 between April 2020 and January 2022 were retrospectively evaluated.

Results: Twenty-four (48%) of the patients were diagnosed with multisystem inflammatory syndrome (MIS-C). Twenty-six (52%) patients had fever and 14 (28%) patients had chest pain, which were the most common complaints. Eight (16%) patients had systolic dysfunction. Pericardiocentesis was performed in one patient due to cardiac tamponade. In four (8%) of the patients, acute fulminant myocarditis developed and intensive care was required. One patient required intubation and was later extubated. Twenty-one (42%) patients were treated with intravenous immunoglobulin alone, and 8 patients were treated with intravenous immunoglobulin + steroids. Four (8%) patients received intravenous inotropic therapy. Twenty-one (42%) patients did not receive any treatment and recovered with bed rest only. None of our patients died.

Conclusions: In our study, approximately half of the pediatric patients who had developed myocarditis due to Coronavirus disease 2019 recovered with bed rest only. However, as shown in our study, it may progress to fulminant myocarditis in some patients. Therefore, even if such patients are stable, they need to be followed up closely since mortality can be prevented at a high rate when the appropriate treatments are rapidly provided to patients in need.

Anahtar Kelimeler

• Children
• Coronavirus Disease 2019
• Myocarditis
• FulminantCorresponding

Kaynakça

1. 1. Cooper LT Jr. Myocarditis. N Engl J Med 2009;360(15):1526-38.
2. 2. Baboonian C, Treasure T. Meta-analysis of the association of enteroviruses with human heart disease. Heart (British Cardiac Society) 1997;78(6):539-43.
3. 3. Agrawal AS, Garron T, Tao X, Peng BH, Wakamiya M, Chan TS et al. Generation of a transgenic mouse model of Middle East respiratory syndrome coronavirus infection and disease. J Virol 2015;89(7):3659-70.
4. 4. Esfandiarei M, McManus BM. Molecular biology and pathogenesis of viral myocarditis. Annu Rev Pathol 2008;3(1):127-55.
5. 5. Seko Y, Takahashi N, Yagita H, Okumura K, Yazaki Y. Expression of cytokine mRNAs in murine hearts with acute myocarditis caused by coxsackievirus B3. J Pathol 1997;183(1):105-8.
6. 6. Blyszczuk P, Kania G, Dieterle T, Marty RR, Valaperti A, Berthonneche C, et al. Myeloid diferentiation factor-88/interleukin-1 signaling controls cardiac fbrosis and heart failure progression in infammatory dilated cardiomyopathy. Circ Res 2009;105(9):912-20.
7. 7. Baldeviano GC, Barin JG, Talor MV, Srinivasan S, Bedja D, Zheng D, et al. Interleukin-17A is dispensable for myocarditis but essential for the progression to dilated cardiomyopathy. Circul Res 2010;106(10):1646-55.
8. 8. Oleszak F, Maryniak A, Botti E, Abrahim C, Salifu M O, Youssef M, Henglein V L, McFarlane S I, et al. Myocarditis associated with COVID-19. Am J Med Case Rep 2020;8(12):498-02.

9. 9. Qian Z, Travanty EA, Oko L, Edeen K, Berglund A, Wang J, et al. Innate immune response of human alveolar type II cells infected with severe acute respiratory syndrome-coronavirus. Am J Respir Cell Mol Biol 2013;48(6):742-8.
10. 10. Goulter AB, Goddard MJ, Allen JC, Clark KL. ACE2 gene expression is up-regulated in the human failing heart. BMC Med. 2004 May 19;2:19.
11. 11. Sharma YP, Agstam S, Yadav A, Gupta A, Gupta A. Cardiovascular manifestations of COVID-19: an evidence-based narrative review. Indian J Med Res 2021;153(1&2):7-16.
12. 12. Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, et al. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail 2020;22(5):911-5.
13. 13. Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, et al. Recognizing COVID19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm 2020;17(9):1463-71.
14. 14. Kawakami R, Sakamoto A, Kawai K, Gianatti A, Pellegrini D, Nasr A, et al. Pathological evidence for SARS-CoV-2 as a cause of myocarditis: JACC review topic of the week. J Am Coll Cardiol 2021;77(3):314-25.
15. 15. Lee DW, Gardner R, Porter DL, Louis CU, Ahmed N, Jensen M, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood 2014;124(2):188-95.
16. 16. Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: an overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev 2020;53:25-32.
17. 17. Talasaz AH, Sadeghipour P, Kakavand H, Aghakouchakzadeh M, Kordzadeh-Kermani E, Van Tassell BW, et al. Recent randomized trials of antithrombotic therapy for patients with COVID-19: JACC state of-the-art review. J Am Coll Cardiol 2021; 77(15):1903-21.
18. 18. Mele D, Flamigni F, Rapezzi C, Ferrari R. Myocarditis in COVID-19 patients: current problems. Intern Emerg Med 2021;16(5):1123-9.
19. 19. Marcinkiewicz K, Petryka-Mazurkiewicz J, Nowicki MM, Kuriata J, Dzielińska Z, Demkow M, et al. Acute heart failure in the course of fulminant myocarditis requiring mechanical circulatory support in a healthy young patient after coronavirus disease 2019. Kardiologia Polska (Polish Heart J) 2021;79(5):583-4.
20. 20. Dasgupta S, Iannucci G, Mao C, Clabby M, Oster ME. Myocarditis in the pediatric population: A review. Congenit Heart Dis. 2019 Sep;14(5):868-77.
21. 21. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med 2020; 383(4): 334-46
22. 22. Combes A. Myocardites aiguës [Acute myocarditis]. Presse Med. 2012 Jun;41(6 Pt 1):621-7.
23. 23. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med 2020;46:10-67.
24. 24. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An Outbreak of Severe Kawasaki-Like Disease at the Italian Epicenter of the SARS-CoV-2 Epidemic: An Observational Cohort Study. The Lancet 2020;395:1771-8.
25. 25. Chiotos K, Bassiri H, Behrens EM, Blatz AM, Chang J, Diorio C, et al. Multisystem Inflammatory Syndrome in Children during the Coronavirus 2019 Pandemic: A Case Series. Journal of the Pediatric Infectious Diseases Society 2020;9, 393-8.
26. 26. Zhu H, Rhee J-W, Cheng P, Waliany S, Chang A, Witteles RM, et al. Cardio-vascular complications in patients with COVID-19: consequences of viral toxicities and host immune response. Curr Cardiol Rep 2020;22:32.
27. 27. Oberweis ML, Codreanu A, Boehm W, Olivier D, Pierron C, Tsobo C, et al. Pediatric life-threatening coronavirus disease 2019 with myocarditis. Pediatr Infect Dis J 2020;39:e147-9.
28. 28. Anthony RM, Nimmerjahn F, Ashline DJ, Reinhold VN, Paulson JC, Ravetch JV. Recapitulation of IVIG anti-infammatory activity with a recombinant IgG Fc. Science 2008;320(5874):373-6.
29. 29. Huang X, Sun Y, Su G, Li Y, Shuai X. Intravenous immunoglobulin therapy for acute myocarditis in children and adults. Int Heart J 2019;60(2):359-65.
30. 30. Kohli U, Meinert E, Chong G Tesher M, Jani P. Fulminant myocarditis and atrial fibrillation in child with acute COVID-19. J Electrocardiol 2020;18(20):30571-9.
31. 31. Fischer Q, Savarin BN, Ducrocq G, Ou P. Case report of an isolated myocarditis due to COVID-19 infection in a paediatric patient. European Heart Journal 2020;4:1-5.
32. 32. Nappi F, Avtaar Singh SS. SARS-CoV-2-Induced Myocarditis: A State-of-the-Art Review. Viruses. 2023 Apr 2;15(4):916.
33. 33. Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, et al. COVD-19 and Multisystem Inflammatory Syndrome in Children and Adolescents. Lancet Infect Dis 2020;20(11):e276-e88.
34. 34. Fu YJ, Cheng YX, Wu YT. Understanding SARS-CoV-2-Mediated Inflammatory Responces: From Mechanisms to Potential therapeutics Tools. Virologica Sinica 2020;35:266-71.
35. 35. Sawalha K, Abozenah M, Kadado AJ, Battisha A, Al-Akchar M, Salerno C, et al. Systematic review of COVID-19 related myocarditis: insights on management and outcome. Cardiovasc Revascular Med Include Mol Intervent 2021;23:107-13.
36. 36. Chen HS, Wang W, Wu SN, Liu JP. Corticosteroids for viral myocarditis. Cochrane Database Syst Rev 2013(10):CD004471-CD1.
37. 37. Zhao H, Zhu Q, Zhang C, Li J, Wei M, Qin Y, et al. Tocilizumab combined with favipiravir in the treatment of COVID-19: a multicenter trial in a small sample size. Biomed Pharmacother 2021;133:110825.
38. 38. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in Children. N Engl J Med 2020;382:1663-5.