Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may res...Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.展开更多
Background Recent infection with SARS‑CoV-2 in children has been associated with multisystem inflammatory syndrome in children(MIS-C).SARS‑CoV-2 has undergone different mutations.Few publications exist about specific ...Background Recent infection with SARS‑CoV-2 in children has been associated with multisystem inflammatory syndrome in children(MIS-C).SARS‑CoV-2 has undergone different mutations.Few publications exist about specific variants and their correlation with the severity of MIS-C.Methods This was a single-center,retrospective study including all patients admitted with MIS-C at Rady Children’s Hospital-San Diego between May 2020 and March 2022.Local epidemiologic data,including viral genomic information,were obtained from public records.Demographics,clinical presentation,laboratory values,and outcomes were obtained from electronic medical records.Results The analysis included 104 pediatric patients.Four MIS-C waves were identified.Circulating variants in San Diego during the first wave included clades 20A to C.During the second wave,there were variants from clades 20A to C,20G,21C(Epsilon),20I(Alpha),and 20J(Gamma).The third wave had Delta strains(clades 21A,21I,and 21J),and the fourth had Omicron variants(clades 21K,21L,and 22C).MIS-C presented with similar symptoms and laboratory findings across all waves.More patients were admitted to the pediatric intensive care unit(PICU)(74%)and required inotropic support(63%)during the second wave.None of the patients required mechanical circulatory support,and only two required invasive ventilatory support.There was no mortality.Conclusions The various strains of SARS-CoV-2 triggered MIS-C with differing severities,with the second wave having a more severe clinical course.Whether the differences in disease severity across variants were due to changes in the virus or other factors remains unknown.展开更多
Introduction: We report an eight-case series of coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C). Methods: Children who tested positive for COVID-19, met the MIS-C crit...Introduction: We report an eight-case series of coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C). Methods: Children who tested positive for COVID-19, met the MIS-C criteria of the World Health Organization (WHO), and were <span style="font-family: ">hospitalized at a tertiary hospital in Riyadh from September to December 2021 were identified and their clinical data reviewed. Results: The age at diagnosis is <span style="font-family: ">between 4 to 13 years old. Fever, decreased oral intake, gastroenteritis, and abdominal pain were the most common symptoms. All cases showed hyperinflammation with high C-reactive protein, erythrocyte sedimentation rate, ferritin levels, and deranged coagulation profiles. Most of the cases had elevated B-type natriuretic peptide (75%) and troponin (100%) levels. However, two cases had cardiovascular involvement. Two patients presented with acute respiratory distress syndrome and required mechanical ventilation. The mean hospital stay was 13.1 days, with seven patients initially requiring intensive care management for ionotropic support. Most cases required broad-spectrum antibiotics, intravenous steroids, intravenous immunoglobulin, and aspirin. All patients recovered and were discharged from the hospital in good clinical condition. Conclusion: Children with COVID-19 are at risk of developing MIS-C. Practitioners must have a high index of suspicion for its diagnosis and should start treatment as soon as possible to prevent unfavorable outcomes.展开更多
Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at t...Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further attention from clinicians.Meanwhile,the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.Data sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang databases.Searched keywords included“COVID-19 in children”,“severe pediatric COVID-19”,and“critical illness in children with COVID-19”.Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status.Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be seen.Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways,whose dysregulation in severe and critical diseases translates into adverse clinical manifestations.Multisystem inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity.Despite the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.Conclusions Severe pediatric COVID-19 can affect multiple organ systems.The dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults.Consequently,further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.展开更多
Background Since December 2019,the SARS-CoV-2 virus has been a global health issue.The main clinical presentation of this virus is a flu-like disease;however,patients with diverse neurologic manifestations have also b...Background Since December 2019,the SARS-CoV-2 virus has been a global health issue.The main clinical presentation of this virus is a flu-like disease;however,patients with diverse neurologic manifestations have also been reported.In this review,we attempt to summarize,discuss and update the knowledge of the neurologic manifestations in the pediatric population affected by SARS-CoV-2 infection and the pandemic’s effects in children with neurologic diseases.Data sources This review analyzes studies found on the PubMed database using the following keywords:Neurologic manifestations COVID-19,Neurological COVID-19,coronavirus,SARS-CoV-2,pediatric COVID-19,COVID-19 in children,MIS-C,Pediatric Inflammatory Multisystem Syndrome,Guillain BarréSyndrome,Stroke,ADEM,and Anti-NMDA encephalitis.All studies cited were published between 2004 and 2022,and represent the most relevant articles in the field.The World Health Organization COVID-19 online dashboard was assessed to obtain updated epidemiological data.Results The most common neurologic symptoms in the pediatric population are headache,seizures,encephalopathy,and muscle weakness.These can be present during COVID-19 or weeks after recovering from it.Children who presented with multi-system inflammatory syndrome had a higher incidence of neurologic manifestations,which conferred a greater risk of morbidity and mortality.Several neuro-pathophysiological mechanisms have been proposed,including direct virus invasion,hyper-inflammatory reactions,multi-systemic failure,prothrombotic states,and immune-mediated processes.On the other hand,the COVID-19 pandemic has affected patients with neurologic diseases,making it challenging to access controls,treatment,and therapies.Conclusions Various neurologic manifestations have been associated with children’s SARS-CoV-2 infection.It is important to identify and give them proper and opportune treatment because they can be potentially grave and life-threatening;some can lead to long-lasting sequelae.Different neuro-pathophysiological mechanisms have been proposed,however,a causal relationship between SARS-CoV-2 infection and neurologic manifestations remains to be proven.Patients with neurologic diseases are especially affected by COVID-19,not only by the disease itself but also by its complications and pandemic management measures.展开更多
Background In multisystem inflammatory syndrome in children(MIS-C),diagnostic delay could be associated with severity.This study aims to measure the time to diagnosis in MIS-C,assess its impact on the occurrence of ca...Background In multisystem inflammatory syndrome in children(MIS-C),diagnostic delay could be associated with severity.This study aims to measure the time to diagnosis in MIS-C,assess its impact on the occurrence of cardiogenic shock,and specify its determinants.Methods A single-center prospective cohort observational study was conducted between May 2020 and July 2022 at a tertiary care hospital.Children meeting the World Health Organization MIS-C criteria were included.A long time to diagnosis was defined as six days or more.Data on time to diagnosis were collected by two independent physicians.The primary outcome was the occurrence of cardiogenic shock.Logistic regression and receiver operating characteristic curve analysis were used for outcomes,and a Cox proportional hazards model was used for determinants.Results Totally 60 children were assessed for inclusion,and 31 were finally analyzed[52%males,median age 8.8(5.7-10.7)years].The median time to diagnosis was 5.3(4.2-6.2)days.In univariable analysis,age above the median,time to diagnosis,high C-reactive protein,and high N-terminal pro-B-type natriuretic peptide(NT-proBNP)were associated with cardiogenic shock[odds ratio(OR)6.13(1.02-36.9),2.79(1.15-6.74),2.08(1.05-4.12),and 1.70(1.04-2.78),respectively].In multivariable analysis,time to diagnosis≥6 days was associated with cardiogenic shock[adjusted OR(aOR)21.2(1.98-227)].Time to diagnosis≥6 days had a sensitivity of 89% and a specificity of 77% in predicting cardiogenic shock;the addition of age>8 years and NT-proBNP at diagnosis≥11,254 ng/L increased the specificity to 91%.Independent determinants of short time to diagnosis were age<8.8 years[aHR 0.34(0.13-0.88)],short distance to tertiary care hospital[aHR 0.27(0.08-0.92)],and the late period of the COVID-19 pandemic[aHR 2.48(1.05-5.85)].Conclusions Time to diagnosis≥6 days was independently associated with cardiogenic shock in MIS-C.Early diagnosis and treatment are crucial to avoid the use of inotropes and limit morbidity,especially in older children.展开更多
Introduction:Coronavirus disease-2019(COVID-19)presents with a variety of symptoms,but rhabdomyolysis has rarely been reported in children.Case presentation:We report a 10-year-old girl who presented with fever,myalgi...Introduction:Coronavirus disease-2019(COVID-19)presents with a variety of symptoms,but rhabdomyolysis has rarely been reported in children.Case presentation:We report a 10-year-old girl who presented with fever,myalgia,and limping.The patient was tested positive for severe acute respiratory syndrome coronavirus-2.On admission,creatine kinase(CK)level was 13147 units per liter and the patient was diagnosed with rhabdomyolysis.She was treated with intravenous fluids,which resulted in CK levels decrease.There are currently seven case reports of children with rhabdomyolysis associated with acute COVID-19 infection and two reports with the multisystemic inflammatory syndrome.Conclusion:Children presenting with muscle pain and weakness in the acute phase or following COVID-19 infection,should alert physicians of the possibility of rhabdomyolysis.展开更多
文摘Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.
文摘Background Recent infection with SARS‑CoV-2 in children has been associated with multisystem inflammatory syndrome in children(MIS-C).SARS‑CoV-2 has undergone different mutations.Few publications exist about specific variants and their correlation with the severity of MIS-C.Methods This was a single-center,retrospective study including all patients admitted with MIS-C at Rady Children’s Hospital-San Diego between May 2020 and March 2022.Local epidemiologic data,including viral genomic information,were obtained from public records.Demographics,clinical presentation,laboratory values,and outcomes were obtained from electronic medical records.Results The analysis included 104 pediatric patients.Four MIS-C waves were identified.Circulating variants in San Diego during the first wave included clades 20A to C.During the second wave,there were variants from clades 20A to C,20G,21C(Epsilon),20I(Alpha),and 20J(Gamma).The third wave had Delta strains(clades 21A,21I,and 21J),and the fourth had Omicron variants(clades 21K,21L,and 22C).MIS-C presented with similar symptoms and laboratory findings across all waves.More patients were admitted to the pediatric intensive care unit(PICU)(74%)and required inotropic support(63%)during the second wave.None of the patients required mechanical circulatory support,and only two required invasive ventilatory support.There was no mortality.Conclusions The various strains of SARS-CoV-2 triggered MIS-C with differing severities,with the second wave having a more severe clinical course.Whether the differences in disease severity across variants were due to changes in the virus or other factors remains unknown.
文摘Introduction: We report an eight-case series of coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C). Methods: Children who tested positive for COVID-19, met the MIS-C criteria of the World Health Organization (WHO), and were <span style="font-family: ">hospitalized at a tertiary hospital in Riyadh from September to December 2021 were identified and their clinical data reviewed. Results: The age at diagnosis is <span style="font-family: ">between 4 to 13 years old. Fever, decreased oral intake, gastroenteritis, and abdominal pain were the most common symptoms. All cases showed hyperinflammation with high C-reactive protein, erythrocyte sedimentation rate, ferritin levels, and deranged coagulation profiles. Most of the cases had elevated B-type natriuretic peptide (75%) and troponin (100%) levels. However, two cases had cardiovascular involvement. Two patients presented with acute respiratory distress syndrome and required mechanical ventilation. The mean hospital stay was 13.1 days, with seven patients initially requiring intensive care management for ionotropic support. Most cases required broad-spectrum antibiotics, intravenous steroids, intravenous immunoglobulin, and aspirin. All patients recovered and were discharged from the hospital in good clinical condition. Conclusion: Children with COVID-19 are at risk of developing MIS-C. Practitioners must have a high index of suspicion for its diagnosis and should start treatment as soon as possible to prevent unfavorable outcomes.
文摘Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further attention from clinicians.Meanwhile,the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.Data sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang databases.Searched keywords included“COVID-19 in children”,“severe pediatric COVID-19”,and“critical illness in children with COVID-19”.Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status.Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be seen.Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways,whose dysregulation in severe and critical diseases translates into adverse clinical manifestations.Multisystem inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity.Despite the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.Conclusions Severe pediatric COVID-19 can affect multiple organ systems.The dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults.Consequently,further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
文摘Background Since December 2019,the SARS-CoV-2 virus has been a global health issue.The main clinical presentation of this virus is a flu-like disease;however,patients with diverse neurologic manifestations have also been reported.In this review,we attempt to summarize,discuss and update the knowledge of the neurologic manifestations in the pediatric population affected by SARS-CoV-2 infection and the pandemic’s effects in children with neurologic diseases.Data sources This review analyzes studies found on the PubMed database using the following keywords:Neurologic manifestations COVID-19,Neurological COVID-19,coronavirus,SARS-CoV-2,pediatric COVID-19,COVID-19 in children,MIS-C,Pediatric Inflammatory Multisystem Syndrome,Guillain BarréSyndrome,Stroke,ADEM,and Anti-NMDA encephalitis.All studies cited were published between 2004 and 2022,and represent the most relevant articles in the field.The World Health Organization COVID-19 online dashboard was assessed to obtain updated epidemiological data.Results The most common neurologic symptoms in the pediatric population are headache,seizures,encephalopathy,and muscle weakness.These can be present during COVID-19 or weeks after recovering from it.Children who presented with multi-system inflammatory syndrome had a higher incidence of neurologic manifestations,which conferred a greater risk of morbidity and mortality.Several neuro-pathophysiological mechanisms have been proposed,including direct virus invasion,hyper-inflammatory reactions,multi-systemic failure,prothrombotic states,and immune-mediated processes.On the other hand,the COVID-19 pandemic has affected patients with neurologic diseases,making it challenging to access controls,treatment,and therapies.Conclusions Various neurologic manifestations have been associated with children’s SARS-CoV-2 infection.It is important to identify and give them proper and opportune treatment because they can be potentially grave and life-threatening;some can lead to long-lasting sequelae.Different neuro-pathophysiological mechanisms have been proposed,however,a causal relationship between SARS-CoV-2 infection and neurologic manifestations remains to be proven.Patients with neurologic diseases are especially affected by COVID-19,not only by the disease itself but also by its complications and pandemic management measures.
文摘Background In multisystem inflammatory syndrome in children(MIS-C),diagnostic delay could be associated with severity.This study aims to measure the time to diagnosis in MIS-C,assess its impact on the occurrence of cardiogenic shock,and specify its determinants.Methods A single-center prospective cohort observational study was conducted between May 2020 and July 2022 at a tertiary care hospital.Children meeting the World Health Organization MIS-C criteria were included.A long time to diagnosis was defined as six days or more.Data on time to diagnosis were collected by two independent physicians.The primary outcome was the occurrence of cardiogenic shock.Logistic regression and receiver operating characteristic curve analysis were used for outcomes,and a Cox proportional hazards model was used for determinants.Results Totally 60 children were assessed for inclusion,and 31 were finally analyzed[52%males,median age 8.8(5.7-10.7)years].The median time to diagnosis was 5.3(4.2-6.2)days.In univariable analysis,age above the median,time to diagnosis,high C-reactive protein,and high N-terminal pro-B-type natriuretic peptide(NT-proBNP)were associated with cardiogenic shock[odds ratio(OR)6.13(1.02-36.9),2.79(1.15-6.74),2.08(1.05-4.12),and 1.70(1.04-2.78),respectively].In multivariable analysis,time to diagnosis≥6 days was associated with cardiogenic shock[adjusted OR(aOR)21.2(1.98-227)].Time to diagnosis≥6 days had a sensitivity of 89% and a specificity of 77% in predicting cardiogenic shock;the addition of age>8 years and NT-proBNP at diagnosis≥11,254 ng/L increased the specificity to 91%.Independent determinants of short time to diagnosis were age<8.8 years[aHR 0.34(0.13-0.88)],short distance to tertiary care hospital[aHR 0.27(0.08-0.92)],and the late period of the COVID-19 pandemic[aHR 2.48(1.05-5.85)].Conclusions Time to diagnosis≥6 days was independently associated with cardiogenic shock in MIS-C.Early diagnosis and treatment are crucial to avoid the use of inotropes and limit morbidity,especially in older children.
文摘Introduction:Coronavirus disease-2019(COVID-19)presents with a variety of symptoms,but rhabdomyolysis has rarely been reported in children.Case presentation:We report a 10-year-old girl who presented with fever,myalgia,and limping.The patient was tested positive for severe acute respiratory syndrome coronavirus-2.On admission,creatine kinase(CK)level was 13147 units per liter and the patient was diagnosed with rhabdomyolysis.She was treated with intravenous fluids,which resulted in CK levels decrease.There are currently seven case reports of children with rhabdomyolysis associated with acute COVID-19 infection and two reports with the multisystemic inflammatory syndrome.Conclusion:Children presenting with muscle pain and weakness in the acute phase or following COVID-19 infection,should alert physicians of the possibility of rhabdomyolysis.
