# ent

id: cord-030192-ebsh62ll
type: DISEASE
entity:
  multisystem 2 organ involvement cardiac renal respiratory hematologic gastrointestinal dermatologic or neurologic 2


id: cord-035239-5zdjxtm7
type: EVENT
entity:
  A Rare Presentation of Multi System Inflammatory Disease in Children Associated With Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 date 2020


id: cord-271662-h281jgcb
type: CHEMICAL
entity:
  C Mongkolrattanothai K Morton T Nakra N Olivero R Osborne C Parsons S Panesar L Patel R Schuette J Thacker D Tremoulet A


id: cord-278672-pxzsntfg
type: GPE
entity:
  the Republic of Serbia Current Status and Possible Improvements in Information Technologies Present and Future State


id: cord-278672-pxzsntfg
type: ORG
entity:
  Decision Making and Analysis Web Tool for MEDIS NET Medical Information System Deep Learning Techniques


id: cord-278672-pxzsntfg
type: ORG
entity:
  Using Random Forest Algorithm for Breast Cancer Diagnosis Optimization of Health Service Schedule Adaption


id: cord-315508-8bcpxo02
type: ORG
entity:
  the Royal College of Pediatrics and Child Health RCPCH the Centers for Disease Control and Prevention


id: cord-322435-c88tkbnz
type: WORK_OF_ART
entity:
  Mucocutaneous Disease and Related Clinical Characteristics in Hospitalized Children and Adolescents with COVID 19


id: cord-314662-nem6dw34
type: PROTEIN
entity:
  alanine transaminase AST aspartate transaminase pro BNP pro B type natriuretic peptide BUN blood urea nitrogen CRP C reactive protein CT


id: cord-314662-nem6dw34
type: ORG
entity:
  SARS CoV 2 Infection Review of Clinical Presentation Hypothetical Pathogenesis and Proposed Management


id: cord-351634-x1aw6gv2
type: DNA
entity:
  5 following 1 Bilateral bulbar conjunctival injection 2 Oral mucositis erythematous or fissured lips


id: cord-351634-x1aw6gv2
type: ORG
entity:
  the Multisystem Inflammatory Syndrome in Children through the Pandemic Pediatric Coronavirus Disease


id: cord-351634-x1aw6gv2
type: WORK_OF_ART
entity:
  Kawasaki Disease Novel Virus and Novel Case Incomplete Kawasaki Disease in a Child with Covid 19 Introductory


id: cord-351634-x1aw6gv2
type: DISEASE
entity:
  cardiovascular abnormalities myocarditis ventricular dysfunction coronary artery aneurysms hypotension


id: cord-293367-0fe62h2f
type: PROTEIN
entity:
  Amino Terminal Pro B Type Natriuretic Peptide and Severity of Illness in Pediatric Septic Shock Pediatric critical care medicine a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies A


id: cord-293367-0fe62h2f
type: ORG
entity:
  American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome


id: cord-293367-0fe62h2f
type: WORK_OF_ART
entity:
  Virus Disease 2019 and Paediatric Inflammatory Bowel Diseases Global Experience and Provisional Guidance


id: cord-293367-0fe62h2f
type: WORK_OF_ART
entity:
  Favorable Anakinra Responses in Severe Covid 19 Patients with Secondary Hemophagocytic Lymphohistiocytosis Cell Host Microbe Targeting


id: cord-354608-1me3nopu
type: CELL_LINE
entity:
  Coronavirus 2019 COVID 19 pandemic for child and adolescent mental health a narrative review to highlight clinical and research needs in the acute phase and the long


id: cord-354608-1me3nopu
type: GGP
entity:
  SARS CoV 2 proteinases papain like proteinase and 3C like proteinase which are key enzymes in polyprotein


id: cord-354093-zdhfyotl
type: DISEASE
entity:
  pneumonia acute kidney injury liver injury metabolic acidosis neurological injury rhabdomyolysis multi organ system failure


# bib

id: cord-030192-ebsh62ll
author: Winant, Abbey J.
date: 2020-07-30
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397565/
doi: 10.1148/ryct.2020200346
title:
  Thoracic Imaging Findings of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: What Radiologists Need to Know Now

abstract:
  The COVID-19 global pandemic is an ongoing public health emergency, with over 4 million confirmed cases worldwide. Due to the novel nature of this coronavirus and our evolving understanding of its pathophysiology, there is continued uncertainty surrounding diagnosis and management of COVID-19, especially in pediatric patients. In addition, a new febrile hyperinflammatory Kawasaki-like syndrome (also known as multisystem inflammatory syndrome in children, or MIS-C) has emerged in pediatric patients with temporal association to COVID-19 infection. This review article aims to provide an up-to-date review of the clinical and imaging findings of pediatric MIS-C associated with COVID-19, compared with typical acute pediatric COVID-19 infection, with an emphasis on thoracic imaging findings.


id: cord-035239-5zdjxtm7
author: Makvandi, Shayan
date: 2020-10-10
txt: ./txt/cord-035239-5zdjxtm7.txt
cache: ./cache/cord-035239-5zdjxtm7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654563/
doi: 10.7759/cureus.10892
summary:
  title: A Rare Presentation of Multi-System Inflammatory Disease in Children Associated With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) This article reports a rare presentation of multi-system inflammatory disease in a previously healthy 16-month-old male who fully recovered with minimal residual cardiac insufficiency upon discharge. Since April 2020, multiple reports emerged from Europe and later from New York of multi-system inflammatory disease in children (MIS-C) presenting with different clinical patterns that occur from one to six weeks following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the pediatric age group [1] [2] [3] [4] [5] [6] [7] [8] . Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic Characteristics, cardiac involvement, and outcomes of multisystem inflammatory disease of childhood (MIS-C) associated with SARS-CoV-2 infection COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach Cardiac MRI of children with multisystem inflammatory syndrome (MIS-C) associated with COVID-19: case series

title:
  A Rare Presentation of Multi-System Inflammatory Disease in Children Associated With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

abstract:
  Management of multi-system inflammatory disease in children (MIS-C) remains a challenge due to the evolving nature of the coronavirus disease 2019 (COVID-19) pandemic. This article reports a rare presentation of multi-system inflammatory disease in a previously healthy 16-month-old male who fully recovered with minimal residual cardiac insufficiency upon discharge. Our case is unique due to patient's young age, cardiac findings, and his response to our treatment protocol. A multi-disciplinary team in a tertiary center was involved with care.


id: cord-271186-82q22u6i
title: Cardiac Involvment in SARS-CoV-2-Associated Inflammatory Syndromes
author: Picichè, Marco
date: 2020-08-05
txt: ./txt/cord-271186-82q22u6i.txt
cache: ./cache/cord-271186-82q22u6i.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1050173820301055
doi: 10.1016/j.tcm.2020.07.008
abstract: nan
summary:
  In their review discussing the effects of Severe Acute Respiratory Syndrome Coronavirus-2 (SARSin children and adolescents, Loke, Berul and Harahsheh highlight the overlapping features between Kawasaki disease (KD) and the recently described inflammatory syndrome called Multisystem Inflammatory Syndrome in Children (MIS-C) [1] . Although in children with MIS-C, the inflammatory response may sometimes be associated with transitory respiratory impairment, this feature is more prominent in adults with COVID-19, who may even require venous-venous extracorporeal membrane oxygenation (V-V ECMO) support. However, notwithstanding the existence of considerable observational data on the use of ECMO for influenza A (H1N1) and Middle East Respiratory Syndrome (MERS) coronavirus-related ARDS, the real utility of ECMO in adult COVID-19 patients with respiratory failure is uncertain and remains under investigation [15] . In conclusion, SARS-CoV-2 may generate an inflammatory syndrome in both adults and children, albeit with several different characteristics and consequences. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease


id: cord-271662-h281jgcb
title: Multisystem Inflammatory Syndrome in Children: Survey of Early Hospital Evaluation and Management
author: Dove, M.
date: 2020-08-01
url: https://doi.org/10.1101/2020.07.29.20164459
doi: 10.1101/2020.07.29.20164459
abstract:
  Background: In the absence of evidence-based therapies for Multisystem Inflammatory Syndrome in Children (MIS-C), we aimed to describe the similarities and differences in the evaluation and treatment of MIS-C at hospitals in the United States. Methods: We conducted a cross-sectional survey from June 16 to July 16, 2020 of U.S. pediatric hospitals regarding protocols for patients with MIS-C. Elements included hospital characteristics, clinical definition of MIS-C, evaluation, treatment, and follow-up. We summarized key findings and compared results from centers that had treated >5 patients vs. those that had treated <5 patients. Results: Forty centers of varying size and experience with MIS-C participated. About half (21/40) of centers required only 1 day of fever for MIS-C to be considered. In the evaluation of patients, there was often a tiered approach. Intravenous immunoglobulin was the most widely used medication to treat MIS-C (98% of centers). Corticosteroids were listed in 93% of protocols for primarily the moderate or severe cases. Aspirin was commonly used including for mild cases, whereas heparin or low molecular weight heparin were used primarily in severe cases. In severe cases, anakinra and vasopressors were frequently recommended. Nearly all centers (39/40) recommended follow up with cardiology. There were similar findings between centers that had treated >5 patients vs. those that had treated <5 patients. A supplement containing hospital protocols is provided. Conclusion: There are many similarities yet some key differences between hospital protocols for MIS-C. These findings can help healthcare providers learn from others regarding options for managing MIS-C patients.


id: cord-274834-24v2b509
author: Lima, Rosiane
date: 2020-09-11
txt: ./txt/cord-274834-24v2b509.txt
cache: ./cache/cord-274834-24v2b509.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32917141/
doi: 10.1186/s12874-020-01110-y
summary:
  Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. METHODS: A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. Specific questions that must be addressed revolve around the role children play in viral transmission, differences in pediatric viral susceptibility and immune responses, which could guide potential therapies for adults, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the development of severe hyperinflammatory shock and cardiac damage seen in Multisystem Inflammatory Syndrome in Children (MIS-C). In order to capture the full range of SARS-CoV-2 infection in the pediatric population, a COVID-19 biospecimen collection study was designed and implemented, including patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2-infected mothers, and asymptomatic children.

title:
  Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children

abstract:
  BACKGROUND: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. METHODS: A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic. RESULTS: Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. CONCLUSIONS: Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.


id: cord-278672-pxzsntfg
author: Milenkovic, Aleksandar
date: 2020-06-16
url: https://www.sciencedirect.com/science/article/pii/S1386505620305700?v=s5
doi: 10.1016/j.ijmedinf.2020.104224
title:
  Extensions and Adaptations of Existing Medical Information System in Order to Reduce Social Contacts During COVID-19 Pandemic

abstract:
  OBJECTIVE: The main objective of this paper is the reduction of the COVID-19 pandemic spread by increasing the degree of social distancing by using and upgrading the existing Medical Information System (MIS). MATERIAL AND METHODS: The existing MIS MEDIS.NET, currently used in the largest health center in the Balkans, has been adapted and further developed. RESULTS: During the adaptation of existing MIS MEDIS.NET 4 new and 9 existing modules were developed. A quick questionnaire for the smart triage of patients was also implemented. DISCUSSION: The adapted MIS successfully influenced the reduction of social contacts within the Health Center Nis. The need for the arrival of children and their parents to receive appropriate health certificates for the school enrolment is reduced. The therapy of chronic patients has been prolonged for 6 months via an electronic prescription. An online service for the communication between patients and the chosen physicians is provided. Possible social contacts and exposure to the viral environment of patients are reduced by making appointments in extended slots and at determined physical locations. Patients are notified per SMS or email about the availability of chosen and physician on duty. The social distancing of patients and physicians is also established by sending laboratory analyses per email or SMS. Keeping the central registry for COVID-19 is enabled throughout the country. CONCLUSION: The smart adaptation of MIS, and its collaboration with other state systems can significantly influence the reduction of social contacts and thus mitigate the consequences of COVID-19 pandemic.


id: cord-281948-xv7vuypd
title: COVID-19 in 7780 pediatric patients: A systematic review
author: Hoang, Ansel
date: 2020-06-26
txt: ./txt/cord-281948-xv7vuypd.txt
cache: ./cache/cord-281948-xv7vuypd.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2589537020301772
doi: 10.1016/j.eclinm.2020.100433
summary:
  We included published or in press peer-reviewed cross-sectional, case series, and case reports providing clinical signs, imaging findings, and/or laboratory results of pediatric patients who were positive for COVID-19. Data collected included the type of article (e.g., case series), country of origin, number of pediatric patients, demographic information, and all clinical symptoms (e. Compared to that review and other COVID-19 pediatric systematic reviews, [18À21] this manuscript has several key advantages: (1) we summarize 131 studies that includes 7780 children from 26 different countries, (2) this report synthesizes underlying pediatric medical conditions and delineates bacterial and viral coinfections, (3) we quantitatively describe clinical symptoms and imaging findings, (4) herein, we conglomerate the mean and standard deviation of frequently used laboratory analytes in COVID-19 positive children, (5) our report presents antiviral therapies by specific agents, and (6) our systematic review offers a preliminary comparison of patients with/without MIS-C.

abstract:
  BACKGROUND: Studies summarizing the clinical picture of COVID-19 in children are lacking. This review characterizes clinical symptoms, laboratory, and imaging findings, as well as therapies provided to confirmed pediatric cases of COVID-19. METHODS: Adhering to PRISMA guidelines, we searched four medical databases (PubMed, LitCovid, Scopus, WHO COVID-19 database) between December 1, 2019 to May 14, 2020 using the keywords “novel coronavirus”, “COVID-19” or “SARS-CoV-2”. We included published or in press peer-reviewed cross-sectional, case series, and case reports providing clinical signs, imaging findings, and/or laboratory results of pediatric patients who were positive for COVID-19. Risk of bias was appraised through the quality assessment tool published by the National Institutes of Health. PROSPERO registration # CRD42020182261. FINDINGS: We identified 131 studies across 26 countries comprising 7780 pediatric patients. Although fever (59·1%) and cough (55·9%) were the most frequent symptoms 19·3% of children were asymptomatic. Patchy lesions (21·0%) and ground-glass opacities (32·9%) depicted lung radiograph and computed tomography findings, respectively. Immunocompromised children or those with respiratory/cardiac disease comprised the largest subset of COVID-19 children with underlying medical conditions (152 of 233 individuals). Coinfections were observed in 5.6% of children and abnormal laboratory markers included serum D-dimer, procalcitonin, creatine kinase, and interleukin-6. Seven deaths were reported (0·09%) and 11 children (0·14%) met inclusion for multisystem inflammatory syndrome in children. INTERPRETATION: This review provides evidence that children diagnosed with COVID-19 have an overall excellent prognosis. Future longitudinal studies are needed to confirm our findings and better understand which patients are at increased risk for developing severe inflammation and multiorgan failure. FUNDING: Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study.


id: cord-293259-o51fnvuw
title: Why COVID-19 is less frequent and severe in children: a narrative review
author: Sinaei, Reza
date: 2020-09-25
txt: ./txt/cord-293259-o51fnvuw.txt
cache: ./cache/cord-293259-o51fnvuw.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s12519-020-00392-y
doi: 10.1007/s12519-020-00392-y
summary:
  Thus far, only a small number of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection have involved children, so that they have accounted for only 1-5% of total patients [2, [6] [7] [8] [9] [10] . Severe SARS-CoV-2 infection is characterized by a hyperproinflammatory response or cytokine storm state that results to acute respiratory distress syndrome (ARDS) and multisystem inflammatory syndrome (MIS). The search strategy was constructed based on searching terms 2019 novel coronavirus, COVID-19, SARS-CoV-2 with using and/or, also the terms of child, pediatric, newborn, infant, adolescence, adult, age, age groups, severity, epidemiology, prevalence, difference, immune system, etiology, reasons in title, abstract, and key words. The first results stem from some considerations that children have a less vigorous immune response to the virus than adults because the cytokine storm is thought to be important in the pathogenesis of severe SARS-CoV-2 infections [28] .

abstract:
  BACKGROUND: Despite the streaks of severity, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is, in general, less frequent and severe in children than in adults. We searched for causal evidence of this mystery. DATA SOURCES: An extensive search strategy was designed to identify papers on coronavirus disease 2019 (COVID-19). We searched Ovid MEDLINE, PubMed, EMBASE databases, and Cochrane library and carried out a review on the causes of this dilemma. RESULTS: Our searches produced 81 relevant articles. The review showed that children accounted for a lower percentage of reported cases, and they also experienced less severe illness courses. Some potential explanations, including the tendency to engage the upper airway, the different expression in both receptors of angiotensin-converting enzyme and renin–angiotensin system, a less vigorous immune response, the lower levels of interleukin (IL)-6, IL-10, myeloperoxidase, and P-selectin and a higher intracellular adhesion molecule-1, a potential protective role of lymphocytes, and also lung infiltrations might have protective roles in the immune system–respiratory tract interactions. Finally, what have shed light on this under representation comes from two studies that revealed high-titer immunoglobulin-G antibodies against respiratory syncytial virus and mycoplasma pneumonia, may carry out cross-protection against SARS-CoV-2 infection, just like what suggested about the vaccines. CONCLUSIONS: These results require an in-depth look. Properties of the immune system including a less vigorous adaptive system beside a preliminary potent innate response and a trained immunity alongside a healthier respiratory system, and their interactions, might protect children against SARS-CoV-2 infection. However, further studies are needed to explore other possible causes of this enigma.


id: cord-293367-0fe62h2f
author: Henderson, Lauren A.
date: 2020-07-23
txt: ./txt/cord-293367-0fe62h2f.txt
cache: ./cache/cord-293367-0fe62h2f.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1002/art.41454
doi: 10.1002/art.41454
summary:
  Since its initial description in December 2019 in Wuhan China, coronavirus disease 2019 , caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a worldwide pandemic affecting millions of lives.(1) Unlike adults, the vast majority of children with COVID-19 have mild symptoms. Reports in the literature and unpublished observations by members of the panel both note that some patients with MIS-C can decompensate rapidly; however, the risk factors that predispose patients to such severe and progressive illness have not been identified.(10, 13) Accordingly, children with abnormal vital signs, concerning physical examination findings, significantly elevated inflammatory markers, or signs of cardiac involvement will need to be admitted to the hospital for supportive care while Tier 2 testing is completed.

title:
  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 1

abstract:
  OBJECTIVE: To provide guidance on the management of Multisystem Inflammatory Syndrome in Children (MIS‐C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of SARS‐CoV‐2 infection. The Task Force also provided recommendations for children with hyperinflammation during COVID‐19, the acute, infectious phase of SARS‐CoV‐2 infection. METHODS: The Task Force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS‐C and hyperinflammation in COVID‐19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9‐point scale was used to determine the appropriateness of each statement (1‐3, inappropriate; 4‐6, uncertain; 7‐9, appropriate), and consensus was rated as low (L), moderate (M), or high (H) based on dispersion of the votes along the numeric scale. Approved guidance statements had to be classified as appropriate with moderate or high levels of consensus, which were pre‐specified prior to voting. RESULTS: A total of 128 statements were approved by the Task Force, which were refined into 40 final guidance statements accompanied by a flow diagram depicting the diagnostic pathway for MIS‐C. CONCLUSION: Our understanding of SARS‐CoV‐2‐related syndromes in the pediatric population continues to evolve. This guidance document reflects currently available evidence coupled with expert opinion but is meant to be modified as additional data become available.


id: cord-293715-lipme817
author: Hutchison, Lisa
date: 2020-06-30
txt: ./txt/cord-293715-lipme817.txt
cache: ./cache/cord-293715-lipme817.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.psym.2020.06.015
doi: 10.1016/j.psym.2020.06.015
summary:
  BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) related to coronavirus disease-2019 (COVID-19) is an emergent syndrome affecting children globally in the wake of the SARS-CoV-2 pandemic. METHOD: This case describes a 14-year-old boy who developed prominent neuropsychiatric symptoms including delirium followed by impairments in executive functioning in the context of MIS-C with positive SARS-CoV-2 antibodies. The recent SARS-CoV-2 pandemic has been associated with emergence of a new syndrome referred to as Multisystem Inflammatory Syndrome in Children (MIS-C) related to coronavirus disease-2019 (COVID19) . Given the paucity of knowledge concerning this syndrome''s effect on the nervous system, the intent of this case report is to describe the neuropsychiatric symptoms in one 14-year-old boy presenting with multisystem inflammatory syndrome and positive SARS-CoV-2 antibodies. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicenter cohort

title:
  Neuropsychiatric Symptoms in an Adolescent Boy with Multisystem Inflammatory Syndrome in Children (MIS-C)

abstract:
  BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) related to coronavirus disease-2019 (COVID-19) is an emergent syndrome affecting children globally in the wake of the SARS-CoV-2 pandemic. The clinical presentation has similarities to Kawasaki disease and toxic shock syndrome. As knowledge of the cardiac and gastrointestinal manifestations has been emerging, little is known about the impact on the brain. METHOD: This case describes a 14-year-old boy who developed prominent neuropsychiatric symptoms including delirium followed by impairments in executive functioning in the context of MIS-C with positive SARS-CoV-2 antibodies. These symptoms improved in correlation with improvements in inflammatory markers. RESULTS: Neuropsychiatric manifestations including confusion, irritability, and headaches have been reported in pediatric patients with MIS-C. Potential mechanisms include direct neurotropic effect of SARS-CoV-2, secondary effects of systemic inflammation, and/or adverse side effects of treatment. CONCLUSIONS: MIS-C is a novel and poorly understood syndrome related to SARS-CoV-2 with effects on multiple organ systems including the central nervous system. As additional cases are reported and research expands, so too will our understanding of the neuropsychiatric manifestations. Better understanding of the underlying pathophysiology would aid in determining targeted interventions.


id: cord-294729-c9f0iokr
author: Orr, William B.
date: 2020-10-01
url: https://doi.org/10.1097/cce.0000000000000236
doi: 10.1097/cce.0000000000000236
title:
  Delayed Development of Coronary Artery Dilitation in Suspected Severe Acute Respiratory Syndrome Coronavirus 2 Multisystem Inflammatory Syndrome: More Research Needed

abstract:
  Although significant disease burden in the severe acute respiratory syndrome coronavirus 2 pandemic has been relatively uncommon in children, worldwide cases of a postinfectious multisystem inflammatory syndrome in children and possible atypical Kawasaki-like disease attributing to severe acute respiratory syndrome coronavirus 2 infection have arisen. Original thinking for coronavirus disease-19 disease was that an overwhelming proinflammatory response drove disease pathogenesis. Emerging reports suggest that a robust immune suppression may be more relevant and predominant. Recently reported data on children with multisystem inflammatory syndrome in children have demonstrated a heterogeneity of immune phenotypes among these patients, with concern for a strong initial proinflammatory state; however, data are lacking to support this. Likewise, understanding development of certain clinical findings to changes in the immune system is lacking. CASE SUMMARY: We report a 12-year-old multiracial male with negative coronavirus disease-19 nasopharyngeal RNA polymerase chain reaction testing but positive severe acute respiratory syndrome coronavirus 2 serology, subsequent development of vasodilatory shock with myocardial depression, and subsequent delayed development of coronary artery dilatation after resolution of myocardial depression. Unlike previous reported cases of multisystem inflammatory syndrome in children, he exhibited profound lymphopenia without specific inflammatory cytokines elevations, whereas nonspecific markers (ferritin and C-reactive protein) were increased. He subsequently was discharged on day 12 of hospitalization with complete recovery. CONCLUSION: Our representative case of a patient with coronavirus disease-19-associated multisystem inflammatory syndrome in children without robust hyperinflammation and a delayed finding of coronary artery dilatation compared with reported case series highlights the need for further mechanistic understanding of coronavirus disease-19 disease and subsequent multisystem inflammatory syndrome in children or Kawasaki disease development. This report offers a number of disease mechanisms and clinical evolution considerations for further elucidation to guide development of potential therapies.


id: cord-301868-ehck72z2
author: Jhaveri, Simone
date: 2020-08-05
txt: ./txt/cord-301868-ehck72z2.txt
cache: ./cache/cord-301868-ehck72z2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jpeds.2020.08.002
doi: 10.1016/j.jpeds.2020.08.002
abstract: nan
summary:
  title: Longitudinal Echocardiographic Assessment of Coronary Arteries and Left Ventricular Function Following Multisystem Inflammatory Syndrome in Children (MIS-C) On May 14, 2020, the Centers for Disease Control and Prevention (CDC) recognized this clinical complex as multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 and released a case definition based on clinical and laboratory criteria. [4] MIS-C patients come to medical attention with fever, elevated inflammatory markers, multisystem organ involvement (renal, gastrointestinal, neurologic, dermatologic, cardiac), with evidence of a current or recent SARS-CoV-2 infection or recent close contact with a known or suspected case of COVID-19. We sought to describe the echocardiographic manifestations of MIS-C including evolution of abnormalities of coronary artery dilation and ventricular systolic function over short-term follow-up after discharge from the hospital. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection: A Multiinstitutional Study from New York City

title:
  Longitudinal Echocardiographic Assessment of Coronary Arteries and Left Ventricular Function Following Multisystem Inflammatory Syndrome in Children (MIS-C)


id: cord-308046-y9kui730
title: A Dermatologic Perspective on Multisystem Inflammatory Syndrome in Children()()
author: Naka, Fludiona
date: 2020-09-23
txt: ./txt/cord-308046-y9kui730.txt
cache: ./cache/cord-308046-y9kui730.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0738081X20301772?v=s5
doi: 10.1016/j.clindermatol.2020.09.003
summary:
  This syndrome has been termed multisystem inflammatory syndrome in children (MIS-C), and is observed in association with the coronavirus disease 2019 (COVID-19). The majority of patients had a negative COVID PCR at the time of diagnosis, likely because the disease tends to present 4-6 weeks after the viral infection. Documented cutaneous findings reported in children with COVID-19 include non-specific maculopapular eruptions, followed by chilblain-like or pernio-like acral lesions, urticarial lesions, livedo reticularis, papulovesicular or varicella-like lesions, petechiae or dengue-like lesions, and erythema multiforme-like lesions. 19 Looking at all the thirteen-case series presented in Table 3 , the percentage of children diagnosed with MIS-C who developed mucocutaneous findings included: conjunctivitis 27% -93%, oral mucosal changes 25% -87%, eruption 47% -81%, and hand/feed erythema and edema 27% -68%. Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19: A New York City Experience Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management

abstract:
  As of May 2020, an emerging immune-mediated syndrome primarily affecting children has been detected primarily in Europe and the United States. The incidence of this syndrome appears to mirror the initial infectious assault, with a delay of several weeks. This syndrome has been termed multisystem inflammatory syndrome in children (MIS-C), and is observed in association with the coronavirus disease 2019 (COVID-19). The phenotypes of presentation include several characteristic features, including prolonged fever, eruption, neck stiffness and gastrointestinal manifestations with pronounced abdominal pain. Shock and organ dysfunction on presentation are frequently but inconsistent, while respiratory distress is typically, and notably, absent. We have reviewed recently published data aiming to better understanding MIS-C, with a focus on its mucocutaneous manifestations. • Mucocutaneous manifestations of MIS-C: conjunctivitis, oral mucosal changes, rash. • The rash of MIS-C is typically diffuse and non-specific. • Mucocutaneous manifestations of MIS-C are more common in younger children. • KD and MIS-C differ in mean age of onset, race predilection, and associated symptoms.


id: cord-313058-nrrl4kjc
author: Rivas, Magali Noval
date: 2020-10-16
txt: ./txt/cord-313058-nrrl4kjc.txt
cache: ./cache/cord-313058-nrrl4kjc.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0091674920314147
doi: 10.1016/j.jaci.2020.10.008
abstract: nan
summary:
  title: COVID-19 Associated Multisystem Inflammatory Syndrome in Children (MIS-C): a novel disease that mimics Toxic Shock Syndrome. As of mid-September, the novel severe acute respiratory syndrome coronavirus 2 26 (SARS-CoV-2) has infected more than 30 million people, resulting in approximately one 27 million deaths worldwide, including over 200,000 deaths in the USA alone. Exacerbation of the COVID-19 immune response manifested by extensive cytokines 33 release, called cytokine storm, may lead to multisystem inflammatory syndrome that is 34 fatal in 28% of cases 1 . Interestingly, SAg-induced TSS has been associated with long-term 94 neuropsychologic deficits in adults, including cognitive decline 10 , and we identified a 95 homology between the SAg motif of SARS-CoV-2 and neurotoxin-like sequences which 96 are able to bind the TCR 5 . Clinical 131 Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome 132 Temporally Associated With SARS-CoV-2

title:
  COVID-19 Associated Multisystem Inflammatory Syndrome in Children (MIS-C): a novel disease that mimics Toxic Shock Syndrome. The superantigen hypothesis


id: cord-314662-nem6dw34
author: Nakra, Natasha A.
date: 2020-07-01
txt: ./txt/cord-314662-nem6dw34.txt
cache: ./cache/cord-314662-nem6dw34.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/children7070069
doi: 10.3390/children7070069
summary:
  Initial reports surfaced in the UK [3] and Italy [4] , followed by New York and other parts of the U.S. Preliminary accounts of the features of this syndrome resemble those of known entities such as Kawasaki Disease (KD), toxic shock syndrome (TSS), and secondary hemophagocytic lymphohistiocytosis (SHLH)/macrophage activation syndrome (MAS). Early consultation of specialists to assist in management, such as intensive care, cardiology, rheumatology, infectious diseases, allergy/immunology, neurology Abbreviations: ALT, alanine transaminase; AST, aspartate transaminase; pro-BNP, pro-B-type natriuretic peptide; BUN, blood urea nitrogen; CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; GI, gastrointestinal; HLH, hemophagocytic lymphohistiocytosis; IL, interleukin; MIS-C, multisystem inflammatory syndrome in children; NK, natural killer; NP, nasopharyngeal; PT, prothrombin time; PTT, partial thromboplastin time; RT-PCR, reverse transcriptase polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

title:
  Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management

abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may result in the multisystem inflammatory syndrome in children (MIS-C). The clinical presentation of MIS-C includes fever, severe illness, and the involvement of two or more organ systems, in combination with laboratory evidence of inflammation and laboratory or epidemiologic evidence of SARS-CoV-2 infection. Some features of MIS-C resemble Kawasaki Disease, toxic shock syndrome, and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. The relationship of MIS-C to SARS-CoV-2 infection suggests that the pathogenesis involves post-infectious immune dysregulation. Patients with MIS-C should ideally be managed in a pediatric intensive care environment since rapid clinical deterioration may occur. Specific immunomodulatory therapy depends on the clinical presentation. The relationship between the immune response to SARS-CoV-2 vaccines in development and MIS-C requires further study.


id: cord-315508-8bcpxo02
author: Sperotto, Francesca
date: 2020-08-15
txt: ./txt/cord-315508-8bcpxo02.txt
cache: ./cache/cord-315508-8bcpxo02.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00431-020-03766-6
doi: 10.1007/s00431-020-03766-6
summary:
  Patients with SARS-Cov-2-associated multisystem inflammatory syndrome frequently presented with persistent fever, gastrointestinal symptoms, polymorphic rash, conjunctivitis, and mucosal changes. Notably, a subset of patients presents with hypotension and shock from either acute myocardial involvement or systemic hyperinflammation/vasodilation, frequently requiring intensive care admission, circulatory, and respiratory support (Tables 2 and 3 ) [4, 5, 8, 9, 13-20, 22-25, 27] . Possible causes of myocardial injury in adults with COVID-19 include acute myocarditis, hypoxic injury, ischemic injury caused by cardiac microvascular damage or coronary artery disease, right heart strain (acute cor pulmonale), stress cardiomyopathy (Takotsubo), and systemic inflammatory response syndrome [3, [34] [35] [36] [37] . Due to the scarce knowledge and the small number of reported cases so far, the management of patients with MIS-C has been largely based on expert opinion and extrapolated from KD treatment, adult experience with COVID-19, and other systemic inflammatory disorders in children. Cardiac MRI of children with multisystem inflammatory syndrome (MIS-C) associated with COVID-19: case series Eléonore

title:
  Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach

abstract:
  Initial reports on COVID-19 described children as largely spared from severe manifestations, with only 2–6% of children requiring intensive care treatment. However, since mid-April 2020, clusters of pediatric cases of severe systemic hyperinflammation and shock epidemiologically linked with COVID-19 have been reported. This condition was named as SARS-Cov-2-associated multisystem inflammatory syndrome in children and showed similarities to Kawasaki disease. Here, we present a narrative review of cases reported in literature and we discuss the clinical acute and follow-up management of these patients. Patients with SARS-Cov-2-associated multisystem inflammatory syndrome frequently presented with persistent fever, gastrointestinal symptoms, polymorphic rash, conjunctivitis, and mucosal changes. Elevated inflammatory markers and evidence of cytokine storm were frequently observed. A subset of these patients also presented with hypotension and shock (20–100%) from either acute myocardial dysfunction or systemic hyperinflammation/vasodilation. Coronary artery dilation or aneurysms have been described in 6–24%, and arrhythmias in 7–60%. Cardiac support, immunomodulation, and anticoagulation are the key aspects for the management of the acute phase. Long-term structured follow-up of these patients is required due to the unclear prognosis and risk of progression of cardiac manifestations. Conclusion: Multisystem inflammatory syndrome is a novel syndrome related to SARS-CoV-2 infection. Evidence is still scarce but rapidly emerging in the literature. Cardiac manifestations are frequent, including myocardial and coronary involvement, and need to be carefully identified and monitored over time. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00431-020-03766-6) contains supplementary material, which is available to authorized users.


id: cord-317822-e4uhop4w
author: Bahrami, Ahmad
date: 2020-07-08
txt: ./txt/cord-317822-e4uhop4w.txt
cache: ./cache/cord-317822-e4uhop4w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32640066/
doi: 10.1111/jpc.15048
abstract: nan
summary:
  A growing body of evidence from the UK, Europe and the USA suggests that a number of paediatric patients could present with fever, rash and shock with concomitant COVID-19 infection. Vital signs showed a temperature of 39.5 C, sinus tachycardia (165 beats/min), tachypnoea with normal Key Points 1 A growing body of evidence from the United Kingdom (UK), Europe, and the United States of America (USA) suggests that a number of paediatric patients could present with Kawasakilike symptoms such as fever, rash and shock with concomitant COVID-19 infection which has been referred to multisystem inflammatory syndrome in children (MIS-C). 2 The negative results of polymerase chain reaction (PCR) test for COVID-19 in a patient with high levels of serum IgG could suggest that the virus had been cleared and the presence of Kawasaki-like manifestations may be due to delayed immunemediated phenomenon caused by COVID-19.

title:
  Hyperinflammatory shock related to COVID‐19 in a patient presenting with multisystem inflammatory syndrome in children: First case from Iran


id: cord-322435-c88tkbnz
author: Rekhtman, Sergey
date: 2020-10-24
txt: ./txt/cord-322435-c88tkbnz.txt
cache: ./cache/cord-322435-c88tkbnz.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0190962220328723?v=s5
doi: 10.1016/j.jaad.2020.10.060
summary:
  title: Mucocutaneous Disease and Related Clinical Characteristics in Hospitalized Children and Adolescents with COVID-19 and MIS-C Objective To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C. [1] [2] [3] [4] [5] In addition to fever and respiratory symptoms, pediatric patients infected with 74 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen in COVID-19, also 75 develop eruptions and mucositis. The purpose of this study was to estimate prevalence of integumentary findings in hospitalized 81 patients with COVID-19 and MIS-C, to characterize their morphologic patterns, to evaluate whether rash 82 Criteria for confirming the diagnosis of MIS-C included age <21 years, fever for ≥24 hours, clinically 89 severe illness requiring hospitalization, multisystem organ involvement, no alternative plausible 90 diagnosis, and exposure to a suspected or confirmed COVID-19 case or positive SARS-CoV-2 infection 91 by PCR/serology testing. Clinical and epidemiological features of 36 children 219 with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study

title:
  Mucocutaneous Disease and Related Clinical Characteristics in Hospitalized Children and Adolescents with COVID-19 and MIS-C

abstract:
  Background Little is known about mucocutaneous disease in acutely-ill children and adolescents with COVID-19 and MIS-C. Objective To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C. Methods Descriptive cohort study of prospectively and consecutively hospitalized eligible patients between May 11, 2020 and June 5, 2020. Results In COVID-19 patients, 4/12 (33%) had rash and/or mucositis, including erythema, morbilliform pattern, and lip mucositis. In MIS-C patients, 9/19 (47%) had rash and/or mucositis, including erythema, morbilliform, retiform purpura, targetoid and urticarial patterns, along with acral edema, lip mucositis, tongue papillitis, and conjunctivitis. COVID-19 patients with rash had less frequent respiratory symptoms, PICU admission, and invasive ventilation, as well as shorter stay (vs COVID-19 without rash). MIS-C patients with rash had less frequent PICU admission, shock, ventilation, as well as lower levels of CRP, ferritin, D-dimer, and troponin (vs MIS-C without rash). Neutrophil-to-lymphocyte ratio was similar for patients with and without rash in both groups. None of the MIS-C patients met criteria for Kawasaki disease. Limitations Small sample sizes. Conclusions Mucocutaneous disease is common among children and adolescents with COVID-19 and MIS-C. Laboratory trends observed in patients with rash may prognosticate a less severe course.


id: cord-336049-n3swuykg
title: Multisystem inflammatory syndrome in children: A systematic review
author: Ahmed, Mubbasheer
date: 2020-09-04
txt: ./txt/cord-336049-n3swuykg.txt
cache: ./cache/cord-336049-n3swuykg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32923992/
doi: 10.1016/j.eclinm.2020.100527
summary:
  INTERPRETATION: Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. However, in early May 2020, investigators from South Thames Retrieval Service in London, UK published a report describing eight severely ill pediatric patients presenting in hyperinflammatory shock with multiorgan involvement [6] Specifically, the children manifested with high fever, rash, conjunctivitis, peripheral edema, and gastrointestinal symptoms. We included patients with COVID-19 to reinforce to the healthcare community and public the differences in the clinical presentation, to highlight the degree of systemic inflammation in MIS-C, and to iterate the differences in treatment and outcome between the two diseases. Data collected from the studies included demographics, number of patients, signs and symptoms, laboratory markers, imaging results, medications, and outcomes. Cardiac MRI of children with multisystem inflammatory syndrome (MIS-C) associated with COVID-19: case series

abstract:
  BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome, is a new dangerous childhood disease that is temporally associated with coronavirus disease 2019 (COVID-19). We aimed to describe the typical presentation and outcomes of children diagnosed with this hyperinflammatory condition. METHODS: We conducted a systematic review to communicate the clinical signs and symptoms, laboratory findings, imaging results, and outcomes of individuals with MIS-C. We searched four medical databases to encompass studies characterizing MIS-C from January 1st, 2020 to July 25th, 2020. Two independent authors screened articles, extracted data, and assessed risk of bias. This review was registered with PROSPERO CRD42020191515. FINDINGS: Our search yielded 39 observational studies (n = 662 patients). While 71·0% of children (n = 470) were admitted to the intensive care unit, only 11 deaths (1·7%) were reported. Average length of hospital stay was 7·9 ± 0·6 days. Fever (100%, n = 662), abdominal pain or diarrhea (73·7%, n = 488), and vomiting (68·3%, n = 452) were the most common clinical presentation. Serum inflammatory, coagulative, and cardiac markers were considerably abnormal. Mechanical ventilation and extracorporeal membrane oxygenation were necessary in 22·2% (n = 147) and 4·4% (n = 29) of patients, respectively. An abnormal echocardiograph was observed in 314 of 581 individuals (54·0%) with depressed ejection fraction (45·1%, n = 262 of 581) comprising the most common aberrancy. INTERPRETATION: Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. With prompt recognition and medical attention, most children will survive but the long-term outcomes from this condition are presently unknown. FUNDING: Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study


id: cord-339709-49q2xxkw
author: sermet, i.
date: 2020-06-30
txt: ./txt/cord-339709-49q2xxkw.txt
cache: ./cache/cord-339709-49q2xxkw.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1101/2020.06.29.20142596
doi: 10.1101/2020.06.29.20142596
summary:
  Despite a low frequency of respiratory symptoms, cases of Multisystem Inflammatory 108 Syndrome (MIS) have been reported in children that were infected by SARS-CoV-2 or were in contact 109 with COVID-19 patients 14, 15 . We also analysed SARS-CoV-2 and seasonal HCoVs humoral responses of patients with MIS 122 regarding antibody targets and functional neutralizing activity. Our study is the first to analyse in depth 123 the typology of humoral responses to SARS-CoV-2 in children, and provides evidence that prior 124 infections by seasonal coronaviruses has no significant impact on SARS-CoV-2 infection or related MIS 125 disease in children. We compared the prevalence of anti-N and -S antibodies against the four seasonal HCoVs in a 220 subpopulation of children among the HOS-P (n=54), MIS-P (n=15) and CTL (n=118) groups (Figure 1) .

title:
  Prior infection by seasonal coronaviruses does not prevent SARS-CoV-2 infection and associated Multisystem Inflammatory Syndrome in children

abstract:
  Background: Children have a lower rate of COVID-19, potentially related to cross-protective immunity conferred by seasonal coronaviruses (HCoVs). We tested if prior infections with seasonal coronaviruses impacted SARS-CoV-2 infections and related Multisystem Inflammatory Syndrome (MIS). Methods: This cross-sectional observational study in Paris hospitals enrolled 739 pauci or asymptomatic children (HOS group) plus 36 children with suspected MIS (MIS group). Prevalence, antigen specificity and neutralizing capability of SARS-CoV-2 antibodies were tested. Antibody frequency and titres against Nucleocapsid (N) and Spike (S) of the four seasonal coronaviruses (NL63, HKU1, 229E, OC43) were measured in a subset of seropositive patients (54 SARS-CoV-2 (HOS-P subgroup) and 15 MIS (MIS-P subgroup)), and in 118 matched SARS-CoV-2 seronegative patients (CTL subgroup). Findings: SARS-CoV-2 mean prevalence rate in HOSP children was 11.7% from April 1 to June 1. Neutralizing antibodies were found in 55.6% of seropositive children, and their relative frequency increased with time (up to 100 % by mid-May). A majority of MIS children (25/36) were SARS-CoV-2 seropositive, of which all tested (n=15) had neutralizing antibodies. On average, seropositive MIS children had higher N and S1 SARS-CoV-2 titres as compared to HOS children. Patients from HOS-P, MIS-P, and CTL subgroups had a similar prevalence of antibodies against the four seasonal HCoVs (66.9 -100%). The level of anti-SARS-CoV-2 antibodies was not significantly different in children who had prior seasonal coronavirus infection. Interpretation: Prior infection with HCoVs does not prevent SARS-CoV-2 infection and related MIS in children. Children develop neutralizing antibodies after SARS-CoV-2 infection.


id: cord-344683-lr1xr2um
title: A Cytokine Circus with a Viral Ringleader: SARS-CoV-2-Associated Cytokine Storm Syndromes
author: Cabler, Stephanie
date: 2020-09-30
txt: ./txt/cord-344683-lr1xr2um.txt
cache: ./cache/cord-344683-lr1xr2um.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33051104/
doi: 10.1016/j.molmed.2020.09.012
summary:
  An unbridled host immune response to SARS-CoV-2 infection likely underlies severe cases of the disease and has been labeled a "Cytokine Storm Syndrome". Infection with SARS-CoV-2, the etiologic agent of Coronavirus Disease 2019 (COVID19) , can lead to severe pneumonia, multi-organ failure, and death. Given the clinical and laboratory features, it is reasonable to consider MIS-C as a separate but related entity to the severe multi-organ dysfunction observed in patients with S-CSS (Figure 1 ). A second study showed pediatric patients with MIS-C exhibit distinct cytokine profiles from those with severe SARS-CoV-2 respiratory disease, exhibiting higher IL-10 and TNF [19] . What are the optimal clinical characteristics and biomarkers to identify and classify cases of MIS-C, S-CSS, and other diseases associated with Cytokine Storm Syndrome? Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2

abstract:
  An unbridled host immune response to SARS-CoV-2 infection likely underlies severe cases of the disease and has been labeled a “Cytokine Storm Syndrome”. We emphasize that categorization of syndromes triggered by a completely novel pathogen based on other seemingly similar, but potentially distinct, known entities is an inherently risky endeavor.


id: cord-350401-suefuurq
author: Lima-Setta, Fernanda
date: 2020-11-09
txt: ./txt/cord-350401-suefuurq.txt
cache: ./cache/cord-350401-suefuurq.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0021755720302254
doi: 10.1016/j.jped.2020.10.008
summary:
  title: Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study()()() From March 25 to August 23, 2020, pediatric patients (age range: 1 month -19 years) were consecutively included if they met the CDC case definition[8] for MIS-C: 1) fever > 38.0°C for ≥ 24 hours (objective or subjective); 2) laboratory evidence of inflammation, including, but not limited to, one or more of the following: high values of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6); elevated neutrophils, reduced lymphocytes, and low albumin; 3) no alternative plausible diagnosis; 4) current or recent SARS-CoV-2 infection diagnosed by a positive reverse transcription polymerase chain reaction (RT-PCR) or positive serological tests (IgM, IgG or IgA), or exposure to a suspected or confirmed COVID-19 case within the four weeks prior to the onset of symptoms.

title:
  Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study()()()

abstract:
  OBJECTIVE: To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C. METHOD: Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively. RESULTS: Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. D-dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%). CONCLUSIONS: Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.


id: cord-351126-d6lfktf9
author: Kofman, Aaron D.
date: 2020-09-29
url: https://doi.org/10.1186/s12879-020-05439-z
doi: 10.1186/s12879-020-05439-z
title:
  A young adult with COVID-19 and multisystem inflammatory syndrome in children (MIS-C)-like illness: a case report

abstract:
  BACKGROUND: A healthy 25-year-old woman developed COVID-19 disease with clinical characteristics resembling Multisystem Inflammatory Syndrome in Children (MIS-C), a rare form of COVID-19 described primarily in children under 21 years of age. CASE PRESENTATION: The patient presented with 1 week of weakness, dyspnea, and low-grade fevers, followed by mild cough, sore throat, vomiting, diarrhea, and lymph node swelling. She was otherwise healthy, with no prior medical history. Her hospital course was notable for profound acute kidney injury, leukocytosis, hypotension, and cardiac dysfunction requiring ICU admission and vasopressor support. MIS-C-like illness secondary to COVID-19 was suspected due to physical exam findings of conjunctivitis, mucositis, and shock. She improved following IVIG, aspirin, and supportive care, and was discharged on hospital day 5. CONCLUSION: MIS-C-like illness should be considered in adults presenting with atypical clinical findings and concern for COVID-19. Further research is needed to support the role of IVIG and aspirin in this patient population.


id: cord-351634-x1aw6gv2
title: Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children
author: Brumfiel, Caitlin M.
date: 2020-11-01
txt: ./txt/cord-351634-x1aw6gv2.txt
cache: ./cache/cord-351634-x1aw6gv2.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0738081X20302121?v=s5
doi: 10.1016/j.clindermatol.2020.10.021
summary:
  Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. 1,2 Despite a relatively benign clinical course for most, pediatric patients may rarely exhibit exaggerated immune responses that fall on a spectrum ranging from a mild febrile inflammatory state without multisystem involvement, to a moderate Kawasaki disease (KD)-like illness, to a severe multisystem inflammatory syndrome with shock. 3 Beginning in late April 2020, multisystem inflammatory syndrome in children (MIS-C) became an increasingly recognized hyperinflammatory phenotype in pediatric patients with evidence of COVID-19 infection. detailed 78 cases of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), which is very similar to MIS-C but with a slightly less restrictive case definition, particularly patients may exhibit single organ system dysfunction and may or may not require hospitalization.

abstract:
  Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. Skin findings are often present in these patients and while initially compared to Kawasaki disease, likely represent distinct phenomena and overall remain poorly characterized. In this retrospective review of 34 case reports and series, we identified cutaneous manifestations documented in 417 of 736 patients (57%) with MIS-C associated with COVID-19. “Rash” was the sole descriptor of skin findings in nearly half of patients. Case reports and smaller case series provided more detail, outlining a broad range of lesion morphologies (polymorphic, maculopapular, morbilliform, erythrodermic, urticarial, reticular, petechial, purpuric) in variable anatomic distribution. More thorough descriptions of dermatologic manifestations in patients with MIS-C are warranted to better characterize this syndrome, as they may lend important insight into pathogenic mechanisms of disease.


id: cord-354093-zdhfyotl
title: Cardiac Involvement in Children With COVID-19
author: Kohli, Utkarsh
date: 2020-08-07
txt: ./txt/cord-354093-zdhfyotl.txt
cache: ./cache/cord-354093-zdhfyotl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32769232/
doi: 10.1007/s13312-020-1998-0
summary:
  This review focuses on cardiac involvement during COVID-19 infection and the multisystem inflammatory syndrome in children (MIS-C) [6, 7] . Cardiac involvement, which can manifest as acute myocardial injury with elevated plasma troponin concentration, acute coronary events, heart failure and arrhythmias is both common and associated with a higher morbidity and mortality in adults with COVID-19 [8] [9] [10] . Cardiac involvement during COVID-19 is not common in children who require pediatric intensive care unit (PICU) admission; use of inotropes was reported in 12 (25%) patients admitted to a North American PICU in a recent study [4] . Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19 Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 and Hyperinflammation in COVID-19

abstract:
  In contrast to adults, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) usually leads to a mild illness in children. However, a few children have been reported to have severe manifestations including pneumonia, acute kidney injury, multi-organ failure and cardiac injury. This review focuses on cardiac involvement during SARS-CoV-2 infection and the recently described likely immune mediated post-COVID-19 syndrome. Therapeutic strategies for cardiac dysfunction in both these settings are briefly discussed.


id: cord-354608-1me3nopu
title: COVID-19 in the Pediatric Population—Review and Current Evidence
author: Rabinowicz, Shira
date: 2020-09-19
txt: ./txt/cord-354608-1me3nopu.txt
cache: ./cache/cord-354608-1me3nopu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32982599/
doi: 10.1007/s11908-020-00739-6
summary:
  By mid-August 2020, the World Health Organization reported over 23 million confirmed cases of infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), resulting in more than 710,000 death worldwide [1] . We review the current evidence of epidemiology, clinical presentation, treatment, and indirect health consequences of SARS-CoV-2 on children. In reports from countries that were severely affected early in course of the pandemic, children comprise 1-2% the diagnosed COVID-19 cases, underrepresented compared with other age groups [3, [13] [14] [15] . In summary, children at any age may be infected with SARS-CoV-2, with reduced frequency and severity compared with adults, although clear epidemiologic data is still missing. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian Pediatric Intensive Care Units 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.

abstract:
  PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) pandemic has major health and economic impacts. We review disease characteristics in children. RECENT FINDINGS: Children comprise 1–2% of the diagnosed cases, and typically suffer mild disease. The median age of infected children is 3.3–11 years, and male/female ratio is 1.15–1.55. Common symptoms in children include upper respiratory symptoms (26–54%), cough (44–54%), fever (32–65%), and gastrointestinal (15–30%) symptoms. Substantial proportion (4–23%) are asymptomatic. Death rates are up to 0.7%. Risk factors associated with severe disease are neonatal age group, male gender, lower respiratory tract disease, and pre-existing medical conditions. Vertical transmission was reported. Multisystem inflammatory syndrome (MIS), characterized by fever, multisystem organ involvement, and laboratory markers of inflammation, causes critical illness in > 50% of cases and is increasingly reported from endemic countries. Indirect effects of the coronavirus epidemic include higher rates of psychiatric morbidities, education loss, unhealthy lifestyle changes, and increased child neglect. Vaccines are in clinical trials and immunogenicity has not yet been shown in children. SUMMARY: Overall, COVID-19 has lower incidence and causes milder disease in children compared with adult patients. MIS is a rare severe complication more common in children. More data on the efficacy and safety of antivirals in children are needed.


id: cord-355636-mq7xb9d4
title: Minimally invasive surgery in the COVID‐19 pandemic: An early single centre experience
author: Booth, R.
date: 2020-08-21
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url: https://www.ncbi.nlm.nih.gov/pubmed/32822507/
doi: 10.1002/bjs.11986
abstract: nan
summary:
  Various surgical societies published guidelines which were not in favour of minimally invasive surgery (MIS) due to the perceived risk of virus spread from aerosolisation 2,3 . Guidelines have suggested caution with a perceived risk of virus spread through aerosol generating procedures (AGPs) including laparoscopy and robotic surgery. All patients for elective surgery were self-isolated for two weeks and had COVID-19 test performed 48 hours before the procedure. Emergency surgery patient underwent PCR COVID-19 test prior to their procedure where feasible. During the study period, there was no COVID-19 positive case reported amongst the patients in the MIS group or theatre staff. This data would suggest that, with appropriate screening of patients and protection of theatre staff as outlined, MIS is safe and feasible. Patients should not be denied the clear advantages of laparoscopic surgery over open surgery during the current COVID-19 pandemic.


