Physician Follow-up Treatment for Children Threatened by Dangerous COVID-19 Syndrome

On a warm afternoon in mid-June, a worried mother took her 11-year-old daughter who had a high fever and severe abdominal pain to the emergency room. Hasbro Children’s Hospital Dr. Providence, RI, began to seriously consider a diagnosis that would have been unthinkable two months ago, after excluding the usual suspects for symptoms such as bacterial infections and appendicitis. 4 weeks after being exposed to the new coronavirus.

Rare Disease-In the United States it was called Childhood Multisystem Inflammation Syndrome (MIS-C) and in the United Kingdom it was called Childhood Multisystem Inflammation Syndrome. First defined This spring is a hyperimmune response to SARS-CoV-2. It disproportionately affects black, Hispanic and Latin children. In some cases of MIS-C, which mimic bacterial overload of toxic shock syndrome, young people arrive at the hospital with shock symptoms and organ failure. In others, they experience high fever and inflammatory symptoms that resemble Kawasaki disease, which attack blood vessels in children. Or, although the affected child may still have high fever and widespread inflammation, the disease may not appear to either of these threats. Almost all children treated with MIS-C appear to be alive and healthy thereafter. However, if it is not diagnosed or treated, this condition can cause permanent damage to the heart and even death.

This disease is so new that there is no consensus on some of its basic features or how to treat it. But the insights from doctors facing MIS-C this summer, along with new research into the victim, have begun to reveal important clues. For example, a small study published on August 18th Natural medicine condition is Different from Kawasaki disease, As many doctors doubted. Also, some recently launched large-scale research efforts may soon reveal ways to diagnose MIS-C and identify the most likely treatment trends.

As of August 20, 694 MIS-C cases and 11 deaths Reported to US Centers for Disease Control.. about 1,000 cases It was documented around the world by the end of July. According to various reports, children are hospitalized with COVID-19 more than MIS-C, but doctors say the latter is more dangerous. Most young people recover, but often after a severe illness. by three Recently the studyIn comparison, 64% to 80% of patients in the hospital needed intensive care. About 33 percent Number of children hospitalized for COVID-19.

With so few cases and no descriptive studies, diagnostic tests, and randomized results to guide treatment, hospital pediatricians had to dig deeper to understand how to help young victims .. Sylvia Chen, A pediatric infectious disease (ID) expert at Brown University and her colleague Sabina Holland managed the case at Hasbro. Chien followed Evaluation guidelines Developed by the Children’s Hospital in Philadelphia, to the point where they read the “consultation ID,” in other words, she would have to consult herself. “I thought,” Haha. Yes. So what do I do now?” she recalls.

Because no doctor is experienced with MIS-C, doctors with infectious diseases work in-house with colleagues in fields such as cardiology, hematology, and rheumatology. Some have consulted distant colleagues with experience in treating inflammatory Kawasaki disease of unknown cause, affecting thousands of infants annually in the United States and more common in Japan.

When Chen sought clues about how to treat patients, she not only had limited CDC guidelines, Webinars for clinicians Sponsored by an agency. The latter featured doctors at Imperial College London and St Mary’s Hospital in London, who described dozens of local children with the high fever and severe inflammation characteristic of MIS-C. Coronavirus. Four weeks before coming to the hospital, Chen learned that two of the families of Hasbro patients recovered from their relatively mild cases of COVID-19 at home. The girl tested positive in the hospital for coronavirus and antibodies against it. In addition to imaging scans, blood tests, and a description of CDC, evidence was added up to MIS-C, the first case reported in Rhode Island.

A rapid and accurate diagnosis of MIS-C is important for treating a child before the disease damages the heart or causes other life-threatening complications. “The children are annoyed and enthusiastic, and after hours they suddenly get worse.” Russell McCullough, Pediatric Infectious Diseases Specialist at the Children’s Hospital and Medical Center in Omaha. In some cases, hospitalized children develop coronary artery inflammation, heart dysfunction, such as a weakly pumping heart, or even heart failure, and the patient is placed on a so-called extracorporeal membrane oxygenation machine to operate the heart or lungs. A ventilator for doing the latter work.

American Children’s Hospital, American College of Rheumatism And that American Academy of Pediatrics He recently published guidance for physicians on MIS-C evaluation, diagnosis and treatment methods, including reference materials from Chen. However, that information is preliminary. The guidelines will probably evolve as more cases progress with physicians’ understanding, says McAraw. He and his colleagues have Currently we are dealing with about 12 cases. However, according to pediatric rheumatologists, the guidelines are not as useful as the undeveloped diagnostic criteria. Grant Schrad.. He is working with a team at the Cincinnati Children’s Hospital who treated several young people diagnosed with MIS-C. So far, the definition of cases has been so widely written that it can obscure the diagnosis, Schrat said.

Another problem is that the MIS-C case definitions often specify the use of antibody tests for the virus, indicating that the patient was infected at some recent time. These results are useful markers in areas where infections are currently peaking, but where the virus slowly creeps among people for months, such as in most parts of the Midwest where he works. Not so. “If you see a patient in winter who has symptoms that are consistent with antibody-positive COVID-19, it doesn’t necessarily mean that you’ve been infected in the last four weeks,” he says. “This underscores the need to understand the biology of MIS-C, so we can build more biology-based classification and diagnostic criteria.”

A thread common in all cases says, Michael levinA pediatric infectious disease specialist who appeared in the CDC webinar is severe inflammation of multiple organ systems, as evidenced by blood markers, along with exposure to SARS-CoV-2. Levin’s team was the first to define MIS-C at the Royal College of Pediatrics. of CDC And World Health Organization It immediately followed.

To avoid misdiagnosis, physicians should also consider laundry lists for other conditions, from tick-borne illness to sepsis. However, fear of missing potential MIS-C patients can lead hospital doctors to perform excessive and unnecessary tests in patients with fever, says pediatric infectious disease expert Jocelyn. AngShe and his colleagues say they treated at least three dozen MIS-C patients in a children’s hospital in Michigan, Detroit.

Some doctors say that understanding how to treat MIS-C is even more difficult than making a diagnosis. “For now, we’re using very blunt therapies based on other disorders, because there’s no better information,” McCulloh says. Because some MIS-C symptoms overlap with those of Kawasaki disease and other inflammatory diseases, doctors have had some success in helping to control inflammation and the excess immune system that causes it. Has depended on the treatment of. Treatments include intravenous immunoglobulins (anti-inflammatory blood products), as well as steroids and monoclonal antibodies. In mild cases, some patients recover with minimal intervention to stabilize blood pressure and breathing until the immune system subsides. However, so far, no data are available to demonstrate which drug is effective or is the best route of action.

Researchers have begun case registration efforts in the United States and the United Kingdom as a temporary move to fund randomized controlled treatment studies. Headed by the Healthcare Professionals at Imperial College London health, it represents 90 different hospitals in 39 countries, including Brazil, Norway and Pakistan. We have entered long MIS-C cases and treatment details into an anonymous online database. Statistical correction of treatment bias based on disease severity allows analysts to compare how a particular approach would benefit patients in many locations. With enough entries, Levin said there will be useful guidance by the end of the year.

Similarly, the CDC Investigation It is headed by Boston Children’s Hospital, which collects data from more than 70 US hospitals and analyzes the risk factors and consequences for 2,000 children and adolescents admitted to COVID-19 and MIS-C. The group reported characteristics and treatments for 186 MIS-C patients in 26 US states, an analysis of which is ongoing, says Adrienne Randolph. Boston Children and Project Principal Investigator and Senior Associate in Critical Care. And Multinational researchIs collecting blood samples from patients with COVID-19, MIS-C and other infectious diseases, funded by the European Commission and headed by Imperial College in London. Researchers are looking for distinct compounds in the blood to classify conditions by molecular signature for use in diagnosis, Levin said. The first results may come this fall.

Regarding Chen’s challenging case in June, her patient recovered well and showed no persistent problems. But a few weeks ago, the girl’s mother told Chen that her daughter was worried, probably due to her MIS-C experience involving two hospitalizations and multiple drug treatments. Chen sympathizes and sees the big picture. “I can imagine being a young adult like her,” she says. “You have a brand new illness so doctors have little experience treating it. And you hear all these things in the media about how terrifying the illness is. Imagine it would be a bit difficult I will.”

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