Studies help identify severe COVID from associated childhood syndrome

Two new studies detail the signs and symptoms specific to US children and teens with rare but severe coronavirus-related pediatric multisystem inflammatory syndrome (MIS-C), and are severe. Helps to distinguish it from COVID-19.

Age, race, organ system involvement

the first Survey, A case series led by researchers at the US Centers for Disease Control and Prevention was announced yesterday JAMAWas a comparison of 539 patients under the age of 21 with MIS-C and 577 patients with severe COVID-19 at 66 hospitals in 31 states from March 15 to October 31, 2020. .. Patients with MIS-C had fever, inflammation, and multi-organ inflammation, and patients with severe COVID-19 had severe organ system involvement.

Scientists have found that patients with MIS-C are more likely to be 6-12 years of age than those with severe coronavirus (40.8% vs. 19.4%; absolute risk difference). [RD], 21.4%) and non-hispanic blacks (32.3% vs 21.5%; RD, 10.8%), severe cardiovascular lesions (56.0% vs 8.8%; RD, 47.2%), cardiovascular No respiratory lesions (10.6% vs 2.9%); RD, 7.7%), and mucosal skin without cardiovascular involvement (including both mucosa and skin) (7.1% vs 2.3%; RD, 4.8% ).

Patients with severe COVID-19 have respiratory involvement but no cardiovascular lesions, or hematological, neurological, or gastrointestinal lesions but cardiovascular, respiratory, Or there are often no lesions of the mucocutaneous system.

Compared to their counterparts, MIS-C patients were more likely to have no underlying medical condition (69.% Vs. 37.9%). Signs and symptoms were similar between the two patient groups (66.8% vs 10.2%), except for mucosal skin lesions.

Compared to patients with severe COVID-19, MIS-C patients have a higher proportion of neutrophils and lymphocytes, indicating infection or distress. Shows higher C-reactive protein concentration, inflammation. Platelet counts decrease and show an abnormal immune response.

Of the 539 patients with MIS-C, 398 (73.8%) were admitted to the intensive care unit (ICU), while 253 (43.8%) of the 577 patients with severe COVID-19 were admitted. did. Ten MIS-C patients (1.9%) and eight with severe COVID-19 (1.4%) died in the hospital.

MIS-C patients with decreased left ventricular contractile function (172 out of 503) [34.2%]) And coronary artery aneurysm (57/424) [13.4%]), About 91.0% and 79.1% recovered by the 30th, respectively.

According to researchers, most MIS-C patients had severe respiratory lesions, but had COVID-19 with cardiovascular lesions, as reported in adult patients rather than MIS-C. It may have been. “Misclassification of these patients can interfere with optimal treatment if the etiology differs between MIS-C and COVID-19, but anti-inflammatory agents such as steroids may be beneficial to both. There are, “they write.

The authors influence the results of this study by allowing clinicians to distinguish between MIS-C and severe COVID-19, improve the definition of cases, and increase the specificity of diagnostic testing, immunotherapy, and follow-up use. He informed the children and teenagers who received the effort and said it would help improve the results. up.

Prolonged ear, nose and throat symptoms

A Research letter Released today JAMA Otolaryngology Head and Neck SurgeryMeanwhile, signs and symptoms of otolaryngology (ear, nose, throat) in 50 children under the age of 18 admitted to the UK for pediatric inflammatory multisystem syndrome temporarily associated with COVID-19 or PIMS. Describes a single-center observation cohort study-TS. It is defined in the same way as MIS-C in the United States.

From April 1st to June 22nd, 2020, a team led by a doctor at the Great Ormond Street Children’s Hospital in London surveyed 50 children with PIMS-TS, 19 of whom (38%) were followed by otolaryngology. I received an up visit. , And throat problems with an otolaryngologist.

The most common otolaryngological signs and symptoms were dysphagia (difficult to speak), dysphagia (dysphagia), anosmia (loss of smell), or hyposmia (decreased olfactory ability). .. Of the 50 patients, 15 (30%) had significant and persistent otolaryngology involvement at follow-up, and 4 (8%) had it during their illness.

Of the 50 patients, 38 (76%) needed ICU care and 18 (36%) needed a ventilator.

The authors stated that some explanations for adult otolaryngological symptoms may also apply to children. “For example, dysphonia can be caused by the involvement of the larynx in the airway inflammatory process that leads to vocal cord edema or inflammation,” they write.

Further research is needed to identify factors such as race and the need for intubation that may increase the risk of long-term otolaryngology symptoms and symptoms, according to researchers. “Because the long-term sequelae of this disease are unknown, children with a history of PIMS-TS may be reassessed by the infectious disease team within 12 months and referred to the otolaryngologist for persistent symptoms. It’s wise, “they wrote.