Çocuklarda Multi̇si̇stem Enflamatuvar Sendrom (MIS-C)
Özet
Çocuklarda Multisistem Enflamatuvar Sendrom (MIS-C), SARS-CoV-2 enfeksiyonunu takiben genellikle 3-4 hafta sonra ortaya çıkan, ısrarlı ateş, laboratuvar düzeyinde yüksek hiperenflamasyon belirteçleri ve çoklu organ sistemik bozukluğu ile karakterize tehlikeli pediyatrik bir hastalıktır. Olguların ortanca yaşı 8,6 yıl olup erkek cinsiyet baskınlığı (%52,3-59) ve Afrika kökenli çocuklarda daha yüksek insidans dikkat çekmektedir. CDC vaka tanı kriterleri; 21 yaşından küçük olma, en az 24 saat süren ateş, hastaneye yatış gerektiren ağır tablo, en az iki organ sisteminin (kalp, böbrek, solunum, gastrointestinal, dermatolojik vb.) etkilenmesi, CRP, ESR, ferritin, prokalsitonin ve D-dimer yüksekliği ile SARS-CoV-2 laboratuvar veya epidemiyolojik kanıtını içerir. Klinik tabloda en sık ateş (%98-100), gastrointestinal bulgular (%70-88), hipotansiyon (%40-74), döküntü ve konjonktivit saptanır. MIS-C; Kawasaki hastalığına göre daha ileri yaşlarda görülmesi, Afrika kökenlilerde sık olması, daha yüksek şok oranı (%56-63), şiddetli gastrointestinal/nörolojik tutulum ve daha belirgin lenfopeni/trombositopeni ile ayrılır. Tedavide birincil basamak olarak IVIG ve kortikosteroitler kullanılır; dirençli durumlarda anakinra ve klinik özelliklere göre aspirin ile antikoagülan tedavi eklenir. Olguların %68-71'i yoğun bakım izlemi gerektirirken mortalite oranı %1-2 civarındadır.
Referanslar
RCPCH. Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID‐19. Accessed January 7, 2021. https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf
CDC. Emergency preparedness and response: health alert network. Accessed January 7, 2021. https://emergency.cdc.gov/han/2020/han00432.asp
WHO. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Accessed January 7, 2021. https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19
Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26:100527.
Radia T, Williams N, Agrawal P, et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatric respiratory reviews. 2020;
Ludvigsson JF. Systematic review of COVID‐19 in children shows milder cases and a better prognosis than adults. Acta Paediatrica. 2020;109(6):1088-1095.
Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. The Pediatric infectious disease journal. 2020;39(11):e340-e346.
Abrams JY, Godfred-Cato SE, Oster ME, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: a systematic review. The Journal of pediatrics. 2020;226:45-54. e1.
Sabbour MA, El-Swaify ST, Farrag N, et al. Multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection: a scoping review of the literature. medRxiv. 2020;
Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet. 2020;
Aronoff SC, Hall A, Del Vecchio MT. The Natural History of SARS-Cov-2 Related Multisystem Inflammatory Syndrome in Children (MIS-C): A Systematic Review. Journal of the Pediatric Infectious Diseases Society. 2020:piaa112.
Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children. 2020;7(7):69.
Rawat M, Chandrasekharan P, Hicar MD, Lakshminrusimha S. COVID-19 in Newborns and Infants—Low Risk of Severe Disease: Silver Lining or Dark Cloud? American journal of perinatology. 2020;37(8):845.
Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. Jama. 2020;
Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1. Arthritis. 2020;72(11):1791-1805.
Yetkin O, Hacievliyagil S, Gunen H. Assessment of B‐type natriuretic peptide in patients with pneumonia. International journal of clinical practice. 2008;62(3):488-491.
Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–associated multisystem inflammatory syndrome in children—United States, March–July 2020. Morbidity Mortality Weekly Report. 2020;69(32):1074.
Dufort EM, Koumans EH, Chow EJ, et al. Multisystem inflammatory syndrome in children in New York State. New England Journal of Medicine. 2020;383(4):347-358.
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-e999.
Kanegaye JT, Wilder MS, Molkara D, et al. Recognition of a Kawasaki disease shock syndrome. Pediatrics. 2009;123(5):e783-e789.
Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. New England Journal of Medicine. 1986;315(6):341-347.
MP DL, Redzepi A, McGrath E, et al. COVID-19 Associated Pediatric Multi-System Inflammatory Syndrome. Journal of the Pediatric Infectious Diseases Society. 2020;
Halyabar O, Chang MH, Schoettler ML, et al. Calm in the midst of cytokine storm: a collaborative approach to the diagnosis and treatment of hemophagocytic lymphohistiocytosis and macrophage activation syndrome. Pediatric Rheumatology. 2019;17(1):7.
Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation. 2006;113(22):2606-2612.
de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease–the SHARE initiative. 2019;58(4):672-682.
Belhadjer Z, Méot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. 2020;
Whittaker E, Bamford A, Kenny J, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. Jama. 2020
Hoang A, Chorath K, Moreira A, et al. COVID-19 in 7780 pediatric patients: a systematic review. EClinicalMedicine. 2020;24:100433.
