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Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2.
- Source :
-
The Journal of clinical investigation [J Clin Invest] 2020 Nov 02; Vol. 130 (11), pp. 5967-5975. - Publication Year :
- 2020
-
Abstract
- BACKGROUNDInitial reports from the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease 2019 (COVID-19) than adults. Subsequently, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. We report on unique hematologic and immunologic parameters that distinguish between COVID-19 and MIS-C and provide insight into pathophysiology.METHODSWe prospectively enrolled hospitalized patients with evidence of SARS-CoV-2 infection and classified them as having MIS-C or COVID-19. Patients with COVID-19 were classified as having either minimal or severe disease. Cytokine profiles, viral cycle thresholds (Cts), blood smears, and soluble C5b-9 values were analyzed with clinical data.RESULTSTwenty patients were enrolled (9 severe COVID-19, 5 minimal COVID-19, and 6 MIS-C). Five cytokines (IFN-γ, IL-10, IL-6, IL-8, and TNF-α) contributed to the analysis. TNF-α and IL-10 discriminated between patients with MIS-C and severe COVID-19. The presence of burr cells on blood smears, as well as Cts, differentiated between patients with severe COVID-19 and those with MIS-C.CONCLUSIONPediatric patients with SARS-CoV-2 are at risk for critical illness with severe COVID-19 and MIS-C. Cytokine profiling and examination of peripheral blood smears may distinguish between patients with MIS-C and those with severe COVID-19.FUNDINGFinancial support for this project was provided by CHOP Frontiers Program Immune Dysregulation Team; National Institute of Allergy and Infectious Diseases; National Cancer Institute; the Leukemia and Lymphoma Society; Cookies for Kids Cancer; Alex's Lemonade Stand Foundation for Childhood Cancer; Children's Oncology Group; Stand UP 2 Cancer; Team Connor; the Kate Amato Foundations; Burroughs Wellcome Fund CAMS; the Clinical Immunology Society; the American Academy of Allergy, Asthma, and Immunology; and the Institute for Translational Medicine and Therapeutics.
- Subjects :
- Adolescent
COVID-19
Child
Child, Preschool
Female
Humans
Male
Prospective Studies
SARS-CoV-2
Severity of Illness Index
Betacoronavirus metabolism
Complement Membrane Attack Complex metabolism
Coronavirus Infections blood
Coronavirus Infections epidemiology
Cytokines blood
Pandemics
Pneumonia, Viral blood
Pneumonia, Viral epidemiology
Systemic Inflammatory Response Syndrome blood
Systemic Inflammatory Response Syndrome epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1558-8238
- Volume :
- 130
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The Journal of clinical investigation
- Publication Type :
- Academic Journal
- Accession number :
- 32730233
- Full Text :
- https://doi.org/10.1172/JCI140970