Review of available therapies for the treatment of pediatric COVID-19-associated polyarticular inflammatory syndrome
DOI:
https://doi.org/10.12775/JEHS.2024.57.014Keywords
MIS-C, PIMS-TS, COVID-19Abstract
Recently, there have been an increasing number of reports from around the world describing children and adolescents with multisystemic inflammatory conditions associated with COVID-19. The clinical features of these pediatric cases are both similar to and different from other well-described inflammatory syndromes, including Kawasaki disease. Symptoms appear to develop after infection, rather than in the acute phase of COVID-19. Regarding the clinical spectrum, much remains unknown.
The new disease entity challenges specialists around the world in developing universal management protocols. In the fight for the health and lives of patients, treatment according to standard protocols for Kawasaki disease has been used. However, further clinical trials are required to prove the effectiveness and safety of these treatments. There are reports of successful therapy using intravenous immunoglobulin preparations and steroid therapy. Biologic, antiviral, antibiotic, antiplatelet and anticoagulant therapies are also used. The described pediatric disease can be associated with hemodynamic failure, so treatment should take place in a hospital setting, under the watchful eye of a multidisciplinary team.
References
Jones VG, Mills M, Suarez D, Hogan CA, Yeh D, Segal JB, Nguyen EL, Barsh GR, Maskatia S, Mathew R. COVID-19 and Kawasaki disease: a new virus and a new case. Hosp Pediatr [Internet]. April 7, 2020 [cited January 29, 2024];10(6):537-40. Available from: https://doi.org/10.1542/hpeds.2020-0123
Harwood R, Allin B, Jones CE, Whittaker E, Ramnarayan P, Ramanan AV, Kaleem M, Tulloh R, Peters MJ, Almond S, Davis PJ, Levin M, Tometzki A, Faust SN, Knight M, Kenny S, Agbeko R, Aragon O, Baird J, Bamford A, Bereford M, Bharucha T, Brogan P, Butler K, Carroll E, Cathie K, Chikermane A, Christie S, Clark M, Deri A, Doherty C, Drysdale S, Duong P, Durairaj S, Emonts M, Evans J, Fraser J, Hackett S, Hague R, Heath P, Herberg J, Ilina M, Jay N, Kelly D, Kerrison C, Kraft J, Leahy A, Linney M, Lyall H, Yardley I. National pathway for the management of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi trial. Lancet Child Amp Adolesc Health [Internet]. September 2020 [cited January 29, 2024]. Available from: https://doi.org/10.1016/s2352-4642(20)30304-7
Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, Barranco MA, Maxted AM, Rosenberg ES, Easton D, Udo T, Kumar J, Pulver W, Smith L, Hutton B, Blog D, Zucker H. Multisystem Inflammatory Syndrome in Children in New York State. New Engl J Med [Internet]. July 23, 2020 [cited January 29, 2024];383(4):347-58. Available from: https://doi.org/10.1056
Belot A, Antona D, Renolleau S, Javouhey E, Hentgen V, Angoulvant F, Delacourt C, Iriart X, Ovaert C, Bader-Meunier B, Kone-Paut I, Levy-Bruhl D. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, March 1 to May 17, 2020. Eurosurveillance [Internet]. June 4, 2020 [cited January 29, 2024];25(22). Available from: https://doi.org/10.2807/1560-7917.es.2020.25.22.2001010
Okarska-Napierała M, Ludwikowska K, Szenborn L, Dudek N, Mania A, Buda P, Książyk J, Mazur-Malewska K, Figlerowicz M, Szczukocki M, Kucińska B, Werner B, Stopyra L, Czech A, Berdej-Szczot E, Gawlik A, Opalińska P, Mazur A, Januszkiewicz-Lewandowska D, Niszczota C, Jackowska T, Wysocki J, Kuchar E. Pediatric Inflammatory Multisystem Syndrome (PIMS) Did Occur in Poland during Months with Low COVID-19 Prevalence, Preliminary Results of a Nationwide Registry. J Clin Med [Internet]. October 22, 2020 [cited January 29, 2024];9(11):3386. Available from: https://doi.org/10.3390/jcm9113386
Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, Gupta A. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev [Internet]. August 2020 [cited 28 Jan 2024]. Available from: https://doi.org/10.1016/j.prrv.2020.08.001
Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, Klein JD, Bhutta ZA. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis [Internet]. November 2020 [cited 28 Jan 2024];20(11):e276-e288. Available from: https://doi.org/10.1016/s1473-3099(20)30651-4
Nelson C, Ishimine P, Hayden SR, Correia M, Wardi G. Multisystem Inflammatory Syndrome in Children (MIS-C) in an Adolescent that Developed Coronary Aneurysms: A Case Report and Review of the Literature. J Emerg Med [Internet]. November 2020 [cited January 28, 2024];59(5):699-704. Available from: https://doi.org/10.1016/j.jemermed.2020.09.008
Ouldali N, Toubiana J, Antona D, Javouhey E, Madhi F, Lorrot M, Léger PL, Galeotti C, Claude C, Wiedemann A, Lachaume N, Ovaert C, Dumortier M, Kahn JE, Mandelcwajg A, Percheron L, Biot B, Bordet J, Girardin ML, Yang DD, Grimaud M, Oualha M, Allali S, Bajolle F, Beyler C, Meinzer U, Levy M, Paulet AM, Levy C, Cohen R, Belot A, Angoulvant F. Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA [Internet]. March 2, 2021 [cited January 28, 2024];325(9):855. Available from: https://doi.org/10.1001/jama.2021.0694
Fernández-Cruz E, Alecsandru D, Ramón SS. Mechanisms of action of immunoglobulins. Clin Amp Exp Immunol [Internet]. September 2009 [cited 28 Jan 2024];157:1-2. Available from: https://doi.org/10.1111/j.1365-224
Sato S, Kawashima H, Kashiwagi Y, Hoshika A. Inflammatory cytokines as predictors of resistance to intravenous immunoglobulin therapy in Kawasaki disease patients. Int J Rheum Dis [Internet]. April 2013 [cited 28 Jan 2024];16(2):168-72. Available from: https://doi.org/10.1111/1756-185x.12082
Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol [Internet]. June 8, 2018 [cited January 28, 2024];9. Available from: https://doi.org/10.3389/fimmu.2018.01299
Stiehm ER. Adverse Effects of Human Immunoglobulin Therapy. Transfus Med Rev [Internet]. July 2013 [cited 28 Jan 2024];27(3):171-8. Available from: https://doi.org/10.1016/j.tmrv.2013.05.004
Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F, Brierley J, McDougall M, Carter M, Tremoulet A, Shimizu C, Herberg J, Burns JC, Lyall H, Levin M. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA [Internet]. July 21, 2020 [cited January 28, 2024];324(3):259. Available from: https://doi.org/10.1001/jama.2020.10369
Son MB, Murray N, Friedman K, Young CC, Newhams MM, Feldstein LR, Loftis LL, Tarquinio KM, Singh AR, Heidemann SM, Soma VL, Riggs BJ, Fitzgerald JC, Kong M, Doymaz S, Giuliano JS, Keenaghan MA, Hume JR, Hobbs CV, Schuster JE, Clouser KN, Hall MW, Smith LS, Horwitz SM, Schwartz SP, Irby K, Bradford TT, Maddux AB, Babbitt CJ, Rowan CM, McLaughlin GE, Yager PH, Maamari M, Mack EH, Carroll CL, Montgomery VL, Halasa NB, Cvijanovich NZ, Coates BM, Rose CE, Newburger JW, Patel MM, Randolph AG. Multisystem Inflammatory Syndrome in Children - Initial Therapy and Outcomes. New Engl J Med [Internet]. June 16, 2021 [cited January 28, 2024]. Available from: https://doi.org/10.1056/nejmoa2102605
Oocejo A, Correa R. Methylprednisolone. 2022 Dec 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Shelf ID: NBK544340
ZHANG G, ZHANG L, DUFF GW. A Negative Regulatory Region Containing a Glucocorticosteroid Response Element (nGRE) in the Human Interleukin-1β Gene. DNA Cell Biol [Internet]. February 1997 [cited 28 Jan 2024];16(2):145-52. Available from: https://doi.org/10.1089/dna.1997.16.145
Scheinman RI, Cogswell PC, Lofquist AK, Baldwin AS. Role of Transcriptional Activation of IkappaBalpha in Mediation of Immunosuppression by Glucocorticoi ds. Science [Internet]. October 13, 1995 [cited January 28, 2024];270(5234):283-6. Available from: https://doi.org/10.1126/science.270.5234.283
Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, Klein JD, Bhutta ZA. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis [Internet]. November 2020 [cited 28 Jan 2024];20(11):e276-e288. Available from: https://doi.org/10.1016/s1473-3099(20)30651-4
Fatima SA, Asif M, Khan KA, Siddique N, Khan AZ. Comparison of efficacy of dexamethasone and methylprednisolone in moderate to severe Covid 19. Ann Med Surg [Internet]. December 2020 [cited January 28, 2024];60:413-6. Available from: https://doi.org/10.1016/j.amsu.2020.11.027
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MB, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, Singh AR, Li S, Tarquinio KM, Jaggi P, Oster ME, Zackai SP, Gillen J, Ratner AJ, Walsh RF, Fitzgerald JC, Keenaghan MA, Alharash H, Doymaz S, Clouser KN, Giuliano JS, Gupta A, Parker RM, Maddux AB, Havalad V, Ramsingh S, Bukulmez H, Bradford TT, Smith LS, Tenforde MW, Carroll CL, Riggs BJ, Gertz SJ, Daube A, Lansell A, Coronado Munoz A, Hobbs CV, Marohn KL, Halasa NB, Patel MM, Randolph AG. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. New Engl J Med [Internet]. July 23, 2020 [cited January 28, 2024];383(4):334-46. Available from: https://doi.org/10.1056/nejmoa2021680
Miller J, Cantor A, Zachariah P, Ahn D, Martinez M, Margolis KG. Gastrointestinal symptoms as a major component of the presentation of a novel multisystemic inflammatory syndrome in children associated with coronavirus 2019 disease: A single-center experience including 44 cases. Gastroenterology [Internet]. Oct 2020 [cited 28 Jan 2024];159(4):1571-4. Available from: https://doi.org/10.1053/j.gastro.2020.05.079
Lichtenstein L, Ron Y, Kivity S, Ben-Horin S, Israeli E, Fraser GM, Dotan I, Chowers Y, Confino-Cohen R, Weiss B. Infliximab-Related Infusion Reactions: a Systematic Review. J Crohns Colitis [Internet]. June 19, 2015 [cited January 28, 2024];9(9):806-15. Available from: https://doi.org/10.1093/ecco-jcc/jjv096
Hu S, Liang S, Guo H, Zhang D, Li H, Wang X, Yang W, Qian W, Hou S, Wang H, Guo Y, Lou Z. Comparison of the Inhibition Mechanisms of Adalimumab and Infliximab in Treating Tumor Necrosis Factor α-Associated Diseases from a Molecular View. J Biol Chem [Internet]. August 13, 2013 [cited January 28, 2024];288(38):27059-67. Available from: https://doi.org/10.1074/jbc.m113.491530
Sheppard M, Laskou F, Stapleton PP, Hadavi S, Dasgupta B. Tocilizumab (Actemra). Hum Vaccines Amp Immunother [Internet]. August 25, 2017 [cited January 28, 2024];13(9):1972-88. Available from: https://doi.org/10.1080/21645515.2017.1316909
Van de Veerdonk FL, Netea MG. Blocking IL-1 to prevent respiratory failure in COVID-19. Crit Care [Internet]. July 18, 2020 [cited January 28, 2024];24(1). Available from: https://doi.org/10.1186/s13054-020-03166-0
Lamb YN. Remdesivir: first approval. Drugs [Internet]. September 2020 [cited January 28, 2024];80(13):1355-63. Available from: https://doi.org/10.1007/s40265-020-01378-w
Dove ML, Jaggi P, Kelleman M, Abuali M, Ang JY, Ballan W, Basu SK, Campbell MJ, Chikkabyrappa SM, Choueiter NF, Clouser KN, Corwin D, Edwards A, Gertz SJ, Ghassemzadeh R, Jarrah RJ, Katz SE, Knutson SM, Kuebler JD, Lighter J, Mikesell C, Mongkolrattanothai K, Morton T, Nakra NA, Olivero R, Osborne CM, Panesar LE, Parsons S, Patel RM, Schuette J, Thacker D, Tremoulet AH, Vidwan NK, Oster ME. Multisystem inflammatory syndrome in children: Survey of Protocols for Early Hospital Evaluation and Management. J Pediatr [Internet]. October 2020 [cited January 28, 2024]. Available from: https://doi.org/10.1016/j.jpeds.2020.10.026
Miner J, Hoffhines A. Discovering the anticoagulant effect of aspirin. Tex Heart Inst J. 2007;34(2):179-86.
Singal AK, Karthikeyan G. Aspirin in primary prevention: Is this the end of the road? Indian Heart J [Internet]. March 2019 [cited 28 Jan 2024];71(2):113-7. Available from: https://doi.org/10.1016/j.ihj.2019.04.001
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Michał Leśniewski
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 178
Number of citations: 0
