Neurological manifestations of inflammatory multisystem syndrome temporally associated with COVID 19 in Pediatric intensive care unit

Document Type : Original Article

Authors

1 Pediatrics department, Faculty of Medicine, Beni-Suef University

2 Clinical and chemical pathology, Faculty of Medicine, Beni-Suef University

Abstract

Background: Patients under the age of 21 who present with a high temperature, inflammatory markers in the lab, and a severe illness that necessitates hospitalization due to involvement of multiple systems (such as the cardiovascular, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological systems) and no other probable diagnoses; or who have recently been infected with SARS-CoV-2 (COVID-19) as confirmed by RT-PCR, serology, or antigen testing; or who have been exposed to COVID-19 without suspecting any other possible diagnosis. Aim: to analyze COVID-19 associated MIS-C by recognizing its signs, symptoms (particularly neurological manifestations), investigation, treatment, and prognosis. Methods: This study focuses on children with neurological symptoms to better understand MIS- C's etiology, symptoms, diagnosis, and prognosis in  Beni-Suef university hospital Pediatrics  ICU. 39 kids was included  Results: This study evaluated the signs, symptoms, investigation, therapy, and prognosis of MIS-C in COVID-19-infected children. 14 women (37.5%) and 25 males (62.5%) were included. Their ages ranged from 1.5 to 180 months, with a mean of 52.5 months. The average duration of stay was 9.1 days, ranging from 1 to 22 days. This study of ( 39 ) individuals showed that Misc patients commonly have problems in other organ systems. The neurological manifestation amonge studied patients showed that  (30) case suffered from convulsion of different types, ( 6 ) cases suffered from headache ,  (20)  case ssuffered from encephalopathy, ( 2) cases had acute flaccid paralysis and only one case suffred from acute cerebellar ataxia . 77% of patients have respiratory symptoms (cough, dysnea, cyanosis), 42% have gastrointestinal symptoms (vomiting, diarrhoea, abdominal pain), 30% have cardiac symptoms (shock and hypotension), and 17.5% have renal symptoms (hypertension, oedema, oligiurea). Conclusions  The neurological manifestation amonge MIS-C patients are very common including convulsions of different types , headache , encephalopathy, ataxia , acute flaccid paralysis and we notice that , patients with more  sever neurological manifestations and had more than 2 organ system affections had poor prognosis  (morbidity and mortality) while patients received early treatment IVIG and methyel prednsilone had better prognosis.

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References

  1. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MB, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, Singh AR. Multisystem inflammatory syndrome in US children and adolescents. New England Journal of Medicine. 2020 Jul 23;383(4):334-46.
  2. Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, Acosta S, Naqvi R, Burmeister-Morton F, Burmeister F, Tarriela A. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine. 2020 Sep 1;26.
  3. LaRovere KL, Riggs BJ, Poussaint TY, Young CC, Newhams MM, Maamari M, Walker TC, Singh AR, Dapul H, Hobbs CV, McLaughlin GE. Neurologic involvement in children and adolescents hospitalized in the United States for COVID-19 or multisystem inflammatory syndrome. JAMA neurology. 2021 May 1;78(5):536-47.
  4. Abdel-Mannan O, Eyre M, Löbel U, Bamford A, Eltze C, Hameed B, Hemingway C, Hacohen Y. Neurologic and radiographic findings associated with COVID-19 infection in children. JAMA neurology. 2020 Nov 1;77(11):1440-5.
  5. Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, Debray A, Basmaci R, Salvador E, Biscardi S, Frange P. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. bmj. 2020 Jun 3;369.
  6. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. Jama. 2020 Jul 21;324(3):259-69.
  7. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. Jama. 2020 Jul 21;324(3):259-69.
  8. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. 2020 May 23;395(10237):1607-8.
  9. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, Tan KS, Wang DY, Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Military medical research. 2020 Dec;7:1-0.
  10. Adeyinka A, Bailey K, Pierre L, Kondamudi N. COVID 19 infection: pediatric perspectives. Journal of the American College of Emergency Physicians Open. 2021 Feb;2(1):e12375.
  11. Valverde I, Singh Y, Sanchez-de-Toledo J, Theocharis P, Chikermane A, Di Filippo S, Kucinska B, Mannarino S, Tamariz-Martel A, Gutierrez-Larraya F, Soda G. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation. 2021 Jan 5;143(1):21-32.
  12. Tang A, Xu W, Shen M, Chen P, Li G, Liu Y, Liu L. A retrospective study of the clinical characteristics of COVID-19 infection in 26 children. MedRxiv. 2020 Mar 10:2020-03.
  13. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, Heidemann SM, Kleinman LC, Sen AI, Hall MW, Priestley MA. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA pediatrics. 2020 Sep 1;174(9):868-73.
  14. Mustafa NM, Selim LA. Characterisation of COVID-19 pandemic in paediatric age group: a systematic review and meta-analysis. Journal of Clinical Virology. 2020 Jul 1;128:104395.
  15. Leung C. Clinical characteristics of COVID‐19 in children: Are they similar to those of SARS?. Pediatric pulmonology. 2020 Jul;55(7):1592-7.
  16. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA neurology. 2020 Jun 1;77(6):683-90.
  17. Raj SL, Vasanthi T, Baineni R, Sivabalan S. Neurological manifestations of COVID-19 in children. Indian Pediatrics. 2020;57(12):1185.
  18. Natoli S, Oliveira V, Calabresi P, Maia LF, Pisani A. Does SARS‐Cov‐2 invade the brain? Translational lessons from animal models. European journal of neurology. 2020 Sep;27(9):1764-73.
  19. Schupper AJ, Yaeger KA, Morgenstern PF. Neurological manifestations of pediatric multi-system inflammatory syndrome potentially associated with COVID-19. Child's Nervous System. 2020 Aug;36(8):1579-80.
  20. Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: A literature review. Journal of clinical neuroscience. 2020 Jul 1;77:8-12.
  21. Serrano CO, Alonso E, Andrés M, Buitrago NM, Vigara AP, Pajares MP, López EC, Moll GG, Espin IM, Barriocanal MB, la Calle MD. Pediatric chest x-ray in covid-19 infection. European Journal of Radiology. 2020 Oct 1;131:109236.
  22. Samuel S, Friedman RA, Sharma C, Ganigara M, Mitchell E, Schleien C, Blaufox AD. Incidence of arrhythmias and electrocardiographic abnormalities in symptomatic pediatric patients with PCR-positive SARS-CoV-2 infection, including drug-induced changes in the corrected QT interval. Heart Rhythm. 2020 Nov 1;17(11):1960-6.
  23. Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation. 2014 Jan 7;129(1):115-28.
  24. Serwer G. Ventricular arrhythmia in children: diagnosis and management. Current treatment options in cardiovascular medicine. 2008 Oct;10(5):442-7.
  25. Oba J, Carvalho WB, Silva CA, Delgado AF. Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians. Einstein (Sao Paulo). 2020 Jul 10;18.
  26. Rubin DT, Feuerstein JD, Wang AY, Cohen RD. AGA clinical practice update on management of inflammatory bowel disease during the COVID-19 pandemic: expert commentary. Gastroenterology. 2020 Jul 1;159(1):350-7.
  27. Panahi L, Amiri M, Pouy S. Risks of novel coronavirus disease (COVID-19) in pregnancy; a narrative review. Archives of academic emergency medicine. 2020;8(1).
  28. De Souza TH, Nadal JA, Nogueira RJ, Pereira RM, Brandão MB. Clinical manifestations of children with COVID‐19: a systematic review. Pediatric pulmonology. 2020
  29. Zheng F, Liao C, Fan QH, Chen HB, Zhao XG, Xie ZG, Li XL, Chen CX, Lu XX, Liu ZS, Lu W. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Current medical science. 2020 Apr;40(2):275-80.
  30. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020 May 1;158(6):1831-3.
  31. Kolivras A, Dehavay F, Delplace D, Feoli F, Meiers I, Milone L, Olemans C, Sass U, Theunis A, Thompson CT, Van De Borne L. Coronavirus (COVID-19) infection–induced chilblains: A case report with histopathologic findings. JAAD case reports. 2020 Jun 1;6(6):489-92.
  32. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. Jama. 2020 Jul 21;324(3):259-69.
  33. Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, Barranco MA, Maxted AM, Rosenberg ES, Easton D, Udo T. Multisystem inflammatory syndrome in children in New York State. New England Journal of Medicine. 2020 Jul 23;383(4):347-58.
  34. Pereira MF, Litvinov N, Farhat SC, Eisencraft AP, Gibelli MA, Carvalho WB, Fernandes VR, Fink TD, Framil JV, Galleti KV, Fante AL. Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. Clinics. 2020 Aug 17;75.

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