Sandbox:Sahar: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 2: Line 2:
== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
=====Preliminary [[World Health Organization|WHO]] case definition: Children and adolescents=====
In May 2020, the Centers for Disease Control and Prevention (CDC) set the criteria for multisystem inflammatory syndrome in children (MIS-C):<ref name="FeldsteinRose2020">{{cite journal|last1=Feldstein|first1=Leora R.|last2=Rose|first2=Erica B.|last3=Horwitz|first3=Steven M.|last4=Collins|first4=Jennifer P.|last5=Newhams|first5=Margaret M.|last6=Son|first6=Mary Beth F.|last7=Newburger|first7=Jane W.|last8=Kleinman|first8=Lawrence C.|last9=Heidemann|first9=Sabrina M.|last10=Martin|first10=Amarilis A.|last11=Singh|first11=Aalok R.|last12=Li|first12=Simon|last13=Tarquinio|first13=Keiko M.|last14=Jaggi|first14=Preeti|last15=Oster|first15=Matthew E.|last16=Zackai|first16=Sheemon P.|last17=Gillen|first17=Jennifer|last18=Ratner|first18=Adam J.|last19=Walsh|first19=Rowan F.|last20=Fitzgerald|first20=Julie C.|last21=Keenaghan|first21=Michael A.|last22=Alharash|first22=Hussam|last23=Doymaz|first23=Sule|last24=Clouser|first24=Katharine N.|last25=Giuliano|first25=John S.|last26=Gupta|first26=Anjali|last27=Parker|first27=Robert M.|last28=Maddux|first28=Aline B.|last29=Havalad|first29=Vinod|last30=Ramsingh|first30=Stacy|last31=Bukulmez|first31=Hulya|last32=Bradford|first32=Tamara T.|last33=Smith|first33=Lincoln S.|last34=Tenforde|first34=Mark W.|last35=Carroll|first35=Christopher L.|last36=Riggs|first36=Becky J.|last37=Gertz|first37=Shira J.|last38=Daube|first38=Ariel|last39=Lansell|first39=Amanda|last40=Coronado Munoz|first40=Alvaro|last41=Hobbs|first41=Charlotte V.|last42=Marohn|first42=Kimberly L.|last43=Halasa|first43=Natasha B.|last44=Patel|first44=Manish M.|last45=Randolph|first45=Adrienne G.|title=Multisystem Inflammatory Syndrome in U.S. Children and Adolescents|journal=New England Journal of Medicine|year=2020|issn=0028-4793|doi=10.1056/NEJMoa2021680}}</ref>


*0–19 years of age with [[fever]] >3 days<ref >{{Cite web|url=https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19|title=Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19|first=|date=|website=|archive-url=|archive-date=15 May 2020|dead-url=|access-date=}}</ref>
* Severe disease course leading to hospitalization
* Individuals younger than 21 years old
* Fever (body temperature, >38.0°C) or report of subjective fever present at least 24 hours
* Laboratory evidence of inflammation
* Multisystem organ involvement (at least two systems)
* Laboratory-confirmed SARS-CoV-2 infection


AND
=== History and Symptoms ===
 
*Two of the following:
 
#[[Rash]] or bilateral non-purulent [[conjunctivitis]] or mucocutaneous inflammation signs (oral, hands or feet)
#Hypotension or shock
#Features of myocardial dysfunction, [[pericarditis]], [[valvulitis]], or coronary abnormalities (including ECHO findings or elevated [[Troponin]]/[[NT-proBNP]])
#Evidence of [[coagulopathy]] (by PT, [[Partial thromboplastin time|PTT]], elevated [[D-dimer|D-Dimers]])
#Acute gastrointestinal problems ([[diarrhea]], [[vomiting]], or [[abdominal pain]])
 
AND
 
*Elevated markers of [[inflammation]] such as [[Erythrocyte sedimentation rate|ESR]], [[C-reactive protein]], or [[procalcitonin]]
 
AND
 
*No other obvious microbial cause of [[inflammation]], including bacterial [[sepsis]], [[staphylococcal]] or [[streptococcal]] shock syndromes
 
AND
 
*Evidence of [[COVID-19|COVID]]-19 ([[Reverse transcription-polymerase chain reaction|RT-PCR]], antigen test or serology-positive), or likely contact with patients with [[COVID-19|COVID]]-19
 
=====CDC Case Definition for MIS-C=====
 
*An individual aged <21 years presenting with fever, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological);<ref >{{Cite web|url=https://www.cdc.gov/mis-c/hcp/|title=CDC case definationlast=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
 
AND
 
No alternative plausible diagnoses;
 
AND
 
Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.
=== Signs and Symptoms ===
 
*[[Fever]] lasting 24 hours or longer.<ref name="CC""/>
*[[Vomiting]]<ref name="CC""/>
*[[Diarrhea]]<ref name="CC""/>
*[[Abdominal pain]]<ref name="CC""/>
*[[Skin rash]]<ref name="CC""/>
*[[Conjuctivitis]]<ref name="CC""/>
*[[Erythrocyte sedimentation rate|High ESR]]<ref name="CC""/>
*Redness or swelling of the lips and tongue<ref name="CC""/>
*[[Lethargy]]<ref name="CC""/>
*[[Redness]] or swelling of the hands or feet<ref name="CC""/>
*[[Confusion]]<ref name="CC""/>
*[[Headache]]<ref name="CC""/>
*[[Sore throat]]<ref name="CC""/>
*[[Syncope]]<ref name="CC""/>
*[[Lymphadenopathy]]<ref name="CC""/>
 
'''Emergency Warning Signs'''


*[[Fever]] lasting 24 hours or longer.
*[[Vomiting]]
*[[Diarrhea]]
*[[Abdominal pain]]
*[[Shortness of breath|Difficulty Breathing]]<ref name="CC""/>
*[[Shortness of breath|Difficulty Breathing]]<ref name="CC""/>
*[[Chest pain]]
*[[Chest pain]]
*[[Headache]]
*[[Sore throat]]
*[[Confusion|New onset confusion]]
*[[Confusion|New onset confusion]]
===Physical Examination===
*[[Skin rash]]
*[[Conjuctivitis]]
*Redness or swelling of the lips and tongue
*[[Redness]] or swelling of the hands or feet
*[[Lymphadenopathy]]
*[[Lethargy]]
*[[Lethargy]]
*[[Cyanosis]]
*[[Cyanosis]]
*[[Abdominal pain]]
===Laboratory Findings===
 
*[[Erythrocyte sedimentation rate|High ESR]]
=== Physical Examination ===
'''Blood Investigations'''
'''Blood Investigations'''
 
*[[Lymphopenia]], [[Neutrophilia]], [[Anemia]], [[Thrombocytopenia]] have been seen in MIS-C pateints. [[Fibrinogen|Abnormal fibrinogen]], [[Hypoalbuminaemia]], elevated [[Creatine kinase|creatiine kinase]] (CK), [[Lactate dehydrogenase|LDH]], [[Triglyceride|triglycerides]] have been observed in MIS-C patients.
*[[Lymphopenia]], [[Neutrophilia]], [[Anemia]], [[Thrombocytopenia]] have been seen in MIS-C pateints. [[Fibrinogen|Abnormal fibrinogen]], [[Hypoalbuminaemia]], elevated [[Creatine kinase|creatiine kinase]] (CK), [[Lactate dehydrogenase|LDH]], [[Triglyceride|triglycerides]] have been observed in MIS-C patients.<ref name="CC""/>
 
==== Inflammatory biomarkers ====
==== Inflammatory biomarkers ====
Elevation of inflammatory markers including ESR, C reactive protein and procalcitonin are usually seen in MIS-C. Increased level of  [[Interleukin-6]] (IL-6), Interleukin-10(IL-10) [[d-dimer]], serum [[ferritin]], [[prothrombin time]] have also been seen in MIS-C.<ref name="CC""/>
Elevation of inflammatory markers including ESR, C reactive protein, and procalcitonin are usually seen in MIS-C. Increased level of  [[Interleukin-6]] (IL-6), Interleukin-10(IL-10) [[d-dimer]], serum [[ferritin]], [[prothrombin time]] have also been seen in MIS-C.
==== Cardiac biomarkers ====
==== Cardiac biomarkers ====
Elevation of cardic enzymes including  [[Cardiac troponin|cardiac troponins]] ([[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponin I(cTnI) and cardiac troponin T (cTnT)]]) and [[Brain natriuretic peptide]] ([[BNP]])) has been observed in MIS-C patients.<ref name="CC""/>
Elevation of cardic enzymes including  [[Cardiac troponin|cardiac troponins]] ([[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponin I(cTnI) and cardiac troponin T (cTnT)]]) and [[Brain natriuretic peptide]] ([[BNP]])) has been observed in MIS-C patients.


=== Radiological Findings ===
=== Radiological Findings ===


* Following Radiological Findings are observed in MIS-C patients.<ref name="CC""/>
* Following Radiological Findings are observed in MIS-C patients.


{| border="1" cellpadding="2"
{| border="1" cellpadding="2"

Revision as of 20:21, 13 July 2020

Diagnosis

Diagnostic Criteria

In May 2020, the Centers for Disease Control and Prevention (CDC) set the criteria for multisystem inflammatory syndrome in children (MIS-C):[1]

  • Severe disease course leading to hospitalization
  • Individuals younger than 21 years old
  • Fever (body temperature, >38.0°C) or report of subjective fever present at least 24 hours
  • Laboratory evidence of inflammation
  • Multisystem organ involvement (at least two systems)
  • Laboratory-confirmed SARS-CoV-2 infection

History and Symptoms

Physical Examination

Laboratory Findings

Blood Investigations

Inflammatory biomarkers

Elevation of inflammatory markers including ESR, C reactive protein, and procalcitonin are usually seen in MIS-C. Increased level of Interleukin-6 (IL-6), Interleukin-10(IL-10) d-dimer, serum ferritin, prothrombin time have also been seen in MIS-C.

Cardiac biomarkers

Elevation of cardic enzymes including cardiac troponins (cardiac troponin I(cTnI) and cardiac troponin T (cTnT)) and Brain natriuretic peptide (BNP)) has been observed in MIS-C patients.

Radiological Findings

  • Following Radiological Findings are observed in MIS-C patients.
Test Findings
Chest Xray patchy symmetrical infiltrates, pleural effusion
Echocardiogram and EKG myocarditis, valvulitis, pericardial effusion, coronary artery dilatation
Abdominal USG colitis, ileitis, lymphadenopathy, ascites, hepatosplenomegaly

Blood Culture, Viral PCR

  • Absence of other potential causative organisms. IgG levels and IgM levels of SARS-CoV-2 are detected.

Treatment

Medical Therapy

  • All the children with MIS-C are treated as suspected COVID-19.
  • Mild to Moderate cases of MIS-C are managed supportively.[3][4]
  • Supplemental oxygen is required in children with low oxygen saturation.[4]
  • Fluid resuscitation in 10 ml/kg aliquots with reevaluation after each bolus. Maintain euvolemia. Avoid hypervolemia.[4]
  • Anti-inflammatory treatments with Intravenous immunoglobulin(IVIG) with or without corticosteroids have shown a good response rate.[3][4]
  • Aspirin has been used primarily for its antiplatelet effect. It is recommended in all patients with MIS-C.[3][4]
  • Anakinra is considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[3][4]
  • Tocilizumab is also considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[3][4]
  • Empiric antibiotics like vancomycin, ceftriaxone, and clindamycin are given for community-acquired shock presentation until cultures are negative for 48 hours.[3][4]
Presentation Treatment
Mild Disease
  • Symptomatic Treatment
Severe Disease

Prevention of MIS-C

  • MIS-C can be prevented by reducing the risk of child exposure to COVID-19 infection.

References

  1. ↑ Feldstein, Leora R.; Rose, Erica B.; Horwitz, Steven M.; Collins, Jennifer P.; Newhams, Margaret M.; Son, Mary Beth F.; Newburger, Jane W.; Kleinman, Lawrence C.; Heidemann, Sabrina M.; Martin, Amarilis A.; Singh, Aalok R.; Li, Simon; Tarquinio, Keiko M.; Jaggi, Preeti; Oster, Matthew E.; Zackai, Sheemon P.; Gillen, Jennifer; Ratner, Adam J.; Walsh, Rowan F.; Fitzgerald, Julie C.; Keenaghan, Michael A.; Alharash, Hussam; Doymaz, Sule; Clouser, Katharine N.; Giuliano, John S.; Gupta, Anjali; Parker, Robert M.; Maddux, Aline B.; Havalad, Vinod; Ramsingh, Stacy; Bukulmez, Hulya; Bradford, Tamara T.; Smith, Lincoln S.; Tenforde, Mark W.; Carroll, Christopher L.; Riggs, Becky J.; Gertz, Shira J.; Daube, Ariel; Lansell, Amanda; Coronado Munoz, Alvaro; Hobbs, Charlotte V.; Marohn, Kimberly L.; Halasa, Natasha B.; Patel, Manish M.; Randolph, Adrienne G. (2020). "Multisystem Inflammatory Syndrome in U.S. Children and Adolescents". New England Journal of Medicine. doi:10.1056/NEJMoa2021680. ISSN 0028-4793.
  2. ↑
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 "Emergency Department, ICU and Inpatient Clinical Pathway for Evaluation of Possible Multisystem Inflammatory Syndrome (MIS-C)". line feed character in |title= at position 61 (help)
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 "Evaluation and Management of COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C)" (PDF). line feed character in |title= at position 63 (help)



Bold text

Wikidoc Textbook of Medicine
Name/Project Cardiology Pulmonary Infectious Pediatrics Emergency ENT Ob/Gyn Dermatology Rare disease
Leader of the Project
N of Chapters
N of Complete Chapters
N of Incomplete Chapters
N to be Reviewed
Name of Scholars working on the project







Wikidoc Textbook of Medicine
Name/Project Hematology Oncology Gastroenterology Nephrology Neurology Psychology Endocrinology
Leader of the project
N of Chapters
N of complete Chapters
N of Incomplete Chapters
N to be reviewed Chapters
Name of Scholars working on the project


Disease Name Age of Onset Gender Preponderance Signs/Symptoms Imaging Feature(s) Macroscopic Feature(s) Microscopic Feature(s) Laboratory Findings(s) Other Feature(s) ECG view
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:Sahar&oldid=1626005"