Sandbox:Sahar: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 17: Line 17:
*[[Diarrhea]]
*[[Diarrhea]]
*[[Abdominal pain]]
*[[Abdominal pain]]
*[[Shortness of breath|Difficulty Breathing]]<ref name="CC""/>
*[[Shortness of breath|Difficulty Breathing]]
*[[Chest pain]]
*[[Chest pain]]
*[[Headache]]
*[[Headache]]
*[[Sore throat]]
*[[Sore throat]]
*[[Confusion|New onset confusion]]
*[[Confusion|New onset confusion]]
===Physical Examination===
===Physical Examination===
*[[Skin rash]]
*[[Skin rash]]

Revision as of 20:22, 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.[2][3]
  • Supplemental oxygen is required in children with low oxygen saturation.[3]
  • Fluid resuscitation in 10 ml/kg aliquots with reevaluation after each bolus. Maintain euvolemia. Avoid hypervolemia.[3]
  • Anti-inflammatory treatments with Intravenous immunoglobulin(IVIG) with or without corticosteroids have shown a good response rate.[2][3]
  • Aspirin has been used primarily for its antiplatelet effect. It is recommended in all patients with MIS-C.[2][3]
  • Anakinra is considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[2][3]
  • Tocilizumab is also considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[2][3]
  • Empiric antibiotics like vancomycin, ceftriaxone, and clindamycin are given for community-acquired shock presentation until cultures are negative for 48 hours.[2][3]
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. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 "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)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 "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=1626009"