Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2: Etiopathogenesis, Clinical Picture, Diagnosis, and Treatment (Review)
Keywords:
complications of COVID-19, SARS-CoV-2 in children, multisystem inflammatory syndrome in children, Kawasaki-like syndromeAbstract
This article discusses current ideas about the etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and approaches to the treatment of multisystem inflammatory syndrome in children (MIS-C) associated with the novel coronavirus infection (COVID-19). The causative agent of COVID-19 is the SARS-CoV-2 RNA virus that causes severe acute respiratory syndrome. Multisystem inflammatory syndrome is a symptom complex associated with COVID-19 that occurs in children and adolescents and
includes signs of Kawasaki disease and toxic shock. It debuts 2–6 weeks after COVID-19 exposure and, as a rule, is observed in children older than 5 years. The main pathogenetic mechanism of MIS-C is a pathological hyperimmune response to the virus, activation of neutrophils, macrophages, proinflammatory interleukins and, as a result, an intense cytokine storm leading to the development of multisystem inflammation. Postinfectious multi-organ damage is associated with the prevalence of target organs for autoantibodies. Target antigens are expressed in mucosal tissues, endothelial cells, and myocardium. Clinical and laboratory signs of MIS-C include: fever, skin rash, abdominal symptoms, damage to the nervous and cardiovascular systems, increased levels of inflammatory markers in the blood, myocardial damage, and hypercoagulability. Echocardiography shows signs of myocarditis, coronary artery anomalies, and pericarditis. Abdominal ultrasound and computed tomography reveal signs of ascites, colitis, ileitis, and hepatosplenomegaly. Differential diagnosis should be made to distinguish MIS-C from Kawasaki disease and toxic shock syndrome. MIS-C requires a comprehensive pathogenetic treatment, which includes antibacterial therapy (initially, until a bacterial infection is ruled out), anticoagulants, antiplatelet agents, systemic glucocorticosteroids, monoclonal antibodies, and oxygen therapy. The best way to prevent MIS-C is to vaccinate adolescents against COVID-19.
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