Immune globulin and steroids may help treat Kawasaki like syndrome in kids with Covid 19

Immune globulin and steroids lead to early recovery in Multi-System Inflammatory Syndrome due to Covid 19 in kids, finds study.

A Multi-System Inflammatory Syndrome similar to a heart condition known as Kawasaki disease, together with cardiac inflammation has been encountered in children exposed to COVID-19 lately.The condition is characterized by high spiking fever, asthenia, digestive signs including severe abdominal pain, vomiting or diarrhea, lymphadenopathy and skin rash.

Researchers have found that treatment with antibodies purified from donated blood – immune globulin therapy – and steroids restored heart function in the majority of children with COVID-related multi-system inflammatory syndrome, according to new research published yesterday in Circulation.

In this small study, "Acute heart failure in multisymptom inflammatory syndrome in children (MIS0-C) in the context of global SARS-CoV-2 pandemic," researchers in France and Switzerland retrospectively collected and analyzed clinical, biological, therapeutic and early outcome data for children admitted to the pediatric intensive care unit from March 22 to April 30, 2020, with fever, cardiogenic shock or acute left ventricular dysfunction with inflammatory state.

This analysis included 35 children (ages 2 to 16; median age of 10 years). Thirty-one (88.5%) children tested positive for SARS-CoV-2 infection, and none of the children had underlying cardiovascular disease. Secondary conditions were limited, and 17% of patients were overweight (n=6). All patients presented with fever and unusual lethargy (asthenia) lasting approximately 2 days, and 83% of patients (n=29) presented with gastrointestinal symptoms.

Left ventricular systolic dysfunction was present in all patients in association with low systolic blood pressure. Almost all patients required respiratory assistance (n= 33). Left ventricular function recovered in the majority of patients discharged from the intensive care unit (n=25). Ten patients treated with ECMO (extracorporeal membrane oxygenation) for 3-6 days were successfully weaned. (ECMO is a process whereby the blood is sent through a machine to increase the amount of oxygen in the blood. The oxygen-rich blood is then returned to the body.)

The majority of patients received intravenous immune globulin treatment (n=25), and 12 patients were treated with intravenous steroids. Three children were treated with an interleukin 1 receptor antagonist due to persistent severe inflammatory state. 23 patients were treated with a therapeutic dose of heparin. No deaths were observed.

"The majority of patients recovered within a few days following intravenous immune globulin, with adjunctive steroid therapy used in one third. Treatment with immune globulin appears to be associated with recovery of left ventricular systolic function," researchers reported.

The researchers' key findings are:

Multi-System Inflammatory Syndrome in Children (MIS-C) is a new syndrome that appears to be temporally related to previous exposure to SARS-CoV-2.

MIS-C shares similarities with atypical Kawasaki disease, but prominent clinical signs are largely different.

Myocardial involvement with acute heart failure is likely due to myocardial stunning or edema rather than to inflammatory myocardial damage.

Whereas the initial presentation may be severe with some patients requiring circulatory and respiratory mechanical assistance, rapid recovery with the use of immune globulin and steroids is currently observed.

Early diagnosis and management appear to lead to favorable outcome using classical therapies.

Additional study is needed to determine the full spectrum of the illness and whether long-term cardiac complications may arise.

For further reference log to:

 2020https://doi.org/10.1161/CIRCULATIONAHA.120.048360Circulation. ;0:null