tetano
Editor, Senior Moderator
J Clin Invest
. 2020 Jul 30;140970.
doi: 10.1172/JCI140970. Online ahead of print.
Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2
Caroline Diorio[SUP] 1 [/SUP], Sarah E Henrickson[SUP] 2 [/SUP], Laura A Vella[SUP] 1 [/SUP], Kevin O McNerney[SUP] 1 [/SUP], Julie M Chase[SUP] 1 [/SUP], Chakkapong Burudpakdee[SUP] 1 [/SUP], Jessica H Lee[SUP] 1 [/SUP], Cristina Jasen[SUP] 1 [/SUP], Fran Balamuth[SUP] 3 [/SUP], David M Barrett[SUP] 1 [/SUP], Brenda Banwell[SUP] 4 [/SUP], Kathrin M Bernt[SUP] 5 [/SUP], Allison M Blatz[SUP] 6 [/SUP], Kathleen Chiotos[SUP] 7 [/SUP], Brian T Fisher[SUP] 1 [/SUP], Julie C Fitzgerald[SUP] 7 [/SUP], Jeffrey S Gerber[SUP] 6 [/SUP], Kandace Gollomp[SUP] 8 [/SUP], Christopher Gray[SUP] 1 [/SUP], Stephan A Grupp[SUP] 5 [/SUP], Rebecca M Harris[SUP] 6 [/SUP], Todd J Kilbaugh[SUP] 7 [/SUP], Audrey R Odom John[SUP] 6 [/SUP], Michele P Lambert[SUP] 1 [/SUP], Emily J Liebling[SUP] 9 [/SUP], Michele Paessler[SUP] 10 [/SUP], Whitney Petrosa[SUP] 1 [/SUP], Charles A Phillips[SUP] 5 [/SUP], Anne F Reilly[SUP] 11 [/SUP], Neil Romberg[SUP] 1 [/SUP], Alix E Seif[SUP] 1 [/SUP], Deborah Sesok-Pizzini[SUP] 10 [/SUP], Kathleen Sullivan[SUP] 12 [/SUP], Julie Vardaro[SUP] 1 [/SUP], Edward M Behrens[SUP] 13 [/SUP], David T Teachey[SUP] 14 [/SUP], Hamid Bassiri[SUP] 11 [/SUP]
Affiliations
Abstract
Background: Initial reports from the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to Coronavirus Disease 2019 (COVID-19) than adults. Subsequently, a severe and novel pediatric disorder termed Multisystem Inflammatory Syndrome in Children (MIS-C) emerged. We report on unique hematologic and immunologic parameters that distinguish between COVID-19 and MIS-C and provide insight into pathophysiology.
Methods: We prospectively enrolled hospitalized patients with evidence of SARS-CoV-2 infection and classified them as having MIS-C or COVID-19. Patients with COVID-19 were classified as having either minimal or severe disease. Cytokine profiles, viral cycle thresholds (Cts), blood smears, and soluble C5b-9 values were analyzed with clinical data. Twenty patients were enrolled (9 severe COVID-19, 5 minimal COVID-19, and 6 MIS-C). Five cytokines (IFN-γ, IL-10, IL-6, IL-8 and TNF-α) contributed to the analysis. TNF-α and IL-10 discriminated between patients with MIS-C and severe COVID-19. Cts and burr cells on blood smears also differentiated between patients with severe COVID-19 and those with MIS-C.
Conclusion: Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe COVID-19 and MIS-C. Cytokine profiling and examination of peripheral blood smears may distinguish between patients with MIS-C and severe COVID-19.
Keywords: COVID-19; Cytokines.
. 2020 Jul 30;140970.
doi: 10.1172/JCI140970. Online ahead of print.
Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2
Caroline Diorio[SUP] 1 [/SUP], Sarah E Henrickson[SUP] 2 [/SUP], Laura A Vella[SUP] 1 [/SUP], Kevin O McNerney[SUP] 1 [/SUP], Julie M Chase[SUP] 1 [/SUP], Chakkapong Burudpakdee[SUP] 1 [/SUP], Jessica H Lee[SUP] 1 [/SUP], Cristina Jasen[SUP] 1 [/SUP], Fran Balamuth[SUP] 3 [/SUP], David M Barrett[SUP] 1 [/SUP], Brenda Banwell[SUP] 4 [/SUP], Kathrin M Bernt[SUP] 5 [/SUP], Allison M Blatz[SUP] 6 [/SUP], Kathleen Chiotos[SUP] 7 [/SUP], Brian T Fisher[SUP] 1 [/SUP], Julie C Fitzgerald[SUP] 7 [/SUP], Jeffrey S Gerber[SUP] 6 [/SUP], Kandace Gollomp[SUP] 8 [/SUP], Christopher Gray[SUP] 1 [/SUP], Stephan A Grupp[SUP] 5 [/SUP], Rebecca M Harris[SUP] 6 [/SUP], Todd J Kilbaugh[SUP] 7 [/SUP], Audrey R Odom John[SUP] 6 [/SUP], Michele P Lambert[SUP] 1 [/SUP], Emily J Liebling[SUP] 9 [/SUP], Michele Paessler[SUP] 10 [/SUP], Whitney Petrosa[SUP] 1 [/SUP], Charles A Phillips[SUP] 5 [/SUP], Anne F Reilly[SUP] 11 [/SUP], Neil Romberg[SUP] 1 [/SUP], Alix E Seif[SUP] 1 [/SUP], Deborah Sesok-Pizzini[SUP] 10 [/SUP], Kathleen Sullivan[SUP] 12 [/SUP], Julie Vardaro[SUP] 1 [/SUP], Edward M Behrens[SUP] 13 [/SUP], David T Teachey[SUP] 14 [/SUP], Hamid Bassiri[SUP] 11 [/SUP]
Affiliations
- PMID: 32730233
- DOI: 10.1172/JCI140970
Abstract
Background: Initial reports from the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to Coronavirus Disease 2019 (COVID-19) than adults. Subsequently, a severe and novel pediatric disorder termed Multisystem Inflammatory Syndrome in Children (MIS-C) emerged. We report on unique hematologic and immunologic parameters that distinguish between COVID-19 and MIS-C and provide insight into pathophysiology.
Methods: We prospectively enrolled hospitalized patients with evidence of SARS-CoV-2 infection and classified them as having MIS-C or COVID-19. Patients with COVID-19 were classified as having either minimal or severe disease. Cytokine profiles, viral cycle thresholds (Cts), blood smears, and soluble C5b-9 values were analyzed with clinical data. Twenty patients were enrolled (9 severe COVID-19, 5 minimal COVID-19, and 6 MIS-C). Five cytokines (IFN-γ, IL-10, IL-6, IL-8 and TNF-α) contributed to the analysis. TNF-α and IL-10 discriminated between patients with MIS-C and severe COVID-19. Cts and burr cells on blood smears also differentiated between patients with severe COVID-19 and those with MIS-C.
Conclusion: Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe COVID-19 and MIS-C. Cytokine profiling and examination of peripheral blood smears may distinguish between patients with MIS-C and severe COVID-19.
Keywords: COVID-19; Cytokines.