Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento Emergência, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Departamento Emergência, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil.
J Pediatr (Rio J). 2021 Mar-Apr;97(2):140-159. doi: 10.1016/j.jped.2020.08.004. Epub 2020 Sep 11.
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart.
The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original and review articles, systematic reviews, meta-analyses, case series, and recommendations from medical societies and health organizations published through July 3, 2020. The reference lists of the selected articles were manually searched to identify any additional articles.
COVID-19 infection is less severe in children than in adults, but can present as MIS-C, even in patients without comorbidities. There is evidence of an exacerbated inflammatory response with potential systemic injury, and it may present with aspects similar to those of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop weeks after COVID-19 infection, suggesting an immunomediated cause. The most frequent clinical manifestations include fever, gastrointestinal symptoms, rash, mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, lymphopenia, and coagulopathy are common laboratory findings. Supportive treatment and early immunomodulation can control the intense inflammatory response and reduce complications and mortality.
MIS-C associated with COVID-19 is serious, rare, and potentially fatal. The emergency department pediatrician must recognize and treat it early using immunomodulatory strategies to reduce systemic injury. Further studies are needed to identify the disease pathogenesis and establish the most appropriate treatment.
与冠状病毒病（COVID-19）相关的儿童多系统炎症综合征（MIS-C）是一种罕见且具有挑战性的诊断，需要早期治疗。诊断标准包括临床、实验室和补充检查。本综述旨在引起儿科医生对该诊断的关注，提出早期治疗策略，并提出儿科急救护理流程图。
通过 2020 年 7 月 3 日检索 PubMed/MEDLINE/WHO COVID-19 数据库，查阅了原始和综述文章、系统评价、荟萃分析、病例系列以及医学协会和卫生组织发布的建议。从选定文章的参考文献中手动搜索以确定任何其他文章。
与成人相比，儿童 COVID-19 感染程度较轻，但也可能出现 MIS-C，即使在没有合并症的患者中也是如此。有证据表明存在炎症反应加剧，可能存在全身损伤，其表现可能与川崎病、中毒性休克综合征和巨噬细胞活化综合征相似。MIS-C 可在 COVID-19 感染后数周发生，提示可能为免疫介导的原因。最常见的临床表现包括发热、胃肠道症状、皮疹、黏膜改变和心功能障碍。炎症标志物升高、淋巴细胞减少和凝血功能障碍是常见的实验室发现。支持性治疗和早期免疫调节可以控制强烈的炎症反应，减少并发症和死亡率。
与 COVID-19 相关的 MIS-C 严重、罕见且可能致命。急诊儿科医生必须认识到这一点，并使用免疫调节策略尽早进行治疗，以减少全身损伤。需要进一步研究以确定疾病发病机制并确定最合适的治疗方法。
