Department of Pediatrics, University of Bologna, S. Orsola Hospital, Bologna, Italy.
Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola Hospital, University of Bologna, Italy.
J Pediatric Infect Dis Soc. 2021 Aug 14;10(6):714-721. doi: 10.1093/jpids/piaa162.
Children with coronavirus disease-2019 (COVID-19) have a milder clinical course than adults. We describe the spectrum of cardiovascular manifestations during a COVID-19 outbreak in Emilia-Romagna, Italy.
A cross-sectional multicenter study was performed, including all patients diagnosed with Kawasaki disease (KD), myocarditis, and multisystem inflammatory syndrome in children (MIS-C) from February to April 2020. KD patients were compared with those diagnosed before the epidemic.
KD: 8 patients (6/8 boys, all negative for severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]): complete presentation in 5/8, 7/8 immunoglobulin (IVIG) responders, and 3/8 showed transient coronary lesions (CALs). Myocarditis: one 5-year-old girl negative for SARS-CoV-2 and positive for parvovirus B19. She responded to IVIG. MIS-C: 4 SARS-CoV-2-positive boys (3 patients with positive swab and serology and 1 patient with negative swab and positive serology): 3 presented myocardial dysfunction and pericardial effusion, and 1 developed multicoronary aneurysms and hyperinflammation; all responded to treatment. The fourth boy had mitral and aortic regurgitation that rapidly regressed after steroids.
KD, myocarditis, and MIS-C were distinguishable cardiovascular manifestations. KD did not show a more aggressive form compared with previous years: coronary involvement was frequent but always transient. MIS-C and myocarditis rapidly responded to treatment without cardiac sequelae despite high markers of myocardial injury at the onset, suggesting a myocardial depression due to systemic inflammation rather than focal necrosis. Evidence of actual or previous SARS-CoV-2 infection was documented only in patients with MIS-C.
儿童感染 2019 冠状病毒病（COVID-19）的临床过程比成人轻。我们描述了意大利艾米利亚-罗马涅地区 COVID-19 爆发期间心血管表现的范围。
进行了一项横断面多中心研究，包括 2020 年 2 月至 4 月期间所有被诊断为川崎病（KD）、心肌炎和儿童多系统炎症综合征（MIS-C）的患者。将 KD 患者与流行前诊断的患者进行比较。
KD：8 例（8 例均为男孩，均为严重急性呼吸综合征冠状病毒-2 [SARS-CoV-2]阴性）：5/8 例表现完全，7/8 例免疫球蛋白（IVIG）应答，3/8 例出现短暂性冠状动脉病变（CALs）。心肌炎：一名 5 岁女孩 SARS-CoV-2 阴性，细小病毒 B19 阳性。她对 IVIG 有反应。MIS-C：4 例 SARS-CoV-2 阳性男孩（3 例咽拭子和血清学阳性，1 例咽拭子和血清学阴性）：3 例出现心肌功能障碍和心包积液，1 例出现多支冠状动脉瘤和高炎症；所有患者均对治疗有反应。第 4 名男孩有二尖瓣和主动脉瓣反流，在使用类固醇后迅速消退。
KD、心肌炎和 MIS-C 是可区分的心血管表现。KD 与前几年相比没有表现出更具侵袭性的形式：冠状动脉受累很常见，但都是短暂的。MIS-C 和心肌炎在发病时尽管心肌损伤标志物较高，但仍迅速对治疗有反应，无心脏后遗症，提示全身炎症导致心肌抑制而非局灶性坏死。仅在 MIS-C 患者中发现实际或先前 SARS-CoV-2 感染的证据。
