Schvartz Adrien, Belot Alexandre, Kone-Paut Isabelle
Service De Rhumatologie Pédiatrique, Centre De Référence Des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, Hospital Bicêtre, Assistance Publique des Hôpitaux de Paris, Université Paris Sud Saclay, Le Kremlin-Bicêtre, France.
Service de Néphrologie, Rhumatologie, Dermatologie Pédiatriques, Centre de Référence des Rhumatismes Inflammatoires et Maladies Auto-Immunes Rares de l'Enfant (RAISE), Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
Front Pediatr. 2020 Dec 4;8:605807. doi: 10.3389/fped.2020.605807. eCollection 2020.
Globally, the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appeared to have a milder clinical course in children compared to adults. As severe forms of COVID-19 in adults included an aberrant systemic immune response, children with chronic systemic inflammatory diseases were cautiously followed. No evidence for a specific susceptibility was identified in this pediatric population. European and US Pediatricians started to notice cases of myocarditis, sharing some features with toxic shock syndrome, Kawasaki disease, and macrophage activation syndrome in otherwise healthy patients. Multisystem Inflammatory Syndrome in Children (MIS-C) and Pediatric Inflammatory Multisystem Syndrome (PIMS) have designated this new entity in the US and Europe, respectively. The spectrum of severity ranged from standard hospitalization to pediatric intensive care unit management. Most patients had a clinical history of exposure to COVID-19 patients and/or SARS-COV2 biological diagnosis. Clinical presentations include fever, cardiac involvement, gastro-intestinal symptoms, mucocutaneous manifestations, hematological features, or other organ dysfunctions. The temporal association between the pandemic peaks and outbreaks of PIMS seems to be in favor of a post-infectious, immune-mediated mechanism. Thus, SARS-CoV2 can rarely be associated with severe systemic inflammatory manifestations in previously healthy children differently from adults highlighting the specific need for COVID-19 research in the pediatric population.
在全球范围内，由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）在儿童中的临床病程似乎比成人更为温和。由于成人的重症COVID-19形式包括异常的全身免疫反应，患有慢性全身炎症性疾病的儿童受到密切关注。在这一儿科人群中未发现特定易感性的证据。欧洲和美国的儿科医生开始注意到心肌炎病例，这些病例在其他方面健康的患者中具有一些与中毒性休克综合征、川崎病和巨噬细胞活化综合征相同的特征。儿童多系统炎症综合征（MIS-C）和儿科炎症多系统综合征（PIMS）分别在美国和欧洲定义了这一新实体。严重程度范围从标准住院治疗到儿科重症监护病房管理。大多数患者有接触COVID-19患者和/或SARS-CoV-2生物学诊断的临床病史。临床表现包括发热、心脏受累、胃肠道症状、皮肤黏膜表现、血液学特征或其他器官功能障碍。PIMS大流行高峰与爆发之间的时间关联似乎支持感染后免疫介导机制。因此，与成人不同，SARS-CoV-2在以前健康的儿童中很少与严重的全身炎症表现相关，这突出了儿科人群中COVID-19研究的特殊需求。
