COVID-19 Alerts: Texas Study Shows Children’s Hearts Severely Damaged By Post-COVID-19 Multisystem Inflammatory Syndrome (MIS-C)
Source: COVID-19 Alerts Sep 05, 2020 3 years, 7 months, 2 weeks, 6 days, 19 hours ago
COVID-19 Alerts: Researchers from Texas Children's Hospital-Houston, University of Texas Health Science Center-San Antonio and Georgetown University-Washington have discovered in a new study that the multisystem inflammatory syndrome in children (MIS-C), linked to COVID-19, damages the heart to such an extent that some children will need lifelong monitoring and interventions.
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The number of children suffering from multisystem inflammatory syndrome (MIS-C) is ever growing and sometimes it does not start immediately after a child is infected with COVID-19 but can occur weeks or months after. This is causing a worrying trend as initially during the start of the pandemic, it was assumed that children are not affected much by the SARS-CoV-2 coronavirus.
The study findings were published in the journal: EClinicalMedicine, a journal of The Lancet.
Dr Alvaro Moreira, MD, MSc, of the University of Texas Health Science Center at San Antonio. Dr. Moreira, a neonatologist, is an assistant professor of pediatrics in the university's Joe R. and Teresa Lozano Long School of Medicine warned that numerous case studies also show MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections.
Dr Moreira said, "According to the literature, children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C, which is frightening. Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body."
The study team reviewed 662 MIS-C cases reported worldwide between Jan. 1 and July 25. Among the key findings:
-71% of the children were admitted to the intensive care unit (ICU).
-60% presented with shock.
-Average length of stay in the hospital was 7.9 days.
-100% had fever,
-73.7% had abdominal pain or diarrhea
-68.3% suffered vomiting.
-90% had an echocardiogram (EKG) test and 54% of the results were abnormal.
-22.2% of the children required mechanical ventilation.
-4.4% required extracorporeal membrane oxygenation (ECMO).
-11 children died.
Dr Moreira warned "This is a new childhood disease that is believed to be associated with SARS-CoV-2. It can be lethal because it affects multiple organ systems. Whether it be the heart and the lungs, the gastrointestinal system or the neurologic system, it has so many different faces that initially it was challenging for clinicians to understand."
Significantly, the amount of inflammation in MIS-C surpasses two similar pediatric conditions, Kawasaki disease and toxic shock syndrome.
Dr Moreira said, "The saving grace is that treating these patients with therapies commonly used for Kawasaki ie immunoglobulin and glucocorticosteroids has been effective.
However most of the 662 children in the study suffered cardiac involvement as indicated by markers such as troponin, which is used with great accuracy in adults to diagnose heart attacks.
Dr Moreira said, "Almost 90% of the children (581) un
derwent an echocardiogram because they had such a significant cardiac manifestation of the disease."
The observed and discovered damages include:
-Dilation of coronary blood vessels, a phenomenon also seen in Kawasaki disease.
-Depressed ejection fraction, indicating a reduced ability for the heart to pump oxygenated blood to the tissues of the body.
-More than 10% of children had an aneurysm of a coronary vessel. "This is a localized stretching or ballooning of the blood vessel that can be measured on an ultrasound of the heart," Dr. Moreira said.
It was also observed that children with an aneurysm are at the most risk of a future event.
Dr Moreira further added, "These are children who are going to require significant observation and follow-up with multiple ultrasounds to see if this is going to resolve or if this is something they will have for the rest of their lives."
He commented, "And that's catastrophic to a parent who had a previously healthy child and then he/she is in the percentage of individuals who developed MIS-C after COVID-19 infection.”
Interestingly, another finding from the case studies: Almost half of patients who had MIS-C had an underlying medical condition, and of those, half of the individuals were obese or overweight.
Dr Moreira warned, "Generally, in both adults and children, we are seeing that patients who are obese will have a worse outcome."
Significantly when compared to the initial COVID-19 infection, inflammatory markers in MIS-C were far more abnormal. For instance, troponin, the marker used in adults to diagnose heart attacks, was 50 times its normal level in children with MIS-C.
Dr Moreira added, "Evidence suggests that children with MIS-C have immense inflammation and potential tissue injury to the heart, and we will need to follow these children closely to understand what implications they may have in the long term."
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