Comportamiento por olas del síndrome inflamatorio multisistémico asociado a COVID-19 en una institución colombiana de tercer nivel
Barra lateral del artículo
Contenido principal del artículo
Resumen
Introducción: El síndrome inflamatorio multisistémico asociado al COVID 19 (MIS C) se presenta usualmente 4 semanas post-infección por SARS CoV2. Hay pocos reportes sobre su comportamiento en las diferentes olas de la pandemia. El objetivo de este trabajo es evaluar las características del MIS C en una institución colombiana de tercer nivel durante las tres primeras olas. Materiales y métodos: Estudio observacional de cohorte histórica con pacientes pediátricos atendidos por MIS C. Resultados: La incidencia de MIS-C decreció luego de la segunda ola (34%, 47% y 20%). Se analizaron 80 casos, siendo la mayoría menores de 10 años y de sexo masculino. Un tercio mostraron fenotipo Kawasaki incompleto. La fiebre (92%) y el dolor abdominal (64%) fueron los síntomas más frecuentes. Hubo infección activa por COVID-19 en el 21%. La PCR, ferritina, el dímero D y el fibrinógeno se elevaron en todas las olas. Hubo uso decreciente de la inmunoglobulina y anticoagulantes. El uso de esteroides y de aspirina fue más estable. Un 20% de niños requirió hospitalización en UCIP. La estancia promedio fue de 10 días. Discusión: La evolución histórica del MIS C ha mostrado una incidencia más baja y menos casos severos con cada ola. La población estudiada exhibió un patrón similar. Conclusión: El MIS C tiene espectro clínico amplio y complejo.
Detalles del artículo
Citas
Acevedo L, Piñeres-Olave BE, Niño-Serna LF, Vega LM, Gomez IJA, Chacón S, et al. Mortality and clinical characteristics of multisystem inflammatory syndrome in DOI: 10.1073/pnas.2213879119children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study). BMC Pediatr 2021; 21(1): 1-12. https://doi.org/10.1186/s12887-021-02974-9
Boyle L, Hletko S, Huang J, Lee J, Pallod G, Tung HR, et al. Selective sweeps in SARS CoV 2 variant competition. Proc Natl Acad Sci U S A. 2022; 119(47): 2-5. https://doi.org/10.1073/pnas.2213879119
Koskela U, Helve O, Sarvikivi E, Helminen M, Nieminen T, Peltola V, et al. Multi inflammatory syndrome and Kawasaki disease in children during the COVID 19 pandemic: A nationwide register based study and time series analysis. Acta Paediatr Int J Paediatr. 2021; 110(11): 3063-8. https://doi.org/10.1111/apa.16051
Kenney PO, Chang AJ, Krabill L, Hicar MD. Decreased Clinical Severity of Pediatric Acute COVID-19 and MIS-C and Increase of Incidental Cases during the Omicron Wave in Comparison to the Delta Wave. Viruses. 2023; 15(1): 1-11. https://doi.org/10.3390/v15010180
Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinical Medicine 2020; 000: 100527. https://doi.org/10.1016/j.eclinm.2020.100527
Fernandez-Sarmiento J, De Souza D, Jabornisky R, Gonzalez GA, Arias López M del P, Palacio G. Paediatric inflammatory multisystem síndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee. BMJ Paediatr Open. 2021; 5(1): e000894. https://doi.org/10.1136/bmjpo-2020-000894
Son MBF, Burns JC, Newburger JW. A New Definition for Multisystem Inflammatory Syndrome in Children. Pediatrics 2023; 151(3): e2022060302. https://doi.org/10.1542/peds.2022-060302
Shields K, Atlas K, Farber JS, Lebet R. CE: Multisystem Inflammatory Syndrome in Children. AJN, Am J Nurs 2021; 121(5): 26-37. https://doi.org/10.1097/01.NAJ.0000749756.12090.63
Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS C) Associated with SARS CoV 2 and Hyperinflammation in COVID 19. Version 1. Arthritis Rheumatol. 2020; (M):1-5. https://doi.org/10.1002/art.42062
Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS CoV 2 and Hyperinflammation in Pediatric COVID 19: Version 2. Arthritis Rheumatol. 2021; 73(4): e13-29. https://doi.org/10.1002/art.41454
Abrams JY, Godfred-Cato SE, Oster ME, Chow EJ, Koumans EH, Bryant B, et al. Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. J Pediatr 2020; 226(e1): 45-54. https://doi.org/10.1016/j.jpeds.2020.08.003
Mohsin SS, Abbas Q, Chowdhary D, Khalid F, Sheikh AS, Khan ZGA, et al. Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis. PLoS One 2021; 16(6): 1-13. https://doi.org/10.1371/journal.pone.0253625
Emeksiz S, Celikel Acar B, Kibar AE, Ozkaya Parlakay A, Perk O, Bayhan Gi, et al. Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID 19. Int J Clin Pract. 2021; 75(9): 1-9. https://doi.org/10.1111/ijcp.14471
Bautista-Rodríguez C, Sanchez-de-Toledo J, Clark BC, Herberg J, Bajolle F, Randanne PC, et al. Multisystem Inflammatory Syndrome in Children: An International Survey. Pediatrics. 2021; 147(2): e2020024554. https://doi.org/10.1542/peds.2020-024554
Camacho C. Más de 20.000 niños están vacunados en Bucaramanga contra el Covid-19 [Internet]. Alcaldía de Bucaramanga. 2021 [cited 2024 Dec 16]. Disponible en: https://www.bucaramanga.gov.co/noticias/mas-de-20-000-ninos-estan-vacunados-en-bucaramanga-contra-elcovid-19/
García-Salido A, Antón J, Martínez-Pajares JD, Giralt García G, Gómez-Cortés B, Tagarro A, et al. Documento español de consenso sobre diagnóstico, estabilización y tratamiento del síndrome inflamatorio multisistémico pediátrico vinculado a SARS CoV 2 (SIM-PedS). An Pediatría 2021; 94(2): 116.e1-116.e11. https://doi.org/10.1016/j.anpedi.2020.09.005
Antúnez-Montes OY, Escamilla MI, Figueroa-Uribe AF, Arteaga-Menchaca E, Lavariega-Saráchaga M, Salcedo-Lozada P, et al. COVID 19 and Multisystem Inflammatory Syndrome in Latin American Children. Pediatr Infect Dis J. 2021; 40(1): E1-E6. https://doi.org/10.1097/INF.0000000000002949
Torres JP, Izquierdo G, Acuña M, Pavez D, Reyes F, Fritis A, et al. Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic. Int J Infect Dis 2020; 100: 75-81. https://doi.org/10.1016/j.ijid.2020.08.062
Swann O V., Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid 19 in United Kingdom: prospective multicentre observational cohort study. BMJ 2020; 370: m3249. https://doi.org/10.1136/bmj.m3249
Encinosa W, Moon K, Figueroa J, Elias Y. Complications, Adverse Drug Events, High Costs, and Disparities in Multisystem Inflammatory Syndrome in Children vs COVID-19. JAMA Netw Open. 2023; 6(1): 1-12. https://doi.org/10.1001/jamanetworkopen.2022.44975
Buonsenso D, Perramon A, Catala M, Torres JP, Camacho-Moreno G, Rojas-Solano M, et al. Multisystem Inflammatory Syndrome in Children in Western Countries ¿Decreasing Incidence as the Pandemic Progresses? An Observational Multicenter International Cross-sectional Study. Pediatr Infect Dis J. 2022; 41(12): 989-93. https://doi.org/10.1097/INF.0000000000003713
Yasuhara J, Watanabe K, Takagi H, Sumitomo N, Kuno T. COVID 19 and multisystem inflammatory syndrome in children: A systematic review and meta analysis. Pediatr Pulmonol. 2021; 56(5): 837-848. https://doi.org/10.1002/ppul.25245
Yamazaki-Nakashimada MA, Márquez-González H, Miranda-Novales G, Neme Díaz GA, Prado Duran SA, Luévanos Velázquez A, et al. Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico. Front Pediatr. 2023;11(May): 1167871. https://doi.org/10.3389/fped.2023.1167871
Harahsheh AS, Sharron MP, Bost JE, Ansusinha E, Wessel D, Debiasi RL. Comparison of First and Second Wave Cohorts of Multisystem Inflammatory Disease Syndrome in Children. Pediatr Infect Dis J. 2022; 41(1): E21-5. https://doi.org/10.1097/INF.0000000000003388
Miller AD, Yousaf AR, Bornstein E, Wu MJ, Lindsey K, Melgar M, et al. Multisystem Inflammatory Syndrome in Children During Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2) Delta and Omicron Variant Circulation United States, July 2021-January 2022. Clin Infect Dis. 2022; 75(2): S303-7. https://doi.org/10.1093/cid/ciac471
Krishnamurthy S, Kar SS, Dhodapkar R, Parameswaran N. Comparison of COVID 19 Infection in Children During the First and Second Wave. Indian J Pediatr 2022; 89(10): 1016-8. https://doi.org/10.1007/s12098-022-04127-x
Mishra B, Mishra B, Mohapatra A, Patwari V, Malini SD, Panda M, et al. Clinical Profile and Outcomes of Multisystem Inflammatory Syndrome in Children: A Multicentric Observational Study. Cureus. 2022; 2(9): 3-9. https://doi.org/10.7759/cureus.28821
Levy N, Koppel JH, Kaplan O, Yechiam H, Shahar-Nissan K, Cohen NK, et al. Severity and Incidence of Multisystem Inflammatory Syndrome in Children During 3 SARS CoV 2 Pandemic Waves in Israel. JAMA 2022; 327(24): 2452. https://doi.org/10.1001/jama.2022.8025
Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H, et al. Characteristics and Outcomes of US Children and Adolescents with Multisystem Inflammatory Syndrome in Children (MIS C) Compared with Severe Acute COVID 19. JAMA 2021; 325(11): 1074. https://doi.org/10.1001/jama.2021.2091
Ptak K, Szymonska I, Olchawa-Czech A, Kukla K, Cisowska M, Kwinta P. Comparison of the course of multisystem inflammatory syndrome in children during different pandemic waves. Eur J Pediatr 2023; 182(4): 1647-56. https://doi.org/10.1007/s00431-022-04790-4
Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, et al. COVID 19 Asocciated Multisystem Inflammatory Syndrome in Children- United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(32): 1074-80. https://doi.org/10.15585/mmwr.mm6932e2
Pérez López P, Carvajal Duque D, Salgado García DM, Vega Vega MR, Ramos-Castaneda JA, Ardila Gómez IJ, et al. Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience. Front Pediatr. 2022;10(April):1-8. https://doi.org/10.3389/fped.2022.838922
Lozano-Espinosa DA, Camacho-Moreno G, López-Cubillos JF, Díaz- Maldonado AS, León-Guerra OJ, Galvis-Trujillo DM, et al. Multisystem Inflammatory Syndrome in Children (MIS C) temporally related to COVID 19: the experience at a pediatric reference hospital in Colombia. Rev Paul Pediatr. 2022; 41: e2021267. https://doi.org/10.1590/1984-0462/2023/41/2021267
Yock-Corrales A, Lenzi J, Ulloa-Gutiérrez R, Gómez-Vargas J, Antúnez- Montes OY, Rios Aida JA, et al. High rates of antibiotic prescriptions in children with COVID 19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America. Acta Paediatr Int J Paediatr. 2021;110(6):1902-10. https://doi.org/10.1111/apa.15847
García-Silva J, Ulloa-Gutierrez R, Ivankovich-Escoto G, Yamazaki- Nakashimada MA, Faugier-Fuentes E, del Águila O, et al. Multisystem inflammatory syndrome in children across 16 Latin American countries: A multicenter study from the REKAMLATINA Network. IJID Reg. 2024;12(June):1-5. https://doi.org/10.1016/j.ijregi.2024.100419
Fernández-Sarmiento J, Acevedo L, Niño-Serna LF, Boza R, García- Silva J, Yock-Corrales A, et al. Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2 Related Multisystem Inflammatory Syndrome (MIS C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network. J Intensive Care Med [Internet]. 2024; 39(8):785-93. https://doi.org/10.1177/08850666241233189
Ruvinsky S, Voto C, Roel M, Fustiñana A, Veliz N, Brizuela M, et al. Multisystem Inflammatory Syndrome Temporally Related to COVID 19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems. Front Pediatr. 2022;10(April):1-12. https://doi.org/10.3389/fped.2022.881765