Post-COVID syndrome severely damages children's hearts
'Immense inflammation' causing cardiac blood vessel dilation

Date:
September 4, 2020
Source:
University of Texas Health Science Center at San Antonio
Summary:
Multisystem inflammatory syndrome in children (MIS-C) appears even
after asymptomatic cases of COVID-19, a case review confirms,
and in some children damages the heart to the extent that the
children will need long-term monitoring and interventions.



FULL STORY ========================================================================== Multisystem inflammatory syndrome in children (MIS-C), believed to be
linked to COVID-19, damages the heart to such an extent that some children
will need lifelong monitoring and interventions, said the senior author
of a medical literature review published Sept. 4 in EClinicalMedicine,
a journal of The Lancet.


==========================================================================
Case studies also show MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections, said 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.

"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," Dr. Moreira said. "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." Results The team reviewed
662 MIS-C cases reported worldwide between Jan. 1 and July 25. Among
the 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, and 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.

"This is a new childhood disease that is believed to be associated
with SARS- CoV-2," Dr. Moreira said. "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." The amount of inflammation in MIS-C surpasses two similar pediatric conditions, Kawasaki disease and toxic shock syndrome. "The
saving grace is that treating these patients with therapies commonly
used for Kawasaki -- immunoglobulin and glucocorticosteroids -- has been effective," Dr. Moreira said.



========================================================================== Cardiac abnormalities Most of the 662 children suffered cardiac
involvement as indicated by markers such as troponin, which is used with
great accuracy in adults to diagnose heart attacks.

"Almost 90% of the children (581) underwent an echocardiogram because
they had such a significant cardiac manifestation of the disease,"
Dr. Moreira said.

The damage included:
* 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.

* Almost 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.

Children with an aneurysm are at the most risk of a future event. "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,"
Dr. Moreira said.



==========================================================================
"And that's catastrophic to a parent who had a previously healthy child
and then he/she is in the very small percentage of individuals who
developed MIS- C after COVID-19 infection," he said.

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.

"Generally, in both adults and children, we are seeing that patients
who are obese will have a worse outcome," Dr. Moreira said.

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.

"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," Dr.

Moreira said.

Researchers at Texas Children's Hospital in Houston, Georgetown
University, the National Institutes of Health and the University of Pennsylvania joined Dr.

Moreira in conducting this literature review.


========================================================================== Story Source: Materials provided by University_of_Texas_Health_Science_Center_at_San_Antonio.

Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Mubbasheer Ahmed, Shailesh Advani, Axel Moreira, Sarah Zoretic, John
Martinez, Kevin Chorath, Sebastian Acosta, Rija Naqvi, Finn
Burmeister- Morton, Fiona Burmeister, Aina Tarriela, Matthew
Petershack, Mary Evans, Ansel Hoang, Karthik Rajasekaran, Sunil
Ahuja, Alvaro Moreira.

Multisystem inflammatory syndrome in children: A systematic review.

EClinicalMedicine, 2020; 100527 DOI: 10.1016/j.eclinm.2020.100527 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200904125111.htm

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