Das Pädiatrische Inflammatorische Multisystem Syndrom (PIMS) in der COVID-19 Pandemie

Zusammenfassung

Nach einer meist mild verlaufenden SARS-CoV-2-Infektion kommt es bei einem kleinen Teil der Kinder nach einem Zeitraum von ca. 6–8 Wochen zu einer ausgeprägten multisystemischen Hyperinflammation (Pediatriac multisystemic inflammatory syndrome (PIMS)). Klinisch präsentieren sich diese Patienten mit Zeichen eines Kawasaki-Syndroms bzw. eines toxischen Schocksyndroms. Gerade die kardiale Manifestation mit einer deutlichen Einschränkung der Herzfunktion erfordert in vielen Fällen eine intensivmedizinische Behandlung.

Die Pathophysiologie ist trotz des beeindruckenden Erkenntnisgewinns der letzten 1 ^½ Jahre noch unklar. Möglicherweise spielen Superantigene eine wesentliche Rolle, die T-Zellen an einer bestimmten β-Kette des T-Zellrezeptors polyklonal stimulieren.

Neben den z.T. intensivmedizinischen supportiven Maßnahmen werden zur Kontrolle der Inflammation intravenöse Immunglobuline, Steroide und Biologika eingesetzt.

Abstract

Following a SARS-CoV-2 infection, usually mild, a small proportion of children develop multisystemic hyperinflammation (paediatric inflammatory multisystem syndrome (PIMS)) within approximately 6–8 weeks. Clinically, these patients present with signs of Kawasaki syndrome or toxic shock syndrome. The cardiac manifestation, in particular, with a marked limitation of cardiac function, requires intensive medical treatment in many individuals.

The pathophysiology is still unclear although tremendous knowledge has been gained over the past one and a half years. A key role may be played by superantigens which, by binding to a specific β-chain of T-cell receptors, lead to polyclonal stimulation of T cells.

In addition to intensive care management, intravenous immunoglobulins, steroids, and biologics are used to control inflammation.

Publication History

Article published online:
07 April 2022

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