Multisystem Inflammatory Syndrome in Children (MIS-C): ähnlich und doch ganz anders als das Kawasaki-Syndrom

ZUSAMMENFASSUNG

Im Zeitraum vom 10. November 2020 bis zum 26. Dezember 2021 wurden im Katholischen Kinderkrankenhaus Wilhelmstift in Hamburg sechs Kinder mit MIS-C behandelt. Mögliche Differenzialdiagnosen wie das Kawasaki-Syndrom (KS), Toxisches Schocksyndrom sowie die Hämophagozytische Lymphohistiozytose konnten unter anderem durch den Nachweis einer positiven SARS-CoV-2-Serologie ausgeschlossen werden. Anders als beim KS sind Kinder mit MIS-C älter und fallen durch eine führende kardiale und abdominelle Symptomatik auf. Eine mit ventrikulärer Dysfunktion einhergehende Kreislaufinstabilität macht in der Regel eine intensivmedizinische Behandlung notwendig. Trotz des schweren Krankheitsverlaufs ist die MIS-C-Erkrankung unter adäquater Therapie (intravenöse Immunglobuline, Methylprednisolon, Azetylsalizylsäure sowie hämodynamischer Support) mit einer guten Prognose verbunden.

ABSTRACT

In the period from November 10, 2020 to December 26, 2021, six children were treated with MIS-C at the Catholic Children’s Hospital Wilhelmstift in Hamburg. Possible differential diagnoses such as Kawasaki syndrome (KS), toxic shock syndrome and hemophagocytic lymphohistiocytosis could be ruled out including but not limited to the detection of a positive SARS-CoV-2 serology. In contrast to KS, children with MIS-C are older and stand out due to leading cardiac and abdominal symptoms. Circulatory instability associated with ventricular dysfunction usually requires intensive medical treatment. Despite the severe course of the disease, MIS-C disease is associated with a good prognosis under adequate therapy (intravenous immunoglobulins, methylprednisolone, acetylsalicylic acid and hemodynamic support).

Schlüsselwörter

Multisystem Inflammatory Syndrome in Children - Hyperinflammationssyndrome - Kawasaki-Syndrom - SARS-CoV-2

Keywords

Multisystem inflammatory syndrome in children - hyperinflammatory Syndromes - Kawasaki disease - SARS-CoV-2

Publication History

Article published online:
17 August 2022

• Literatur

• 1 Nakra N, Blumberg D, Herrera-Guerra A. et al Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children 2020; 07: 69
• 2 Riphagen S, Gomez X, Gonzalez-Martinez C. et al Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 10237 1607-1608
• 3 Whittaker E, Bamford A, Kenny J. et al Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020; 324 (03) 259-269
• 4 Deutsche Gesellschaft für Pädiatrische Infektiologie. PIMS Survey Update: 2021, Kalenderwoche 51 (2021). Im Internet. https://dgpi.de/pims-survey-update/ Stand: 30.12.2021
• 5 Children’s Minnesota MIS-C Workgroup. Clinical Guideline Mis-C: Clinic-Diagnostic/Dispo Recs For Suspected Multisystem Inflammatory Syndrome In Children (Age < 21 Years) (2021). Im Internet. https://www.childrensmn.org/departments/infectioncontrol/pdf/mis-c-clinical-guideline.pdf Stand: 19.09.2021
• 6 Neudorf U, Jakob A, Lilienthal E. et al S2k Leitlinie Kawasaki Syndrom. AWMF-Registernummer 027–063. 2020; Im Internet. https://www.awmf.org/uploads/tx_szleitlinien/185-003l_S2k_Kawasaki-Syndrom_2021-01.pdf Stand: 12.01.2022
• 7 World Health Organization (WHO). Scientific Brief – Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 (Mai 2020). Im Internet. https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 Stand: 19.09.2021
• 8 Godfred-Cato S, Bryant B, Leung J. et al COVID-19-Associated Multisystem Inflammatory Syndrome in Children – United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1074-1080
• 9 McClain K, Eckstein O. Clinical features and diagnosis of hemophagocytic lymphohistiocytosis. UpToDate 2021; 1–46. Im Internet:. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hemophagocytic-lymphohistiocytosis%0Ahttps://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hemophagocytic-lymphohistiocytosis?source=history_widget#H543709 Stand: 11.01.2022
• 10 Toubiana J, Poirault C, Corsia A. et al Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369: m2094
• 11 Kanegaye JT, Wilder MS, Molkara D. et al Recognition of a Kawasaki disease shock syndrome. Pediatrics 2009; 123 (05) e783-789
• 12 Hoste L, Van Paemel R, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19: a systematic review. Eur J Pediatr 2021; 180: 2019-2034
• 13 Rostad CA, Chahroudi A, Mantus G. et al Quantitative SARS-CoV-2 Serology in Children With Multisystem Inflammatory Syndrome (MIS-C). Pediatrics 2020; 146 (06) e2020018242
• 14 McArdle AJ, Vito O, Patel H. et al Treatment of Multisystem Inflammatory Syndrome in Children. N Engl J Med 2021; 385: 11-22
• 15 Son MBF, Murray N, Friedman K. et al Multisystem Inflammatory Syndrome in Children – Initial Therapy and Outcomes. N Engl J Med 2021; 385: 23-34
• 16 Ouldali N, Toubiana J, Antona D. et al Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA 2021; 325: 855-864
• 17 Penner J, Abdel-Mannan O, Grant K. et al 6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital: a retrospective cohort study. Lancet Child Adolesc Heal 2021; 05: 473-482
• 18 Centers for Disease Control and Prevention. CDC COVID Data Tracker (2022). Im Internet. https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance Stand: 03.01.2022
• 19 McCrindle BW, Rowley AH, Newburger JW. et al Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135: e927-e999