Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS CoV-2
Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS CoV-2
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DOI：
10.1172/jci140970
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发表时间：
2020-11-02
影响因子：
15.9
通讯作者：
Bassiri, Hamid
中科院分区：
文献类型：
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作者：
Diorio, Caroline;Henrickson, Sarah E.;Bassiri, Hamid
背景严重急性呼吸道冠状病毒2型（SARS-CoV-2）大流行的初步报告称，儿童对2019年冠状病毒病（COVID-19）的易感性低于成人。随后，出现了一种称为儿童多系统炎症综合征（MIS-C）的严重和新型儿科疾病。我们报告了独特的血液学和免疫学参数，这些参数可以区分COVID-19和MIS-C，并提供对病理生理学的深入了解。我们前瞻性地招募了有SARS-CoV-2感染证据的住院患者，并将其分类为MIS-C或COVID-19。COVID-19患者被分为轻微或严重疾病。细胞因子谱、病毒周期阈值（Ct）、血涂片和可溶性C5 b-9值与临床数据一起进行分析。入组了20例患者（9例重度COVID-19，5例轻度COVID-19和6例MIS-C）。五种细胞因子IL-10。IL-6、IL-8和TNF-α）有助于分析。TNF-α和IL-10可区分MIS-C患者和重度COVID-19患者。血涂片上毛刺细胞的存在，以及Ct，区分了严重COVID-19患者和MIS-C患者。患有SARS-CoV-2的儿科患者存在重症COVID-19和MIS-C的危重症风险。细胞因子分析和外周血涂片检查可以区分MIS-C患者和严重COVID-19患者。
BACKGROUND. Initial reports from the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease 2019 (COVID-19) than adults. Subsequently, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. We report on unique hematologic and immunologic parameters that distinguish between COVID-19 and MIS-C and provide insight into pathophysiology.METHODS. We prospectively enrolled hospitalized patients with evidence of SARS-CoV-2 infection and classified them as having MIS-C or COVID-19. Patients with COVID-19 were classified as having either minimal or severe disease. Cytokine profiles, viral cycle thresholds (Cts), blood smears, and soluble C5b-9 values were analyzed with clinical data.RESULTS. Twenty patients were enrolled (9 severe COVID-19, 5 minimal COVID-19, and 6 MIS-C). Five cytokines IL-10. IL-6, IL-8, and TNF-alpha) contributed to the analysis. TNF-alpha and IL-10 discriminated between patients with MIS-C and severe COVID-19. The presence of burr cells on blood smears, as well as Cts, differentiated between patients with severe COVID-19 and those with MIS-C.CONCLUSION. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe COVID-19 and MIS-C. Cytokine profiling and examination of peripheral blood smears may distinguish between patients with MIS-C and those with severe COVID-19.