Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2.
Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2.
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DOI：
10.1007/s40272-020-00435-x
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Principi N
中科院分区：
文献类型：
--
作者：
Esposito S;Principi N
尽管由严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）感染引起的2019年新型冠状病毒病（COVID-19）的发病率和严重程度数据显示，成人和老年人中的疾病更为严重，但在儿童中描述了以多系统炎症综合征为特征的临床表现（MIS-C）。它最初被认为是儿童特有的，但最近的报告表明，它也可以发生在成人身上。MIS-C的特征是许多多系统表现，类似于其他已知的先前描述的疾病，主要是川崎，特别是在休克、中毒性休克综合征和巨噬细胞活化综合征的情况下。现有文献表明，我们对MIS-C的了解在很大程度上是不完整的。它的发展与SARS-CoV-2感染密切相关，似乎有文献记载，在大多数情况下，可以被认为是继发于某些方面异常免疫反应的感染后表现，类似于SARS-CoV-2感染后几天在成人中观察到的表现。然而，在少数病例中，在SARS-CoV-2感染的急性期出现符合MIS-C诊断标准的症状的临床表现。目前用于诊断MIS-C的标准很可能过于宽泛，这意味着包括患有不同疾病的儿童。由于MIS-C的发病机制尚不清楚，已使用不同的治疗方法，但目前尚无特异性治疗方法。迫切需要进一步的研究来改善我们对MIS-C的定义，确定对儿童健康的真实的影响，并阐明最佳的临床和治疗方法以及真实的预后。
Although data on the incidence and severity of new coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed more significant disease among adults and the elderly, a clinical manifestation characterized by a multisystem inflammatory syndrome was described in children (MIS-C). It was initially thought to be specific to children, but recent reports have shown that it can also occur in adults. MIS-C is characterized by a number of multisystemic manifestations resembling other known previously described illnesses, mainly Kawasaki disease, especially in cases with shock, toxic shock syndrome, and macrophage activation syndrome. Available literature shows that our knowledge of MIS-C is largely incomplete. Its development in strict relation with SARS-CoV-2 infection seems documented and, in most cases, can be considered a post-infectious manifestation secondary to an abnormal immune response for some aspects, similar to that seen in adults several days after SARS-CoV-2 infection. However, in a minority of cases, a clinical picture with symptoms fulfilling criteria for MIS-C diagnosis develops during the acute phase of SARS-CoV-2 infection. It is highly likely that the criteria currently used to diagnose MIS-C are too broad, meaning that children with different diseases are included. As clarity on the pathogenesis of MIS-C is lacking, different therapeutic approaches have been used, but no specific therapy is currently available. Further studies are urgently needed to improve our definition of MIS-C, to define the real impact on child health, and to elucidate the best clinical and therapeutic approach and true prognosis.
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