Manifestaciones cardíacas y hallazgos ecocardiográficos asociados al síndrome inflamatorio multisistémico por COVID-19 en niños Un estudio observacional de centro único durante y después de la pandemia.
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Introducción: Se ha observado que en niños hospitalizados por síndrome inflamatorio multisistémico (SIM) por COVID-19 se puede presentar manifestaciones cardíacas cuyo desenlace puede ser fatal. El objetivo del estudio fue analizar las manifestaciones cardíacas y hallazgos ecocardiográficos asociados al SIM por COVID-19 en niños.
Métodos: El presente estudio observacional se realizó en el Hospital “Vicente Corral Moscoso” en Cuenca-Ecuador. El período de estudio fue de abril de 2020 a marzo de 2022. Se reportan casos de niños con SIM y COVID-19, se examinaron las historias clínicas y ecocardiogramas.
Resultados: Fueron 19 casos, el 31.6 % de los niños afectados tenían entre 1 y 4 años, y el 52.6 % eran niñas. Un notable 63.2 % presentó sobrepeso. La obesidad fue la comorbilidad más común, afectó al 84.2 % de los casos. Los síntomas predominantes fueron fiebre (68.4 %), vómitos (47.4 %) y dolor abdominal (42.1 %). Los hallazgos ecocardiográficos fueron: derrame pericárdico en el 15.8 % y disfunción ventricular derecha en el 5.3 %. Las complicaciones cardíacas más frecuentes fueron la disfunción pericárdica, valvular, arritmias y derrame pericárdico, cada una en el 10.5 % de los pacientes. Además, se registró un 26.3 % de mortalidad en la muestra estudiada.
Conclusiones: Se observó una clara relación entre síntomas inflamatorios y complicaciones cardíacas tras la infección por la COVID-19.
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Giles-Corti B, Foster S, Lynch B, Lowe M. What are the les-sons from COVID-19 for creating healthy, sustainable, resil-ient future cities? npj Urban Sustain [Internet]. 2023;3(29):1-6. Disponible en: https://doi.org/10.1038/s42949-023-00107-y
Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Cho-rath K, et al. Multisystem inflammatory syndrome in chil-dren: A systematic review. eClinicalMedicine. 2020;26(100527):1-16. https://doi.org/10.1016/j.eclinm.2020.100527
PMid:32923992 PMCid:PMC7473262
WHO Coronavirus (COVID-19) Dashboard [Internet]. [cita-do 24 de noviembre de 2023]. Disponible en: https://covid19.who.int
Niaz T, Hope K, Fremed M, Misra N, Altman C, Glickstein J, et al. Role of a Pediatric Cardiologist in the COVID-19 Pandemic. Pediatr Cardiol. 1 de enero de 2021;42(1):19-35. https://doi.org/10.1007/s00246-020-02476-y
PMid:33015722 PMCid:PMC7533115
Esposito S, Principi N. Multisystem Inflammatory Syn-drome in Children Related to SARS-CoV-2. Pediatr Drugs. 1 de marzo de 2021;23(2):119-29. https://doi.org/10.1007/s40272-020-00435-x
PMCid:PMC7819738
Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20(11):e276-88. https://doi.org/10.1016/S1473-3099(20)30651-4
PMid:32818434
Yacop B, Helmi M, Saleh M. Multisystem Inflammatory Syndrome in Children with COVID-19-Positive Antibodies. Dubai Med J [Internet]. 2021;4(4):376-81. Disponible en: https://doi.org/10.1159/000518435
Blatz AM, Randolph AG. Severe COVID-19 and Multisystem Inflammatory Syndrome in Children in Children and Ado-lescents. Critical Care Clinics. 1 de julio de 2022;38(3):571-86. https://doi.org/10.1016/j.ccc.2022.01.005
PMid:35667744 PMCid:PMC8743385
Shati AA, Mahmood SE, Alsuheel Asseri A, Alhanshani AA, Alqahtani YA, Ahmad A. SARS-CoV-2 infections and MIS-C among children: A narrative review. Medicine (Baltimore) [Internet]. 2023;102(31:e34475):1-8. Disponible en: https://doi.org/10.1097%2FMD.0000000000034475
Rowley AH. Understanding SARS-CoV-2-related multisys-tem inflammatory syndrome in children. Nat Rev Immunol. agosto de 2020;20(8):453-4. https://doi.org/10.1038/s41577-020-0367-5
PMid:32546853 PMCid:PMC7296515
Turco SD, Vianello A, Ragusa R, Caselli C, Basta G. COVID-19 and cardiovascular consequences: Is the endothelial dys-function the hardest challenge? Thrombosis Research. 1 de diciembre de 2020;196:143-51. https://doi.org/10.1016/j.thromres.2020.08.039
PMid:32871306 PMCid:PMC7451195
Silva Andrade B, Siqueira S, de Assis Soares WR, de Souza Rangel F, Santos NO, dos Santos Freitas A, et al. Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Mo-lecular Mechanisms. Viruses. abril de 2021;13(4):700. https://doi.org/10.3390/v13040700
PMid:33919537 PMCid:PMC8072585
Gómez Carcassés LM, Quintero Méndez Y, Pereira Valdés E, Gómez Carcassés LM, Quintero Méndez Y, Pereira Val-dés E. Complicaciones cardiovasculares en paciente con COVID-19. Presentación de un caso. Revista Finlay. marzo de 2022;12(1):106-16.
Inciardi RM, Solomon SD, Ridker PM, Metra M. Coronavi-rus 2019 Disease (COVID‐19), Systemic Inflammation, and Cardiovascular Disease. Journal of the American Heart As-sociation. 18 de agosto de 2020;9(16):e017756. https://doi.org/10.21037/tp-20-188
PMid:33633944 PMCid:PMC7882293
Tang Y, Li W, Baskota M, Zhou Q, Fu Z, Luo Z, et al. Multi-system inflammatory syndrome in children during the coronavirus disease 2019 (COVID-19) pandemic: a system-atic review of published case studies. Transl Pediatr [Inter-net]. 2021;10(1):121-35. Disponible en: https://doi.org/10.21037/tp-20-188
Vasichkina E, Alekseeva D, Kudryavtsev I, Glushkova A, Starshinova AY, Malkova A, et al. COVID-19 Heart Lesions in Children: Clinical, Diagnostic and Immunological Changes. International Journal of Molecular Sciences. enero de 2023;24(2):1147. https://doi.org/10.3390/ijms24021147
PMid:36674665 PMCid:PMC9866514
Molloy EJ, Nakra N, Gale C, Dimitriades VR, Lakshmin-rusimha S. Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Pediatr Res. mayo de 2023;93(6):1499-508. https://doi.org/10.1038/s41390-022-02263-w
PMid:36050390 PMCid:PMC9436161
Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus Disease 2019-COVID-19. Clin Microbiol Rev [Internet]. 2020;33(4:e00028-20):1-48. Disponible en: https://doi.org/10.1128/CMR.00028-20
Oliveira MC, Scharan KO, Thomés BI, Bernardelli RS, Reese FB, Kozesinski-Nakatani AC, et al. Diagnostic accuracy of a set of clinical and radiological criteria for screening of COVID-19 using RT-PCR as the reference standard. BMC Pulm Med [Internet]. 2023;23(81):1-9. Disponible en: https://doi.org/10.1186/s12890-023-02369-9
Dutta D, Naiyer S, Mansuri S, Soni N, Singh V, Bhat KH, et al. COVID-19 Diagnosis: A Comprehensive Review of the RT-qPCR Method for Detection of SARS-CoV-2. Diagnos-tics (Basel) [Internet]. 2022;12(6:1503):1-18. Disponible en: https://doi.org/10.3390%2Fdiagnostics12061503
Khafaja S, Youssef N, El Zein Z, Boutros CF, Bou Karroum S, Abdel-Halim N, et al. Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum? Front Pediatr [Internet]. 2023;10(988706):1-10. Disponible en: https://doi.org/10.3389/fped.2022.988706
Feng Y. Clinical Value of SARS-CoV2 IgM and IgG Antibod-ies in Diagnosis of COVID-19 in Suspected Cases. J Inflamm Res [Internet]. 2020;13:1089-94. Disponible en: https://doi.org/10.2147/JIR.S287733
Ghasemi D, Araeynejad F, Maghsoud O, Gerami N, Keihan AH, Rezaie E, et al. The Trend of IgG and IgM Antibodies During 6-Month Period After the Disease Episode in COVID-19 Patients. Iran J Sci Technol Trans A Sci [Internet]. 2022;46(6):1555-62. Disponible en: https://doi.org/10.1007/s40995-022-01382-7
Pang NYL, Pang ASR, Chow VT, Wang DY. Understanding neutralising antibodies against SARS-CoV-2 and their im-plications in clinical practice. Military Med Res [Internet]. 2021;8(47):1-17. Disponible en: https://doi.org/10.1186/s40779-021-00342-3
Ghazizadeh Esslami G, Mamishi S, Pourakbari B, Mahmoudi S. Systematic review and meta-analysis on the serological, immunological, and cardiac parameters of the multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection. Journal of Medical Virology. 2023;95(7):e28927. https://doi.org/10.1002/jmv.28927
PMid:37436781
Sharma C, Ganigara M, Galeotti C, Burns J, Berganza FM, Hayes DA, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol [Internet]. 2021;17(12):731-48. Disponible en: https://doi.org/10.1038/s41584-021-00709-9
Simon Junior H, Sakano TMS, Rodrigues RM, Eisencraft AP, Carvalho VEL de, Schvartsman C, et al. Multisystem in-flammatory syndrome associated with COVID-19 from the pediatric emergency physician’s point of view. J Pediatr (Rio J) [Internet]. 2021;97(2):140-59. Disponible en: https://doi.org/10.1016/j.jped.2020.08.004
Giacalone M, Scheier E, Shavit I. Multisystem inflammatory syndrome in children (MIS-C): a mini-review. Int J Emerg Med [Internet]. 2021;14(50):1-4. Disponible en: https://doi.org/10.1186/s12245-021-00373-6
Payne AB, Gilani Z, Godfred-Cato S, Belay ED, Feldstein LR, Patel MM, et al. Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2. JAMA Netw Open [Internet]. 2021;4(6:e2116420):1-13. Disponible en: https://doi.org/10.1001/jamanetworkopen.2021.16420
Stierman B, Abrams JY, Godfred-Cato SE, Oster ME, Meng L, Yip L, et al. Racial and Ethnic Disparities in Multisystem Inflammatory Syndrome in Children in the United States, March 2020 to February 2021. Pediatric Infectious Disease Journal [Internet]. 2021;40(11):e400-6. Disponible en: https://doi.org/10.1097/inf.0000000000003294
Graciano-Machuca O, Villegas-Rivera G, López-Pérez I, Macías-Barragán J, Sifuentes-Franco S. Multisystem Inflam-matory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Role of Oxidative Stress. Frontiers in Im-munology [Internet]. 2021 [citado 24 de noviembre de 2023];12. Disponible en: https://www.frontiersin.org/articles/10.3389/fimmu.2021.723654
Acevedo L, Piñeres-Olave BE, Niño-Serna LF, Vega LM, Gomez IJA, Chacón S, et al. Mortality and clinical charac-teristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study). BMC Pe-diatrics. 18 de noviembre de 2021;21(1):516. https://doi.org/10.1186/s12887-021-02974-9
PMid:34794410 PMCid:PMC8600488
Chait A, den Hartigh LJ. Adipose Tissue Distribution, In-flammation and Its Metabolic Consequences, Including Di-abetes and Cardiovascular Disease. Frontiers in Cardiovas-cular Medicine [Internet]. 2020 [citado 24 de noviembre de 2023];7. Disponible en: https://www.frontiersin.org/articles/10.3389/fcvm.2020.00022
Naranjo Arango YA, Farfán Cortés AYAA, García Henao JP, Arango Slingsby C, Saldarriaga Rivera LM. Multisystemic inflammatory syndrome in children with COVID-19: A rheumatology perspective. Revista Colombiana de Reuma-tología (English Edition). 2021;28(4):289-99. https://doi.org/10.1016/j.rcreue.2020.09.004
PMCid:PMC8526434
Sözeri B, Çağlayan Ş, Atasayan V, Ulu K, Coşkuner T, Pelin Akbay Ö, et al. The clinical course and short-term health outcomes of multisystem inflammatory syndrome in chil-dren in the single pediatric rheumatology center. Post-graduate Medicine. 17 de noviembre de 2021;133(8):994-1000. https://doi.org/10.1080/00325481.2021.1987732
PMid:34605352 PMCid:PMC8544667
McMurray JC, May JW, Cunningham MW, Jones OY. Mul-tisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis—A Critical Review of Its Pathogenesis and Treatment. Front Pediatr [Internet]. 2020;8(626182):1-16. Disponible en: https://doi.org/10.3389/fped.2020.626182
Anderson EM, Diorio C, Goodwin EC, McNerney KO, Weirick ME, Gouma S, et al. SARS-CoV-2 antibody re-sponses in children with MIS-C and mild and severe COVID-19 [Internet]. medRxiv; 2020 [citado 24 de noviembre de 2023]. p. 2020.08.17.20176552. Disponible en: https://www.medrxiv.org/content/10.1101/2020.08.17.20176552v1
Mannarino S, Raso I, Garbin M, Ghidoni E, Corti C, Goletto S, et al. Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study. Italian Journal of Pediatrics. 8 de febrero de 2022;48(1):25. https://doi.org/10.1186/s13052-021-01189-z
PMid:35135600 PMCid:PMC8822778
Ferreira Arantes Junior MA, Conegundes AF, Bran-co Miranda BC, Rodrigues Radicchi Campos AS, França Vieira AL, Faleiro MD, et al. Cardiac manifestations in chil-dren with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis. Reviews in Medical Virology [Internet]. 2023;33(3:e2432). Disponible en: https://doi.org/10.1002/rmv.2432
Gupta V, Singh A, Ganju S, Singh R, Thiruvengadam R, Natchu UCM, et al. Severity and mortality associated with COVID-19 among children hospitalised in tertiary care cen-tres in India: a cohort study. The Lancet Regional Health - Southeast Asia [Internet]. 1 de junio de 2023 [citado 24 de noviembre de 2023];13. Disponible en: https://www.thelancet.com/journals/lansea/article/PIIS2772-3682(23)00063-X/fulltext
Gómez de Diego JJ, García Fernández MÁ, Sales Sales JR. Enfermedad de Kawasaki estudiada mediante TC multide-tectora. Rev Esp Cardiol. 1 de octubre de 2005;58(10):1224-5. https://doi.org/10.1157/13079916
PMid:16238990
van Stijn D, Planken RN, Groenink M, Streekstra GJ, Kui-jpers TW, Kuipers IM. Coronary artery assessment in Kawa-saki disease with dual-source CT angiography to uncover vascular pathology. Eur Radiol. 1 de enero de 2020;30(1):432-41. https://doi.org/10.1007/s00330-019-06367-6
PMid:31428828 PMCid:PMC6890577