COVID-19 Archive

Hyperinflammatory shock in children during COVID-19 pandemic (Lancet 2020.05.07)

South Thames Retrieval Service in London, UK, provides paediatric intensive care support and retrieval to 2 million children in South East England. During a period of 10 days in mid-April, 2020, we noted an unprecedented cluster of eight children with hyperinflammatory shock, showing features similar to atypical Kawasaki disease, Kawasaki disease shock syndrome, or toxic shock syndrome (typical number is one or two children per week). This case cluster formed the basis of a national alert.

All children were previously fit and well. Six of the children were of Afro-Caribbean descent, and five of the children were boys. All children except one were well above the 75th centile for weight. Four children had known family exposure to coronavirus disease 2019 (COVID-19). Demographics, clinical findings, imaging findings, treatment, and outcome for this cluster of eight children are shown in the table.

Clinical presentations were similar, with unrelenting fever (38-40°C), variable rash, conjunctivitis, peripheral oedema, and generalised extremity pain with significant gastrointestinal symptoms. All progressed to warm, vasoplegic shock, refractory to volume resuscitation and eventually requiring noradrenaline and milrinone for haemodynamic support. Most of the children had no significant respiratory involvement, although seven of the children required mechanical ventilation for cardiovascular stabilisation. Other notable features (besides persistent fever and rash) included development of small pleural, pericardial, and ascitic effusions, suggestive of a diffuse inflammatory process.
All children tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on broncho-alveolar lavage or nasopharyngeal aspirates. Despite being critically unwell, with laboratory evidence of infection or inflammation including elevated concentrations of C-reactive protein, procalcitonin, ferritin, triglycerides, and D-dimers, no pathological organism was identified in seven of the children. Adenovirus and enterovirus were isolated in one child.

Baseline electrocardiograms were non-specific; however, a common echocardiographic finding was echo-bright coronary vessels (appendix), which progressed to giant coronary aneurysm in one patient within a week of discharge from paediatric intensive care (appendix). One child developed arrhythmia with refractory shock, requiring extracorporeal life support, and died from a large cerebrovascular infarct. The myocardial involvement in this syndrome is evidenced by very elevated cardiac enzymes during the course of illness.

All children were given intravenous immunoglobulin (2 g/kg) in the first 24 h, and antibiotic cover including ceftriaxone and clindamycin. Subsequently, six children have been given 50 mg/kg aspirin. All of the children were discharged from PICU after 4-6 days. Since discharge, two of the children have tested positive for SARS-CoV-2 (including the child who died, in whom SARS-CoV-2 was detected post mortem). All children are receiving ongoing surveillance for coronary abnormalities.

We suggest that this clinical picture represents a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 infection manifesting as a hyperinflammatory syndrome with multiorgan involvement similar to Kawasaki disease shock syndrome. The multifaceted nature of the disease course underlines the need for multispecialty input (intensive care, cardiology, infectious diseases, immunology, and rheumatology).

The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management. As this Correspondence goes to press, 1 week after the initial submission, the Evelina London Children's Hospital paediatric intensive care unit has managed more than 20 children with similar clinical presentation, the first ten of whom tested positive for antibody (including the original eight children in the cohort described above).

COVID-19パンデミック時の小児における高炎症性ショック (Lancet 2020.05.07)

英国ロンドンのSouth Thames Retrieval Serviceは、イングランド南東部の200万人の子どもたちに小児集中治療の支援と検索を提供している。我々は2020年4月中旬の10日間の間に、非定型川崎病、川崎病ショック症候群、またはトキシックショック症候群(典型的な数は週に1~2人の子ども)に類似した特徴を示す、高炎症性ショックを呈する8人の子どもたちの前例のないクラスターに気づいた。この症例群は全国的な注意喚起のもととなった。



気管支肺胞洗浄液または鼻咽頭吸引液の検査で、重症急性呼吸器症候群コロナウイルス2(SARS-CoV-2)はすべての小児で陰性であった。C 反応性蛋白、プロカルシトニン、フェリチン、トリグリセリド、D-ダイマーの濃度上昇を含む感染または炎症の臨床的証拠があり、重篤な状態であったにもかかわらず、7 人の子供のうち 7人には病理学的生物は確認されなかった。アデノウイルスとエンテロウイルスが1人の子供に分離された。





(Smart119 スタッフコメント)


要約は、deepl.com によって機械翻訳されたものを当社スタッフが修正・編集したものです。 要約、コメント、図画はできる限り正確なものにしようと努めていますが、内容の正確性・完全性・信頼性・最新性を保証するものではありません。
内容の引用を行う場合は、引用元が「Smart119 COVID-19 Archive 」であると明記ください。