Title Multisistemski inflamatorni sindrom u djece (MIS-C)
Author Petar Breglec
Mentor Kristina Lah Tomulić (mentor)
Committee member Srđan Banac (predsjednik povjerenstva)
Committee member Iva Bilić Čače (član povjerenstva)
Committee member Ana Milardović (član povjerenstva)
Granter University of Rijeka Faculty of Medicine (Department of Pediatrics) Rijeka
Defense date and country 2022, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Pediatrics
Abstract Multisistemski inflamatorni sindrom u djece (MIS-C) hiperupalni je poremećaj nastao kao posljedica zaraze teškim akutnim respiratornim sindromom koronavirusa-2 (SARS-CoV-2). Obično zahvaća pedijatrijsku populaciju s najvećom prevalencijom u djece između tri i 12 godina, a najčešći komorbiditeti su pretilost i astma. MIS-C se razvija četiri do šest tjedana nakon infekcije SARS-CoV-2 te se u većini slučajeva prisutnost SARS-CoV-2 ne može otkriti PCR metodom. Sindrom karakteriziraju vrućica, upala i multiorganska disfunkcija te brojne sličnosti s drugim upalnim i autoimunim stanjima. Najistaknutije manifestacije MIS-C-a su simptomi kardiovaskularnog sustava, a uključuju miokarditis i srčano zatajenje. Zbog visoke incidencije kardiovaskularnih komplikacija, ehokardiografija ima veliku vrijednost u dijagnostici i praćenju tijeka bolesti te procjeni ozbiljnosti kardiovaskularne zahvaćenosti. MIS-C karakterizira hiperinflamatorno stanje i nastup citokinske oluje, što se može dokazati laboratorijskim markerima upale. Povišene vrijednosti specifičnog srčanog markera troponina ukazuju na izravnu ozljedu stanica miokarda, a značajna povišenja BNP-a i srodnih peptida ukazaju na pogoršanje intersticijalnog edema miokarda i nastalu vaskulopatiju. Uobičajeni su i laboratorijski nalazi anemije, leukopenije, limfopenije, trombocitopenije i hipoalbuminemije. Teški slučajevi MIS-C-a dovode do razvoja vazodilatacijskog ili kardiogenog šoka koji zahtijeva urgentnu hospitalizaciju u jedinicu intenzivne skrbi. Intravenski imunoglobulin (IVIG), glukokortikoidi i biološki agensi predstavljaju glavne terapijske modalitete za liječenje MIS-C-a. Primjena IVIG-a i visokih doza kortikosteroida indicirana je kao prva linija terapije liječenja MIS-C-a. U drugu liniju terapije spadaju antiagregacijski lijekovi i biološki lijekovi kao što su anakinra, tocilizumab ili infiksimab, posebice u slučaju bolesti refraktorne na primjenu prve linije terapije.
Abstract (english) Multisystem Inflammatory Syndrome in Children (MIS-C) is a hyperinflammatory disorder resulting from infection with severe acute coronavirus-2 respiratory syndrome (SARS-CoV-2). It usually affects the pediatric population with the highest prevalence in children between the ages of three and 12, and the most common comorbidities are obesity and asthma. MIS-C develops four to six weeks after SARS-CoV-2 infection, and in most cases the presence of SARS-CoV-2 cannot be detected by PCR. The syndrome is characterized by fever, inflammation and multiorgan dysfunction and numerous similarities with other inflammatory and autoimmune conditions. The most prominent manifestations of MIS-C are symptoms of the cardiovascular system, and include myocarditis and heart failure. Due to the high incidence of cardiovascular complications, echocardiography is of great value in diagnosing and monitoring the course of the disease and assessing the severity of cardiovascular involvement. MIS-C is characterized by a hyperinflammatory condition and the onset of a cytokine storm, which can be demonstrated by laboratory markers of inflammation. Elevated values of the specific cardiac marker troponin indicate direct injury to myocardial cells, and significant increases in BNP and related peptides indicate exacerbation of interstitial myocardial edema and resulting vasculopathy. Laboratory findings of anemia, leukopenia, lymphopenia, thrombocytopenia and hypoalbuminemia are also common. Severe cases of MIS-C lead to the development of vasodilatory or cardiogenic shock requiring urgent hospitalization in the intensive care unit. Intravenous immunoglobulin (IVIG), glucocorticoids and biological agents are the main therapeutic modalities for the treatment of MIS-C. The use of IVIG and high doses of corticosteroids is indicated as first-line therapy for the treatment of MIS-C. The second line of therapy includes antiplatelet drugs and biologics such as anakinra, tocilizumab or infiximab, especially in the case of refractory diseases on the application of the first line of therapy.
Keywords
Multisistemski inflamatorni sindrom u djece (MIS-C)
Kawasakijeva bolest (KD)
koronavirusna bolest 2019 (COVID-19)
hiperinflamacija
SARS-CoV-2
Keywords (english)
Multisystem Inflammatory Syndrome in Children (MIS-C)
Kawasaki disease (KD)
coronavirus disease 2019 (COVID-19)
hyperinflammation
SARS-CoV-2
Language croatian
URN:NBN urn:nbn:hr:184:233441
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2022-06-28 11:09:40