Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Managem
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ORIGINAL ARTICLE
Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS‑CoV‑2 (PIMS‑TS): Cardiac Features, Management and Short‑Term Outcomes at a UK Tertiary Paediatric Hospital Tristan Ramcharan1 · Oscar Nolan1 · Chui Yi Lai1 · Nanda Prabhu1 · Raghu Krishnamurthy2 · Alex G. Richter3 · Deepthi Jyothish4 · Hari Krishnan Kanthimathinathan5,6 · Steven B. Welch7 · Scott Hackett7 · Eslam Al‑Abadi6,8 · Barnaby R. Scholefield5,9 · Ashish Chikermane1 Received: 28 May 2020 / Accepted: 5 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome—“Paediatric Inflammatory Multisystem Syndrometemporally associated with SARS-CoV-2” (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children’s hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4–11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes. Keywords Hyper-inflammatory · Kawasaki · PIMS-TS · MIS-C · COVID-19 · SARS-CoV-2
Introduction The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease (COVID-19), has rapidly spread worldwide. As of 28th May 2020, there have been an estimated 269,127 confirmed cases reported in the UK with over 37,837 deaths [1]. London and the West Midlands have been the epicenters in the UK.
Barnaby R. Scholefield and Ashish Chikermane Joint senior authors. * Ashish Chikermane [email protected] Extended author information available on the last page of the article
To date, there have been very few cases of children being seriously affe
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