Epidemiología, Manifestaciones Clínicas y Fisiopatología del Síndrome Inflamatorio Sistémico en la Infancia
Resumen
El síndrome multisistémico inflamatorio pediátrico se ha reconocido como una condición emergente, un nuevo espectro de enfermedad pediátrica asociada a la infección por SARS-CoV-2. Este síndrome fue identificado inicialmente en Europa y se denominó PIMS-TS (Pediatric Inflammatory Multisystem Syndrome – Temporally associated with SAR-CoV-2) posteriormente en los Estados Unidos de América, se designó como MIS-C (Multisystem Inflammatory Syndrome in Children), cuando en mayo de 2020 la OMS acuñó el término. La incidencia de MIS-C en pacientes menores de 21 años infectados con SARS-CoV-2 es de 5.1 por 1, 000,000 personasmes [IC 95% 4.5 a 5-8], y es mayor en los pacientes afroamericanos e hispanos o latinos con respecto a los caucásicos. En este artículo resumiremos los principales hallazgos en cuanto a la epidemiología, las manifestaciones clínicas, la fisiopatología y finalmente presentaremos información acerca de si MIS-C pertenece al espectro de la enfermedad de Kawasaki.
PALABRAS CLAVE: manifestaciones clínicas, fisiopatología, SARS-CoV-2, PIMS, MISC
Citas
Riphagen S, Gomez X, González-Martínez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607-8. DOI:10.1016/ S0140-6736(20)31094-1.
Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395:1771-78. DOI:10.1016/ S0140-6736(20)31103-X.
Pain C, Felsenstein S, Cleary G, Mayell S, Conrad K, Harave S, et al. Novel paediatric presentation of COVID-19 with ARDS and cytokine storm syndrome without respiratory symptoms. Lancet. 2020;2:e376-e379. DOI: 10.1016/ S2665-9913(20)30137-5.
White M, Tiesman B, Handforth J, Kenny J. Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): The Evelina Experience. Arch Dis Child. 2020;105:1025-27. DOI: 10.1136/archdischild-2020–319554.
Royal College of Paediatrics and Child Health. Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19. https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-.
World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Available from: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. 2020;(May).
Information for Healthcare Providers abput Multisystem Inflammatory Syndrome in Children (MIS-C). https://www.cdc.gov/mis-c/hcp/.
Riphagen S. Understanding Covid and the associated post-infectious hyper-inflammatory state (PIMS-TS) in children. Med Hypotheses. 2020;144:110029. DOI: 10.1016/j.mehy.2020.110029.
Lee PY, Day-Lewis M, Henderson LA, Friedman KG, Lo J, Roberts JE, et al. Distinct clinical and immunological features of SARS–CoV-2–induced multisystem inflammatory syndrome in children. J Clin Invest. 2020;130:5942-50. DOI: /10.1172/JCI141113.
Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020;DOI: 10.1056/NEJMoa2021756.
Lee EH, Kepler KL, Geevarughese A, Paneth-Pollak R, Dorsinville MS, Ngai S, et al. Race/Ethnicity Among Children With COVID-19–Associated Multisystem Inflammatory Syndrome. JAMA Netw O. 2020;3:e2030280. DOI: 10.1001/jamanetworkopen.2020.30280.
Godfred-Cato S, Bryant B, Leung J, Oster M, Conklin L, Abrams J. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1074-80. DOI: 10.15585/mmwr.mm6932e2.
Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical Characteristics of 58 Children with a Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2. JAMA. 2020;259-69. DOI: 10.1001/jama.2020.10369.
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. 2021;4:e2116420.
Antúnez-Montes OY, Escamilla MI, Figueroa-Uribe AF, Arteaga-Menchaca E, Lavariega-Saráchaga M, Salcedo-Lozada P, et al. COVID-19 and Multisystem Inflammatory Syndrome in Latin American Children. Pediatr Infect Dis J. 2021;40:e1-e6. DOI: 10.1097/INF.0000000000002949.
Swann O V, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: Prospective multicentre observational cohort study. BMJ. 2020;370:m3249. DOI:10.1136/bmj.m3249.
Torres JP, Izquierdo G, Acuña M, Pavez D, Reyes F. Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chie during the SARS-CoV-2 pandemic. Int J Infect Dis. 2020;100:75-81. DOI: 10.1016/j.ijid.2020.08.06.
Lima-Setta F, Magalhães-Barbosa MC de, Rodrigues-Santos G, Figueiredo EA das N, Jacques M de L, Zeitel R de S, et al. Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study. J Pediatr. 2020;DOI: 10.1016/j.jped.2020.10.008.
Aronoff SC, Hall A, Del Vecchio MT. The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2–Related Multisystem Inflammatory Syndrome in Children: A Systematic Review. J Pediatr Infect Dis Soc. 2020;DOI: 10.1093/jpids/piaa112/5905175.
Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev. 2020;DOI: 10.1016/j.prrv.2020.08.001.
Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26:100527. DOI: 10.1016/j.eclinm.2020.100527.
Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J. 2020;39:e340-e346. DOI: 10.1097/INF.0000000000002888.
Panigrahy N, Policarpio J, Ramanathan R. Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review. J Pediatr Rehabil Med. 2020;13:301-16. DOI: 10.3233/PRM-200794.
Miller J, Cantor A, Zachariah P, Ahn D, Martinez M, Margolis KG. Gastrointestinal Symptoms as a Major Presentation Component of a Novel Multisystem Inflammatory Syndrome in Children That Is Related to Coronavirus Disease 2019: A Single Center Experience of 44 Cases. Gastroenterology. 2020;159:1571-74. DOI: 10.1053/j.gastro.2020.05.079.
Stevens JP, Brownell JN, Freeman AJ, Bashaw H. COVID-19-associated Multisystem Inflammatory Syndrome in Children Presenting as Acute Pancreatitis. JPGN. 2020;71:669-671. DOI: 10.1097/MPG.0000000000002860.
Cantor A, Miller J, Zachariah P, DaSilva B, Margolis K, Martinez M. Acute Hepatitis Is a Prominent Presentation of the Multisystem Inflammatory Syndrome in Children: A Single-Center Report. Hepatology. 2020;72:1522-27. DOI: 10.1002/HEP.31526.
Dionne A, Mah DY, Son MBF, Lee PY, Henderson L, Baker AL, et al. Atrioventricular Block in Children with Multisystem Inflammatory Syndrome. Pediatrics. 2020;146:e2020009704. DOI: 10.1542/peds.2020-009704.
Clark BC, Sanchez-de-Toledo J, Bautista-Rodriguez C, Choueiter N, Lara D, Kang H, et al. Cardiac Abnormalities Seen in Pediatric Patients During the SARS-CoV2 Pandemic: An International Experience. J Am Hear Assoc. 2020;9:e018007. DOI: 10.1161/jaha.120.018007.
Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation. 2020;142:429-36. DOI: 10.1161/CIRCULATIONAHA.120.048360.
Minocha PK, Phoon CKL, Verma S, Singh RK. Cardiac Findings in Pediatric Patients With Multisystem Inflammatory Syndrome in Children Associated With COVID-19. Clin Pediatr. 2020;DOI: 10.1177/0009922820961771.
Alsaied T, Tremoulet AH, Burns JC, Saidi A, Dionne A, Lang SM, et al. Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children. Circulation. 2020;DOI: 10.1161/CIRCULATIONAHA.120.049836.
Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG, et al. 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. Pediatr Cardiol. 2020;41:1391-401. 10.1007/s00246-020-02391–2.
Sperotto F, Friedman KG, Son MBF, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 2020;DOI: 10.1007/s00431-020-03766-6.
Valverde I, Singh Y, Sanchez-de-Toledo J, Theocharis P, Chikermane A, Di Filippo S, et al. Acute Cardiovascular Manifestations in 286 Children with Multisystem Inflammatory Syndrome Associated with COVID-19 Infection in Europe. Circulation. 2020;DOI: 10.1161/CIRCULATIONAHA.120.050065.
Rodriguez-Gonzalez M, Castellano-Martinez A, Cascales-Poyatos HM, Perez-Reviriego AA. Cardiovascular impact of COVID-19 with a focus on children: A systematic review. World J Clin Cases. 2020;8:5250-83. DOI: 10.12998/wjcc.v8.i21.5250.
Regan W, O’Byrne L, Stewart K, Miller O, Pushparajah K. Electrocardiographic changes in children with multisystem inflammation associated with COVID-19. J Pediatr. 2020;DOI: 10.1016/j.jpeds.2020.12.033.
Caro-Patón G de L, de Azagra-Garde AM, García-Salido A, Cabrero-Hernández M, Tamariz A, Nieto-Moro M. Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature. J Intensive Care Med. 2020;DOI: 10.1177/0885066620969350.
Matsubara D, Kauffman H, Wang Y, Calderon-Anyosa R, Nadaraj S, Elias M, et al. Echocardiographic Findings in Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 in the United States. JACC. 2020;76:1947-61. DOI: /10.1016/j.jacc.2020.08.056.
Young TK, Shaw KS, Shah JK, Noor A, Alperin RA, Ratner AJ, et al. Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic. JAMA Dermatol. 2020;10016:e204779. DOI:10.1001/jamadermatol.2020.4779.
Lad SS, Kait SP, Suryawanshi PB, Mujawar J, Lad P, Khetre R, et al. Neurological Manifestations in Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS). Indian J Pediatr. 2020;DOI: 10.1007/s12098-020-03530-6.
De Paulis M, Oliveira DBL, Vieira RP, Pinto IC, MacHado RRG, Cavalcanti MP, et al. Multisystem inflammatory syndrome associated with covid-19 with neurologic manifestations in a child: A brief report. Pediatr Infect Dis J. 2020;39:e321-e324. DOI: 10.1097/INF.0000000000002834.
Verkuil LD, Liu GT, Brahma VL, Avery RA. Pseudotumor cerebri syndrome associated with MIS-C: a case report. Lancet. 2020;396:DOI: 10.1016/ S0140-6736(20)31725-6.
Feng Z, Bao Y, Yang Y, Zheng Y, Shen K. Severe Acute Respiratory Syndrome Coronavirus 2-Induced Multisystem Inflammatory Syndrome in Children. Pediatr Invest. 2020;4:257-62. DOI: DOI: 10.1002/ped4.12225.
Lee M, Hilado M, Sotelo S, Opas LM, Im DD. Acute Kidney Injury in Multisystem Inflammatory Syndrome in Children (MIS-C): a Case Report. SN Compr Clin Med. 2020;DOI: 10.1007/s42399-020-00647-9.
McCulloch M, Abugrain K, Mosalakatane T, Coetzee A, Webb K, Scott C. Peritoneal dialysis for treatment of acute kidney injury in a case of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. Perit Dial Int. 2020;40:515-517. DOI: 10.1177/0896860820953716.
Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1. Arthritis Rheumatol. 2020;72:1791–805.
Hennon T, Penque M, Abdul-Aziz R, Alibrahim O, McGreevy M, Prout A. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog Pediatr Cardiol. 2020;DOI: 10.1016/j.ppedcard.2020.101232.
Nijman RG, De Guchtenaere A, Koletzko B, Ross Russell R, Copley S, Titomanlio L, et al. Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics. Front Pediatr. 2020;8:DOI: 10.3389/fped.2020.00490.
Perez-Toledo M, Faustini S, Jossi S, Shields A, Kanthimathinathan HK, Allen J, et al. Serology confirms SARS-CoV-2 infection in PCR-negative children presenting with Paediatric Inflammatory Multi-System Syndrome. medRxiv [Preprint]. 2020;DOI: 10.1101/2020.06.05.20123117.
Henderson L, Canna S, Friedman K, Gorelik M, Lapidus S, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 and Hyperinflammation in COVID-19. Version 2. Arthritis Rheumatol. 2020;DOI: 10.1002/art.41616.
Abrams J, Godfred-Cato S, Oster M, Chow E, Koumans E, Bryant B, et al. Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. J Pediatr. 2020;226:45-54. DOI: 10.1016/j.jpeds.2020.08.003 45.
Blondiaux E, Parisot P, Redheuil A, Tzaroukian L, Levy Y, Sileo C. Cardiac MRI of Children with Multisystem Inflammatory Syndrome (MIS-C) Associated with COVID-19: Case Series. Radiology. 2020;297:E283-E288. DOI: 10.1148/radiol.2020202288.
Gkoutzourelas A, Bogdanos D, Sakkas L. Kawasaki Disease and COVID-19. Mediterr J Rheumatol. 2020;31:268-74. DOI: 10.31138/mjr.31.3.268.
Singh-Grewal D, Lucas R, Macartney K, Cheng A, Wood N, Ostring G. Update on the COVID‐19‐associated inflammatory syndrome in children and adolescents; paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2. J Pediatr Child Heal. 2020;56:1173-77. DOI: 10.1111/jpc.15049.
McCrindle B, Manlhiot C. SARS-CoV-2–Related InflammatoryMultisystem Syndrome in Children Different or Shared Etiology and Pathophysiology as Kawasaki Disease? JAMA. 2020;324:DOI: 10.1001/jama.2020.10370.
Lami F, Scalabrini I, Lucaccioni L, Iughetti L. The “perfect” storm: Current evidence on pediatric inflammatory multisystem disease during sars-cov-2 pandemic. Acta Biomed. 2020;91:e2020034. DOI: 10.23750/abm.v91i3.10360.
Loke Y, Berul C, Harahsheh A. Multisystem inflammatory syndrome in children: Is there a linkage to Kawasaki disease? Trends Cardiovasc Med. 2020;30:389-96. DOI: 10.1016/j.tcm.2020.07.004.
Soma V, Shust G, Ratner A. Multisystem Inflammatory Syndrome in Children. Curr Opin Pediatr. 2021;32:DOI:10.1097/MOP.0000000000000974.
Santos BS Dos, Santos FS Dos, Ribeiro ER. Clinical-Epidemiological Relation Between Sars-Cov-2 and Kawasaki Disease: an Integrative Literature. Rev Paul Pediatr. 2021;39:e2020217. DOI: 10.1590/1984-0462/2021/39/2020217.
Berardicurti O, Conforti A, Ruscitti P, Cipriani P, Giacomelli R. The wide spectrum of Kawasaki-like disease associated with SARS-CoV-2 infection. Expert Rev Clin Immunol. 2020;DOI: 10.1080/1744666X.2021.1847643.
Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): A multicentre cohort. Ann Rheum Dis. 2020;79:999-1006. DOI: 10. 1136/ annrheumdis-2020–218110.
Sethuraman U, Kannikeswaran N, Ang J, Singer A. Multisystem inflammatory syndrome in children associated with novel coronavirus SARS-CoV-2: Presentations to a pediatric emergency department in Michigan. Am J Emerg Med. 2021;39:164-7. DOI: 10.1016/j.ajem.2020.10.035.
Saez-de-Ocariz M, Gámez-González L, Rivas-Larrauri F. Kawasaki disease mimickers. Pediatr Int. 2021;DOI: 10.1111/ped.14561.
Tam H, El Tal T, Go E, Yeung RSM. Pediatric inflammatory multisystem syndrome temporally associated with COVID-19: A spectrum of diseases with many names. CMAJ. 2020;192:E1093-E1096. DOI: 10.1503/cmaj.201600.
Corwin DJ, Sartori LF, Chiotos K, Odom John AR, Cohn K, Bassiri H, et al. Distinguishing multisystem inflammatory syndrome in children from kawasaki disease and benign inflammatory illnesses in the SARS-CoV-2 pandemic. Pediatr Emer Care. 2020;36:554-58. DOI: 10.1097/PEC.0000000000002248.
Koné-Paut I, Cimaz R. Is it Kawasaki shock syndrome, Kawasaki-like disease or pediatric inflammatory multisystem disease? The importance of semantic in the era of COVID-19 pandemic. RMD Open. 2020;6::e001333.DOI:10.1136/rmdopen-2020-001333.
Schroeder AR, Wilson KM, Ralston SL. COVID-19 and Kawasaki Disease: Finding the Signal in the Noise. Hosp Pediatr. 2020;DOI: 10.1542/hpeds.2020-000356.
Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int. 2020;DOI: 10.1007/s00296-020-04749-4.
Kleinmann JF, Tubach F, Le Guern V, Mathian A, Richez C, Saadoun D, et al. International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus. Autoimmun Rev. 2017;16:650–7.
Ebina-shibuya R, Namkoong H, Shibuya Y, Horita N. Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Insights from simultaneous familial Kawasaki Disease cases. Int J Infect Dis. 2020;97:371-73. DOI: 10.1016/j.ijid.2020.06.014.
Tsabouri S, Makis A, Kosmeri C, Siomou E. Risk Factors for Severity in Children with Coronavirus Disease 2019 A Comprehensive Literature Review. Pediatr Clin N Am. 2021;68:321-38. DOI:10.1016/j.pcl.2020.07.014.
Pereira M, Litvinov N, Farhat S, Eisencraft A, Gibelli M, Carvalho W. Severe clinical spectrum with high mortality in pediatric patients with covid-19 and multisystem inflammatory syndrome. Clinics. 2020;75:e2209. DOI: 10.6061/clinics/2020/e2209.
Fernandes D, Oliviera C, Guerguis S, Eisenberg R, Choi J, Kim M. Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth. J Pediatr. 2020;DOI. 10.1016/j.jpeds.2020.11.016.
Rothan HA, Byrareddy SN. The potential threat of multisystem inflammatory syndrome in children during the COVID-19 pandemic. Pediatr Allergy Immunol. 2020;1-6. DOI: 10.1111/pai.13361.
Felsenstein S, Hedrich C. SARS-CoV-2 infections in children and young people. Clin Immunol. 2020;220:DOI: 10.1016/j.clim.2020.108588.
Galipeau Y, Greig M, Liu G, Driedger M, Langlois M-A. Humoral Responses and Serological Assays in SARS-CoV-2 Infections. Front Immunol. 2020;11:610688. DOI: 10.3389/fimmu.2020.610688.
Saratannon N, Dik W, Chatchatee P, van Hagen P. COVID-19 in children: Heterogeneity within the disease and hypothetical pathogenesis. Asian Pac J Allergy Immunol. 2020;38:170-77. DOI: 10.12932/AP-170720–920.
Taefehshokr N, Taefehshokr S, Heit B. Mechanisms of dysregulated humoral and cellular immunity by SARS-CoV-2. Pathogens. 2020;9:1027. DOI: 10.3390/pathogens9121027.
Wan Y, Shang J, Sun S, Tai W, Chen J, Geng Q, et al. Molecular Mechanism for Antibody-Dependent Enhancement of Coronavirus Entry. J Virol. 2020;94:e02015-19. DOI:10.1128/JVI.02015-19.
Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol. 2020;20:355-62. DOI: 10.1038/s41577-020-0331-4.
Feng Z, Diao B, Wang R, Wang G, Wang C, Tan Y, et al. The Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Directly Decimates Human Spleens and Lymph Nodes. medRxiv [Preprint]. 2020;DOI: 10.1101/2020.03.27.20045427.
Gruber C, Patel R, Trachman R, Lepow L, Amanat F, Krammer F. Mapping Systemic Inflammation and Antibody Responses in Multisystem Inflammatory Syndrome in Children (MIS-C). medRxiv [Preprint]. 2020;DOI: 10.1101/2020.07.04.20142752.
Rowley A. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol. 2020;20:453-54. DOI: 10.1038/s41577-020-0367–5.
Moreews M, Le Gouge K, Khaldi-Plassart S, Pescarmona R, Mathieu A, Malcus C. Polyclonal expansion of TCR Vbeta 21.3+ CD4+ and CD8+ T cells is a hallmark of Multisystem Inf lammatory Syndrome in Children.pdf. Sci Immunol. 2021;DOI: 10.1126/sciimmunol.abh.
Roe K. A viral infection explanation for Kawasaki disease in general and for COVID related Kawasaki disease symptoms. Inflammopharmacology. 2020;DOI: 10.1007/s10787-020-00739-x.
Consiglio C, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, et al. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell. 2020;183:968-81. DOI: 10.1016/j.cell.2020.09.016.
Icenogle T. COVID-19: Infection or Autoinmmunity. Front Immunol. 2020;11:DOI: 10.3389/fimmu.2020.02055.
Beckmann N, Comella P, Cheng E, Lepow L, Beckmann A, Mouskas K, et al. Cytotoxic lymphocytes are dysregulated in multisystem inflammatory syndrome in children. medRxiv [Preprint]. 2020;DOI: 10.1101/2020.08.29.20182899.
Cheng M, Zhang S, Porrit R, Arditi M, Bahar I. An insertion unique to SARS-CoV-2 exhibits superantigenic character strengthened by recent mutations. bioRxiv [preprint]. 2020;DOI: 10.1101/2020-05.21.109272.
Cheng M, Zhang S, Porritt R, Rivas M, Paschold L, Willscher E, et al. Superantigenic character of an insert unique to SARS-CoV-2 spike supported by skewed TCR repertoire in patients wirh hyperinflammation. PNAS. 2020;117:DOI: 10.1073/pnas.2010722117.
Rowley A, Shulman S, Arditi M. Immune pathogenesis of COVID-19–related multisystem inflammatory syndrome in children. J Clin Invest. 2020;130:5619-21. DOI: 10.1172/JCI143840.
Weisberg SP, Connors T, Zhu Y, Baldwin M, Lin W-H, Wontakal S, et al. Antibody responses to SARS-CoV2 are distinct in children with MIS-C compared to adults with COVID-19. medRxiv. 2020;DOI: 10.1101/2020.07.12.20151068.
