Síndrome inflamatória multissistêmica (SIMS) pós-COVID-19

Um conceito em evolução

Autores

DOI:

https://doi.org/10.15448/1980-6108.2022.1.42436

Palavras-chave:

síndrome inflamatória multissistêmica, doença de Kawasaki, SARS-CoV-2, COVID-19

Resumo

INTRODUÇÃO: A potencial associação da COVID-19 com fenômenos inflamatórios e autoimunes abre um novo capítulo na prática clínica. Entre várias condições inflamatórias descritas no pós-COVID-19, destacam-se a doença de Kawasaki e uma nova afecção denominada síndrome inflamatória multissistêmica.
OBJETIVOS: Revisar, de forma prática e concisa, conceito e critérios diagnósticos da síndrome inflamatória multisistêmica, as sobreposições com a doença de Kawasaki, assim como a imunopatogênese e o tratamento desta nova e intrigante enfermidade.
MÉTODOS: Revisão da literatura disponível na base de dados Pubmed, com ênfase em revisões sistemáticas com metaanálises.
RESULTADOS: A síndrome inflamatória multisistêmica se configura como uma condição hiperinflamatória multiorgânica pós-viral. A condição é primordialmente pediátrica, e os primeiros casos foram descritos na Inglaterra em maio de 2020. Os critérios diagnósticos são ainda imprecisos, e incluem algumas manifestações doença de Kawasaki-símiles. A síndrome inflamatória multisistêmica difere da doença de Kawasaki, entretanto, por geralmente acometer crianças acima cinco anos e de raças negras ou hispânicas; em termos clínicos, se distingue pela alta frequência de gastroenteropatia, miocardiopatia e choque. O diagnóstico diferencial inclui sepse bacteriana, síndrome de ativação macrofágica e formas sistêmicas de artrite reumatoide. Uma hiperexpressão de interferons e de outras citocinas inflamatórias caracteriza patogenicamente a síndrome inflamatória mulsistêmica. A enfermidade é, via de regra, responsiva a cuidados de terapia intensiva, corticóides, imunoglobulina intravenosa e imunobiológicos.
CONCLUSÕES: A síndrome inflamatória multisistêmica é uma nova e complexa afecção hiperinflamatória associada à exposição prévia ao SARS-CoV-2. Apresenta instigantes interfaces com a doença de Kawasaki. Apesar da descrição recente, a literatura já é quantitativamente robusta, e algumas pendências de imunopatogênese, critérios diagnósticos e terapêutica deverão ser esclarecidas em breve.

Downloads

Não há dados estatísticos.

Biografia do Autor

Henrique Luiz Staub, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, RS, Brasil.

Médico Reumatologista, Doutor em Clínica Médica/Reumatologia, Professor Adjunto de Reumatologia e Imunologia Clínica da Escola de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brasil.

Lia Portella Staub, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, RS, Brasil.

Estudante de Medicina, Escola de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brasil.

Referências

Rodrígues Y, Novelli L, Rojas M, De Santis M, Acosta-Ampudia Y, Monsalve DM, et al. Autoinflammatory and autoimmune conditions at the crossroad of COVID-19. J Autoimmun. 2020;114:102506. https://doi.org/10.1016/j.jaut.2020.102506

Dotan A, Muller S, Kanduc D, David P, Halpert G, Shoenfeld Y. The SARS-CoV-2 as an instrumental trigger of autoimmunity. Autoimmun Rev. 2021;20(4):102792. https://doi.org/10.1016/j.autrev.2021.102792

Panaro S, Marco Cattalini M. The spectrum of manifestations of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) Infection in Children: What we can learn from multisystem inflammatory syndrome in children (MIS-C) Front Med (Lausanne). 2021;8:747190. https://doi.org/10.3389/fmed.2021.747190

Radia T, Williams N, Agrawal P , Harman K, Weale J, Cook J, et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): a systematic review of clinical features and presentation. Paediatr Respir Rev. 2021;38:51-7. https://doi.org/10.1016/j.prrv.2020.08.001

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(11):1791-805. https://doi.org/10.1002/art.41454

Middelburg JG, Crijnen TEM, D’Antiga L, Verdoni L, Chikermane A, Garg P, et al. Association of Ethnicity With Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2 Infection: An International Case-Referent Study. Front Pediatr. 2021;9:707650. https://doi.org/10.3389/fped.2021.707650

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 395(10237):1607-8. https://doi.org/10.1016/S0140-6736(20)31094-1

Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L, Balan S, et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep. 2020;69(40):1450-6. https://doi.org/10.15585/mmwr.mm6940e1

Esposito S, Principi N. Multisystem inflammatory syndrome in children related to SARS-CoV-2. Paediatr Drugs. 2021;23(2):119-29. https://doi.org/10.1007/s40272-020-00435-x

World Health Organization (WHO). Multisystem inflammatory syndrome in children and adolescents with COVID-19. Scientific brief. May 2020 [Citado 2021 dez 12]. Disponível em: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

Royal College of Paediatrics and Child Health (RCPCH). Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS). May 2020 [Citado 2022 jan 07]. Disponível em: https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf

Centers for Disease Control and Prevention (CDC). Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). 14 May 2020 [Citado 2022 jan 07]. Disponível em: https://emergency.cdc.gov/han/2020/han00432.asp

Godfred-Cato S, Bryant B, Leung J, Conklin L, Abrams J, Roguski K, et al. COVID-19-associated multisystem inflammatory syndrome in children - United States, March-July 2020. MMWR. Morbidity and Mortality Weekly Report. 2020;69(32):1074-80. http://dx.doi.org/10.15585/mmwr.mm6932e2

Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Peditr Int. 2005;47(2):232-4. https://doi.org/10.1111/j.1442-200x.2005.02033.x

Hoste L, Van Paemel R, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19: a systematic review. Eur J Pediatr. 2021;180(7):2019-34. https://doi.org/10.1007/s00431-021-03993-5

Yasuhara J, Watanabe K, Takagi H, Sumitomo N, Kuno T. COVID-19 and multisystem inflammatory syndrome in children: A systematic review and meta-analysis. Pediatr Pulmonol. 2021;56(5):837-48. https://doi.org/10.1002/ppul.25245

Zou H, Lu J, Liu J, Wong JH, Cheng S, Li Q, et al. Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: a meta-analysis and insights into pathogenesis. Int J Infect Dis. 2021;102:319-26. https://doi.org/10.1016/j.ijid.2020.11.145

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;324(3):259-69.

https://doi.org/10.1001/jama.2020.10369

Nepal G, Shrestha GS, Rehrig JH, Gajurel BP, Ojha R, Agrawal A, et al. Neurological manifestations of COVID-19 associated multi-system inflammatory syndrome in children: a systematic review and meta-analysis. J Nepal Health Res Counc. 2021;19(1):10-8. https://doi.org/10.33314/jnhrc.v19i1.3410

Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16(3):178-222.

Modesti AM, Plewa MC. Kawasaki Disease. [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; [Citado 2022 jan 07]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK537163/

Kam KQ, Ong JS, Lee JH. Kawasaki disease in the COVID-19 era: a distinct clinical phenotype? Lancet Child Adolesc Health. 2020;4(9):642-3. https://doi.org/10.1016/S2352-4642(20)30207-8

American Heart Association. Kawasaki Disease. Last reviewed May 2017. [Citado 2022 jan 07]. Disponível em:

https://www.heart.org/en/health-topics/kawasaki-disease

Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2006;65(7):936-41. https://doi.org/10.1136/ard.2005.046300

Castro PA, Urbano LM, Costa IM. Kawasaki disease. An Bras Dermatol 2009;84(4):317-29. https://doi.org/10.1590/s0365-05962009000400002

Cattalini M, Paolera SD, Zunica F, Bracaglia C, Giangreco M, Verdoni L, et al. Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey. Pediatr Rheumatol Online J. 2021;19:29. https://doi.org/10.1186/s12969-021-00511-7

Zhang QY, Xu BW, Du JB. Similarities and differences between multiple inflammatory syndrome in children associated with COVID-19 and Kawasaki disease: clinical presentations, diagnosis, and treatment. World J Pediatr. 2021;17(4):335-40. https://doi.org/10.1007/s12519-021-00435-y

Cherqaoui B, Koné-Paut I, Yager H, Le Bourgeois F, Piram M. Delineating phenotypes of Kawasaki disease and SARS-CoV-2-related inflammatory multisystem syndrome: a French study and literature review. Rheumatology (Oxford). 2021;60(10):4530-7. https://doi.org/10.1093/rheumatology/keab026

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(7):1391-401. https://doi.org/10.1007/s00246-020-02391-2

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. 2020:16(12):1205-15. https://doi.org/10.1080/1744666X.2021.1847643

Tanner T, Wahezi DM. Hyperinflammation and the utility of immunomodulatory medications in children with COVID-19. Paediatr Respir Rev. 2020; 35:81-7. https://doi.org/10.1016/j.prrv.2020.07.003

European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children. 15 May 2020 [Citado 2022 jan 07]. Disponível em: https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf

Sardu C, Gambardella J, Morelli MB, Wang X, Marfella R, Santulli G, et al. Hypertension, thrombosis, kidney failure, and diabetes: is COVID-19 an endothelial disease? A comprehensive evaluation of clinical and basic evidence. J Clin Med. 2020:9(5):1417. https://doi.org/10.3390/jcm9051417

Sperotto F, Friedman KG, Son MB, VanderPluym C, 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;180(2):307-22. https://doi.org/10.1007/s00431-020-03766-6

Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children 2020;7(7):69. https://doi.org/10.3390/children7070069

Junior HS, Sakano TM, Rodrigues RM, Eisencraft AP, Lemos de Carvalho PE, Schvarstsman C, et al. Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician’s point of view. J Pediatr (Rio J). 2020; 97(2):140-59. https://doi.org/10.1016/j.jped.2020.08.004

Esteve-Sole A, Anton J, Pino-Ramirez RM, Sanchez-Manubens J, Fumadó V, Fortuny C, et al. Similarities and differences between the immunopathogenesis of COVID-19-related pediatric multisystem inflammatory syndrome and Kawasaki disease. J Clin Invest. 2021;131(6):e144554. https://doi.org/10.1172/JCI144554

Sharma C, Ganigara M, Galeotti C, Burns J, Berganza MF, Hayes DA, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol 2021;17(12):731-48. https://doi.org/10.1038/s41584-021-00709-9

Dhar D, Dey T, Samim MM, Padmanabha G, Chatterjee A, Naznin P, et al. Systemic inflammatory syndrome in COVID-19-SISCoV study: systematic review and meta-analysis. Pediatr Res. 2021;18;1-16. https://doi.org/10.1038/s41390-021-01545-z

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):276-88. https://doi.org/10.1016/S1473-3099(20)30651-4

Graciano-Machuca O, Villegas-Rivera G, López-Pérez I, Macías-Barragán J, Sifuentes-Franco S. Multisystem Inflammatory Syndrome in Children (MIS-C) following SARS-CoV-2 infection: role of oxidative stress.Front Immunol. 2021;12:723654. https://doi.org/10.3389/fimmu.2021.723654

Galeotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020;16(18):413-4. https://doi.org/10.1038/s41584-020-0448-7

Chen MR, Kuo HC, Lee YJ, Chi H, Li SC, Lee HC, et al. Phenotype, susceptibility, autoimmunity, and immunotherapy between Kawasaki disease and Coronavirus Disease-19 associated multisystem inflammatory syndrome in children. Front Immunol. 2021;12:632890. https://doi.org/10.3389/fimmu.2021.632890

Kabeerdoss J, Pilania RK, Karkhele R, Kumar S, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int. 2021;41(1):19-32. https://doi.org/10.1007/s00296-020-04749-4

Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis Arch Dis Child. 2021;106(5):440-8. https://doi.org/10.1136/archdischild-2020-321385

Wang JG, Zhong ZJ, Li M, Fu J, Su YH, Ping YM, et al. Coronavirus Disease 2019-related multisystem inflammatory syndrome in children: a systematic review and meta-analysis. Biochem Res Int. 2021:5596727. https://doi.org/10.1155/2021/5596727

Dhar D, Treshita D, Samin MM, Hansashree Padmanabha, Chatterjee A, Naznin P, et al. Systemic inflammatory syndrome in COVID-19-SISCoV study: systematic review and meta-analysis. Pediatr Res. 2021;18;1-16. https://doi.org/10.1038/s41390-021-01545-z

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; 383(4):347-58. https://doi.org/10.1056/NEJMoa2021756

Jonat B, Gorelik M, Boneparth A, Geneslaw AS, Zachariah P, Shah A, et al. Multisystem inflammatory syndrome in children associated with Coronavirus disease 2019 in a Children’s Hospital in New York City: patient characteristics and an institutional protocol for evaluation, management, and follow-up. Pediatr Crit Care Med. 2021; 22(3):178-91. https://doi.org/10.1097/PCC.0000000000002598

Garcia-Salido A, de Carlos Vicente JC, Hofheinz SB, Ramirez JB, Barrio MS, Gordillo IL, et al. Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain. Crit Care. 2020;24(1):666. https://doi.org/10.1186/s13054-020-03332-4

Sood M, Sharma S, Sood I, Sharma K, Kaushik A. Emerging evidence on multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection: a systematic review with meta-analysis. SN Compr Clin Med. 2021;7:1-10. https://doi.org/10.1007/s42399-020-00690-6

Toraih EA, Hussein MH, Elshazli RM, Kline A, Munshi R, Sultana N, et al. Multisystem inflammatory syndrome in pediatric COVID-19 patients: a meta-analysis.World J Pediatr. 2021;17(2):141-51. https://doi.org/10.1007/s12519-021-00419-y

Tang Y, Weiguo L, Baskota M, Zhou Q, Fu Z, Luo Z, et al. Multisystem inflammatory syndrome in children during the coronavirus disease 2019 (COVID-19) pandemic: a systematic review of published case studies. Transl Pediatr. 2021;10(1):121-35. https://doi.org/10.21037/tp-20-188

Suksatan W, Chupradit S, Yumashev AV, Ravali S, Shalaby MN, Mustafa YF, et al. Immunotherapy of multisystem inflammatory syndrome in children (MIS-C) following COVID-19 through mesenchymal stem cells. Int Immunopharmacol. 2021;101(Pt B):108217. https://doi.org/10.1016/j.intimp.2021.108217

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(11):1791-805. https://doi.org/10.1002/art.41454

Downloads

Publicado

2022-01-25

Como Citar

Staub, H. L., & Staub, L. P. (2022). Síndrome inflamatória multissistêmica (SIMS) pós-COVID-19: Um conceito em evolução. Scientia Medica, 32(1), e42436. https://doi.org/10.15448/1980-6108.2022.1.42436

Edição

Seção

Artigos de Revisão

Artigos mais lidos pelo mesmo(s) autor(es)