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Diorio, Caroline; Henrickson, Sarah E; Vella, Laura A; McNerney, Kevin O; Chase, Julie; Burudpakdee, Chakkapong; Lee, Jessica H; Jasen, Cristina; Balamuth, Fran; Barrett, David M; Banwell, Brenda L; Bernt, Kathrin M; Blatz, Allison M; Chiotos, Kathleen; Fisher, Brian T; Fitzgerald, Julie C; Gerber, Jeffrey S; Gollomp, Kandace; Gray, Christopher; Grupp, Stephan A; Harris, Rebecca M; Kilbaugh, Todd J; John, Audrey R Odom; Lambert, Michele; Liebling, Emily J; Paessler, Michele E; Petrosa, Whitney; Phillips, Charles; Reilly, Anne F; Romberg, Neil D; Seif, Alix; Sesok-Pizzini, Deborah A; Sullivan, Kathleen E; Vardaro, Julie; Behrens, Edward M; Teachey, David T; Bassiri, Hamid
The Journal of clinical investigation, 11/2020, Volume: 130, Issue: 11Journal Article
BACKGROUND. Initial reports from the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease 2019 (COVID-19) than adults. Subsequently, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. We report on unique hematologic and immunologic parameters that distinguish between COVID-19 and MIS-C and provide insight into pathophysiology. METHODS. We prospectively enrolled hospitalized patients with evidence of SARS-CoV-2 infection and classified them as having MIS-C or COVID-19. Patients with COVID-19 were classified as having either minimal or severe disease. Cytokine profiles, viral cycle thresholds (Cts), blood smears, and soluble C5b-9 values were analyzed with clinical data. RESULTS. Twenty patients were enrolled (9 severe COVID-19, 5 minimal COVID-19, and 6 MIS-C). Five cytokines (IFN-y, IL-10, IL-6, IL-8, and TNF-a) contributed to the analysis. TNF-a and IL-10 discriminated between patients with MIS-C and severe COVID-19. The presence of burr cells on blood smears, as well as Cts, differentiated between patients with severe COVID-19 and those with MIS-C. CONCLUSION. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe COVID-19 and MIS-C. Cytokine profiling and examination of peripheral blood smears may distinguish between patients with MIS-C and those with severe COVID-19. FUNDING. Financial support for this project was provided by CHOP Frontiers Program Immune Dysregulation Team; National Institute of Allergy and Infectious Diseases; National Cancer Institute; the Leukemia and Lymphoma Society; Cookies for Kids Cancer; Alex's Lemonade Stand Foundation for Childhood Cancer; Children's Oncology Group; Stand UP 2 Cancer; Team Connor; the Kate Amato Foundations; Burroughs Wellcome Fund CAMS; the Clinical Immunology Society; the American Academy of Allergy, Asthma, and Immunology; and the Institute for Translational Medicine and Therapeutics.
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