Distinct Cytokine and Chemokine Dysregulation in Hospitalized Children with Acute COVID-19 and Multisystem Inflammatory Syndrome with Similar Levels of Nasopharyngeal SARS-CoV-2 Shedding

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Title

Distinct Cytokine and Chemokine Dysregulation in Hospitalized Children with Acute COVID-19 and Multisystem Inflammatory Syndrome with Similar Levels of Nasopharyngeal SARS-CoV-2 Shedding

Subject

Description

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe clinical phenotype of SARS-CoV-2 infection that remains poorly understood.

Date Last Updated (Year-Month-Day)

2021-05-24

Citation

Peart Akindele, Nadine, Theodore Kouo, Andrew H. Karaba, Oren Gordon, Katherine Z. J. Fenstermacher, Jeanette Beaudry, Jessica H. Rubens, Christine C. Atik, Weiqiang Zhou, Hongkai Ji, Xueting Tao, Dhananjay Vaidya, Heba Mostafa, Patrizio Caturegli, Paul W. Blair, Lauren Sauer, Andrea L. Cox, and Deborah Persaud. 2021. "Distinct Cytokine and Chemokine Dysregulation in Hospitalized Children with Acute COVID-19 and Multisystem Inflammatory Syndrome with Similar Levels of Nasopharyngeal SARS-CoV-2 Shedding." The Journal of infectious diseases.

Abstract

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe clinical phenotype of SARS-CoV-2 infection that remains poorly understood.

Methods: Hospitalized children <18 years of age with suspected COVID-19 (N=53) were recruited into a prospective cohort study; 32 had confirmed COVID-19, with 16 meeting the U.S. Centers for Disease Control criteria for MIS-C. Differences in nasopharyngeal viral RNA levels, SARS-CoV-2 seropositivity, and cytokine/chemokine profiles were examined, including after adjustments for age and sex.

Results: The median ages for those with and without MIS-C were 8.7 years (IQR 5.5-13.9) and 2.2 years (IQR 1.1-10.5), respectively, (p=0.18) and nasopharyngeal levels of SARS-CoV-2 RNA did not differ significantly between the two groups (median 63,848.25 copies/mL versus 307.1 copies/mL, p= 0.66); 75% of those with MIS-C were antibody positive compared to 44% without, p=0.026. Levels of 14 of 37 cytokines/chemokines (IL-1RA, IL-2RA, IL-6, IL-8, TNF-α, IL-10, IL-15, IL-18, MCP-1, IP-10, MIP-1α, MCP-2, MIP-1β, Eotaxin) were significantly higher in children with MIS-C compared to those without, irrespective of age or sex (FDR<0.05; p<0.05).

Conclusions: The distinct pattern of heightened cytokine/chemokine dysregulation observed with MIS-C, compared with acute COVID-19, occurs across the pediatric age spectrum and with similar levels of nasopharyngeal SARS-CoV-2 RNA.

Keywords: COVID-19; Coronavirus; MIS-A; MIS-C; SARS-CoV-2; viral RNA.

Accessibility

Free online on Oxford Academic, © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.