Pediatric Intensive Care Specialist Dr. centers of Turkey’s largest pandemic Fatih existing, mutation of England also increased in Turkey, particularly pointing to spread faster among children and teenagers “did not even know Kovid spent most of our cases. “We confirmed the diagnosis with contact history or antibody tests,” he said.
Since the early days of the epidemic, Turkey’s largest pandemic Sancaktepe being treated tens of thousands Kovid case as the central Training and Research Hospital, Feriha Self Emergency Hospital and Cekmekoy State Hospital experts in children, occurring after Kovid “mysterious syndrome” was an important warning about the Own-C. Sancaktepe Martyr Prof. Dr. İlhan Varank Training and Research Hospital Pediatric Emergency and Child Health Diseases Clinic Chief Prof. Dr. Şirin Güven and Pediatric Intensive Care Specialist Dr. Fatih Varol said that they had been following up to 20 Mis-C cases in their centers since September, and that 15 of them were treated in intensive care, and four of them were severe enough to enter the life support unit ECMO. Experts underlined that PCR tests are negative in children followed up with Mis-C, and that they are usually diagnosed with antibody testing and treatment is initiated.
“SEEN IN A MONTHLY BABY”
Prof. Dr. Şirin Güven pointed out that when Mis-C cases resembling Kawasaki were published in the first wave of the pandemic, they encountered one or two cases in their own clinics in July-June, and pointed out that the real climb was in the second wave, since September. Prof. Dr. Güven provided the following information: “We have hospitalized 20 Mis-C cases in the pediatric clinic and pediatric intensive care in about 4 months until today. Our youngest patient was 1-1.5 months old. Our oldest child was 17 years old. PCR tests were negative in most of our cases. These patients had Covid asymptomatically, most of them did not even know that they had Covid. Some had contact history, some did not, but the vast majority of them had antibody testing showing that they had a Covid-19. When Mis-C suspect cases come to us, we do other tests to rule out other viral causes (flu, etc.). But if none is positive, we provide confirmation for Mis-C with an antibody test. We could not even detect antibodies in our 1-2 cases, but we made a diagnosis of Mis-C by evaluating the patients’ close contact history, as well as laboratory and clinical findings in accordance with the guidelines published by the Ministry of Health, WHO and specialty associations in England and America. “
“LONG-TERM FOLLOW-UP IS NECESSARY EVEN IT GETS”
Mentioning that Mis-C cases are actually very critical, Prof. Dr. Güven ended her words as follows: “In many of our patients, we had to go as far as hemoperfusion (removal of tocins in the blood), even ECMO, despite plasma exchange, intravenous (intravenous) immunoglobulin or steroid (cortisone) treatment. ECMO, known as a life support unit, is a very difficult application. The rate of loss of these children in ECMO in the world is around 25 percent. As the center, we were very successful in this regard, we lost only one child; We discharged 75 percent. However, these patients need to be followed for a long time after discharge. Because Mis-C is an inflammatory disease that affects many systems and what kind of damage it will cause in which organ, long-term studies will show this. We collect the data of our own Own-C case with other cases in Turkey. These results and long-term results will emerge very soon. We invited our patients, whom we treated in our own unit, for a long-term follow-up at regular intervals, depending on their monthly conditions or the day we were discharged.
“EVEN VERY LIGHT CASES CAN EXPECT”
Pediatric Intensive Care Specialist Dr. Fatih Varol, on the other hand, pointed out that there was an increase in the cases of Mis-C especially in the second wave, “We followed up nearly 20 children with Mis-C and 15 of them were put into pediatric intensive care. Although there are very mild cases, we have also had very severe cases. Since our severe patients have mild onset, Mis-C cases should be monitored in intensive care in general. Because even very mild cases can get worse, “he said. Underlining that they do not diagnose Mis-C with the same symptoms in every patient, Dr. Varol said, “It is necessary to have contact history, antibody test positivity, previous Kovid or Kovid PCR positivity. A disease with an excessive response of the immune system, this is an exaggerated immune response that usually occurs some time after Covid infection. Therefore, we can clarify the diagnosis in this way, ”he said.
“PATIENTS GOING TO THE LIFE SUPPORT UNIT ECMO ALSO APPEARED”
Stating that they use various medical and interventional treatments, especially in patients with severe disease with two or more organ involvement, Dr. Varol gave the following information: “As medical treatment, we mostly prefer immunoglobulin and steroid (cortisone) treatment from the vascular access. In cases unresponsive to these, we perform the procedure that we call hemofiltration, which can be defined as a cytokine-holding filter (because there is a storm of stock in the immune system in this disease). We apply a treatment to remove antibodies and cytokines in plasma by plasma exchange. Despite these, we also had patients who entered ECMO. These patients are hospitalized with a serious need for heart and circulatory system supportive drugs. There are serious organ deficiencies. We noticed that this picture improved very quickly under hemoperfusion. “
“ENGLISH MUTATION MAY LEAD TO INCREASE IN MIS-C CASES”
Dr. Varol made the following warnings: “This shows that the risk is not over yet for our children. For two reasons, first, face-to-face training will begin, and second, our children are not yet vaccinated. Therefore, even if the child passes Kovid silently or without symptoms, the risk of developing Mis-C should not be ignored. Families should definitely consult a doctor and be evaluated in terms of Mis-C in the presence of symptoms such as prolonged fever, accompanying itching, rash, vomiting, diarrhea, especially if there is a history of Covid, without worrying too much, despite fever reducers. These symptoms are also seen with other viral or bacterial infections, but Mis-C should also be borne in mind. “
“THERE IS NOTHING THAT MIS-C WILL DEVELOP IN EVERY CHILD THAT HAS COVID”
Pointing out that there is no rule that Mis-C will develop in every child with Covid, Dr. Varol said, “There are also pediatric patients who are PCR positive or antibody positive but show no Mis-C symptoms. Likewise, it has nothing to do with how light or heavy Kovid was passed. We are looking for a new disease Mis-C, a genetic predisposition in children with severe disease. We participated in an international study, the results of this will show us the real reasons ”.
“A LUKEMIA PATIENT WITH HIS TEST FOR THREE MONTHS THAT DOES NOT TURN NEGATIVE”
Pointing out that there is no standard for how long after Kovid has developed Mis-C syndrome, Dr. Fatih Varol ended his words as follows: “It usually occurs 2 to 3 weeks after Kovid. But in this process, the patients’ PCRs turn negative. Antibodies are formed. It may occur later than 2-3 weeks, but we do not expect it to develop during Covid infection. It should also be said that, even if PCR is negative in children in families known to have had Covid, it is important to follow up these symptoms in terms of Mis-C. In the severe Mis-C patients we follow here, we generally did not see a serious immune system problem or any other chronic disease. One of our patients had immune deficiency and inflammatory bowel disease. However, we have a very challenging case that we follow these days. We hospitalized at the age of 14 with the diagnosis of T-cell ALL (leukemia). While receiving chemotherapy, Kovid developed but the PCR test was positive for exactly 3 months. It just doesn’t turn negative. There is severe bone marrow depression (suppression). But at the same time, this patient came to us with signs of sepsis. Despite that, we diagnosed Mis-C because the heart findings were positive in this direction. We started hemoperfusion in this patient and his condition improved. We plan to separate the patient from the respirator. The fact that Mis-C is seen in children, not adults, is due to the fact that the immune system of children is very different from adults. There may also be genetic reasons. “