Etiological and pathophysiological enigmas of severe coronavirus disease 2019, multisystem inflammatory syndrome in children, and Kawasaki disease
Open Access
- 15 April 2022
- journal article
- review article
- Published by Korean Pediatric Society in Clinical and Experimental Pediatrics
- Vol. 65 (4), 153-166
- https://doi.org/10.3345/cep.2021.01270
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, a novel multisystem inflammatory syndrome in children (MIS-C) has been reported worldwide since the first cases were reported in Europe in April 2020. MIS-C is temporally associated with severe acute respiratory syndrome coronavirus 2 infection and shows Kawasaki disease (KD)-like features. The epidemiological and clinical characteristics in COVID-19, KD, and MIS-C differ, but severe cases of each disease share similar clinical and laboratory findings such as a protracted clinical course, multiorgan involvement, and similar activated biomarkers. These findings suggest that a common control system of the host may act against severe disease insult. To solve the enigmas, we proposed the protein-homeostasis-system hypothesis in that every disease involves etiological substances and the host's immune system controls them by their size and biochemical properties. Also, it is proposed that the etiological agents of KD and MIS-C might be certain strains in the microbiota of human species and etiological substances in severe COVID-19, KD, and MIS-C originate from pathogen-infected cells. Since disease severity depends on the amounts of inflammation-inducing substances and corresponding immune activation in the early stage of the disease, an early proper dose of corticosteroids and/or intravenous immunoglobulin (IVIG) may help reduce morbidity and possibly mortality among patients with these diseases. Corticosteroids are low cost and an analogue of host-origin cortisol among immune modulators. This study's findings will help clinicians treating severe COVID-19, KD, and MIS-C, especially in developing countries, where IVIG and biologics supplies are insufficient.Keywords
This publication has 125 references indexed in Scilit:
- Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriageBMC Pediatrics, 2012
- Pandemic 2009 H1N1 virus infection in children and adults: A cohort study at a single hospital throughout the epidemicInternational Archives of Medicine, 2012
- Epidemiological and clinical characteristics of childhood pandemic 2009 H1N1 virus infection: an observational cohort studyBMC Infectious Diseases, 2011
- Hyperactive immune cells (T cells) may be responsible for acute lung injury in influenza virus infections: A need for early immune-modulators for severe casesMedical Hypotheses, 2011
- Early corticosteroid treatment for severe pneumonia caused by 2009 H1N1 influenza virusCritical Care, 2011
- Difference of clinical features in childhood Mycoplasma pneumoniae pneumoniaBMC Pediatrics, 2010
- Kawasaki disease may be a hyperimmune reaction of genetically susceptible children to variants of normal environmental floraMedical Hypotheses, 2007
- SARS: Systematic Review of Treatment EffectsPLoS Medicine, 2006
- Arthritis in Kawasaki disease after responding to intravenous immunoglobulin treatmentEuropean Journal of Pediatrics, 2005
- Comprehensive Review of Morbidity and Mortality Trends for Rheumatic Fever, Streptococcal Disease, and Scarlet Fever: The Decline of Rheumatic FeverClinical Infectious Diseases, 1989