COVID-19 nặng, hội chứng viêm đa hệ ở trẻ em và bệnh Kawasaki: cơ chế miễn dịch, biểu hiện lâm sàng và quản lý

Springer Science and Business Media LLC - Tập 41 - Trang 19-32 - 2020
Jayakanthan Kabeerdoss1, Rakesh Kumar Pilania2, Reena Karkhele3, T. Sathish Kumar4, Debashish Danda1, Surjit Singh2
1Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
2Allergy Immunology Unit, Department of Pediatrics and Chief, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
3MGM Medical College and Hospital, Navi Mumbai, India
4Department of Child Health, Christian Medical College, Vellore, India

Tóm tắt

Hội chứng viêm đa hệ (MIS-C) là một rối loạn viêm hyperinflammation ở trẻ em gây ra bởi virus corona gây hội chứng hô hấp cấp tính nghiêm trọng-2 (SARS-CoV-2). Hiện nay, hiện tượng này đã được báo cáo tại nhiều quốc gia trên thế giới. Một số biểu hiện lâm sàng của MIS-C tương tự như hội chứng sốc bệnh Kawasaki (KD). MIS-C phát triển sau 4–6 tuần kể từ khi nhiễm SARS-CoV-2, và có thể được khởi phát bởi phản ứng miễn dịch thích ứng. Mặc dù liên quan đến nhiều hệ thống, nhưng các biểu hiện tim mạch lại nổi bật hơn cả. Nồng độ kháng thể chống SARS-CoV-2 cao được quan sát thấy ở những bệnh nhân này. Do đây là một thực thể bệnh lý mới, cơ chế miễn dịch của nó vẫn chưa được làm sáng tỏ hoàn toàn. Liệu nó có một số điểm trùng lặp với KD vẫn còn chưa rõ ràng. Các hướng dẫn điều trị hiện tại khuyến cáo sử dụng globulin miễn dịch đường tĩnh mạch và corticosteroid liều cao như là phương pháp điều trị đầu tay. Tỷ lệ tử vong của MIS-C thấp hơn so với các dạng COVID-19 nặng ở người lớn.

Từ khóa

#hội chứng viêm đa hệ #COVID-19 #hội chứng Kawasaki #cơ chế miễn dịch #điều trị

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