COVID-19 ve Erişkinlerde Multisistem İnflamatuar Sendrom (MIS-A)
Özet
Bu çalışma, SARS-CoV-2 enfeksiyonunun nadir fakat ciddi bir post-enfeksiyöz komplikasyonu olan Erişkinlerde Multisistem İnflamatuar Sendromu (MIS-A) konusunu detaylıca ele almaktadır. Genellikle çocuklarda tanımlanan MIS-C tablosuna benzer şekilde, MIS-A da COVID-19 geçiren veya virüse maruz kalan 21 yaş ve üzerindeki yetişkinlerde, enfeksiyondan yaklaşık 2 ila 5 hafta sonra hiperinflamasyon ve kalp, böbrek, beyin, deri ile gastrointestinal sistem gibi akciğer dışı çoklu organ fonksiyon bozukluklarıyla karakterize yeni bir hastalık olarak ortaya çıkmaktadır. Kesin patofizyolojisi henüz tam anlaşılamamakla birlikte, antikor aracılı veya düzensiz bağışık yanıttan şüphelenilmektedir. CDC kriterlerine göre tanı için hastanın 21 yaşından büyük olması, en az 24 saat hastanede yatması, dirençli ateş göstermesi ve şiddetli akciğer hastalığı olmaksızın en az üç klinik kriteri (miyokardit gibi birincil kalp rahatsızlığı veya döküntü/konjonktivit dahil) karşılaması gerekir. Laboratuvarda CRP, ferritin ve ESR gibi inflamasyon belirteçlerinin yükselmesi ile aktif veya geçirilmiş SARS-CoV-2 enfeksiyonunun kanıtlanması şarttır. MIS-A tedavisinde randomize kontrollü çalışmalar bulunmamakla birlikte, klinisyenler çoğunlukla kortikosteroidler, intravenöz immünoglobulin ve immünomodülatörler kullanmaktadır.
This study thoroughly examines Multisystem Inflammatory Syndrome in Adults (MIS-A), a rare but serious post-infectious complication of SARS-CoV-2 infection. Similar to the MIS-C clinical presentation described in children, MIS-A emerges as a new illness characterized by hyperinflammation and extrapulmonary multiorgan dysfunction, including the heart, kidneys, brain, skin, and gastrointestinal system, in adults aged 21 and older approximately 2 to 5 weeks after undergoing COVID-19 or being exposed to the virus. Although its exact pathophysiology is not yet fully understood, an antibody-mediated or dysregulated immune response is suspected. According to CDC criteria, diagnosis requires the patient to be at least 21 years old, hospitalized for at least 24 hours, present with a persistent fever, and meet at least three clinical criteria (including primary cardiac conditions like myocarditis, or rash/conjunctivitis) in the absence of severe respiratory disease. Laboratory evidence must demonstrate elevated inflammatory markers such as CRP, ferritin, and ESR, along with confirmation of active or past SARS-CoV-2 infection. While there are no randomized controlled trials for MIS-A treatment, clinicians mostly utilize corticosteroids, intravenous immunoglobulin, and immunomodulators.
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