Table 1.
| Characteristic Feature | PIMS-TS | ARF | |
|---|---|---|---|
| Definition | confirmed pathogen exposure * | SARS-CoV-2 | GAS |
| RT-PCR | pharyngeal swab | ||
| antigen test | antigen test | ||
| serology positive 100% IgG: 2–12 week |
90% ASO: 4–24 week anti-DNase B: 4–36 week |
||
| age of onset | childhood * | childhood, rarely in young adults | |
| fever * | yes (100%) | yes (>90%) | |
| symptoms of the cardiovascular system * | coronary artery dilatation or aneurysms, myocarditis, left ventricular dysfunction, pericardial effusion, mitral regurgitation, hypotension, shock | pancarditis: pericarditis, myocarditis, endocarditis, including valvular inflammation, heart failure |
|
| involvement of other organs and systems * | gastrointestinal, skin, mucosal, respiratory, renal, neurologic | arthritis, brain (chorea), and skin | |
| high inflammation markers * | CRP, ESR, ferritin, PCT | CRP, ESR | |
| Pathogenesis | genetic predisposition | suspected | yes |
| molecular mimicry | suspected | yes | |
| high levels of pro-inflammatory cytokines | yes | yes | |
| increased activity of T lymphocytes | yes | yes | |
| Clinical symptoms | mild course of primary infection | yes | yes |
| age of onset | 4–17 years |
5–14 years,
rare in adults |
|
| time from exposure to illness | 3–6 weeks | 2–3 weeks | |
| Treatment | eradication of the pathogen | yes, if confirmed | yes |
| anti-inflammatory, corticosteroids | yes | yes | |
| acetylsalicylic acid | yes, antithrombotic doses | yes, anti-inflammatory doses | |
| antibiotic therapy | no | primary and secondary prevention | |
| IVIG | yes | possible but not routine | |
| biological drugs | anti IL-6, IL-1, TNF | no | |
| good response to treatment | yes | yes | |
| Course and prognosis | course | no data, probably one course | may be recurrent, GAS infection prevention (secondary) required |
| prognosis | no data, advised observation, especially of the cardiovascular system | chronic and progressive rheumatic heart disease in 50% patients with carditis | |
| Prevention | vaccination | no data, available for adults | ongoing research |
* diagnosis criterion; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; PIMS-TS—paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2; ARF, acute rheumatic fever; GAS, group A streptococcus; ASO, Anti-streptolysin O; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; PCT, procalcitonin; IL, interleukin; TNF, tumor necrosis factor; IVIG, intravenous immunoglobulin.