DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20213304

Assessment of multisystem inflammatory syndrome in children related to COVID-19

Sayeeda Anwar, Zohora Jameela Khan, Naznin Akhter, Fatema Farzana, Zannatul Shormin, Farzana Kabir

Abstract


Background: The COVID-19 pandemic has caused devastating diseases worldwide both in children and adults. Subsequently, a serious and novel pediatric condition called children's multisystem inflammatory syndrome (MIS-C) has emerged and it is important to understand the temporal association between MIS-C and COVID-19. In hyper inflammation syndrome following COVID-19, MIS-C, and multi-organ involvement were documented in the pediatric population. The main goal of this study was to assess the relation of the MIS-C with COVID-19.

Methods: This single-center case-control study was conducted at Dhaka medical college hospital (DMCH), Dhaka, Bangladesh. Among 1715 studied population, 227 COVID-19 positive pediatric patients were included in this study. Among them 103 had features of MIS-C in the case group and 124 were in the control group without MIS-C.

Results: There were 6% MIS-C patients with COVID-19. The prevalence of male patients was observed in this study. The mean age of the patient group with MIS-C was 7.8±3.12 years. The frequencies of fever 93.3 vs 67.7%, p=0.045; conjunctivitis 75.6% vs 53.2%, p=0.039; rash 47.3% vs 16.1%; arterial hypotension 71.3 vs 12.9%, p=0.058 hypoxemia 80.4% vs 57.2%, p=0.049 and other features were significantly higher in MIS-C patients than the patients without MIS-C. More patients with MIS-C had cardiac abnormalities in our study.

Conclusions: MIS-C is an emerging clinical entity and this study was focused on the cases of MIS-C in the pediatric population withCOVID-19. In patients with atypical clinical findings and complaints about COVID-19, MIS-C-like illnesses should be considered.


Keywords


MIS-C, COVID-19, Pediatric population

Full Text:

PDF

References


WHO Director. General’s opening remarks at the media briefing on COVID-19, 11 March 2020. 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-COVID-19---11-march-2020. Accessed on 10 Jan 2020.

Liu W, Zhang Q, Chen J, Xiang R, Song H, Shu S et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. N Engl J Med. 2020;)382(14:1370-1.

Jiehao C, Jin X, Daojiong L, Zhi Y, Lei X, Zhenghai Q et al. A Case Series of Children With 2019 Novel Coronavirus Infection: clinical and Epidemiological Features. Clin Infect Dis. 2020;716:1547-51.

Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Japanese J Allergol. 1967;16:178.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607.

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395:1771.

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescent. N Engl J Med. 2020;383:334.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:10237:160-8.

CDC Health Alert Network. Multisystem inflammatory syndrome in children (MIS-C associated with coronavirus disease 2019) COVID-19. 2020. Available at: https://emency.cdc.gov/han/2020/han00432.asprge.Accessed on 2020 May 22.

COVID-19. COVID-19 May Trigger Rare Complication in Children. WebMD. https://www.webmd.com/lung/news/20200514/covid19-may-trigger-rare-complication-in-children. Accessed June 9, 2020.

COVID-19 and Kawasaki Disease: What Parents Need to Know. Nationwide childrens.org. https://www.nationwidechildrens.org/family-resources-education/700childrens/2020/05/covid-19-and-kawasaki-disease-what-parents-need-to-know. Accessed on June 9, 2020.

Platt B, Belarski E, Manaloor J, Ofner S, Carroll AE, John CC et al. Comparison of risk of recrudescent fever in children with kawasaki disease treated with intravenous immunoglobulin and low-dose vs high-dose aspirin. JAMA Netw Open. 2020;3:e1918565.

Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol .2020;92:589.

Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med .2020;383:347.

Harwood R, Allin B, Jones CE, Whittaker E, Ramnarayan P, Ramanan AV, et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Health. 2021;5:133-41.

Dong Y, Mo X, Hu Y. Epidemiology of COVID‐19 among children in China. Pediatrics .2020;145:e20200702.

Capone CA, Subramony A, Sweberg T, Schneider J, Shah S, Rubin L et al. Characteristics, cardiac involvement, and outcomes of multisystem inflammatory disease of childhood (MIS-C) associated with SARS-CoV-2 infection. J Pediatr .2020;S0022-3476)20)30746-0.

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771-8.

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med .2020.

Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020;1-11.