Clinical, biochemical and echocardiographic characteristics in children with multisystem inflammatory syndrome associated with coronavirus disease: a tertiary care experience
DOI:
https://doi.org/10.18203/2349-3291.ijcp20223419Keywords:
COVID-19, MIS-C, Kawasaki disease, IVIG, MethylprednisoloneAbstract
Background: We describe the clinical, biochemical and echocardiographic characteristics in children diagnosed with multisystem inflammatory syndrome (MISC) temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2), admitted to a tertiary care hospital in Goa, India.
Methods: This was a retrospective observational study conducted at Goa Medical College, Goa, India. Parameters including demographics, clinical features, laboratory markers, medications and outcomes were obtained from patient hospital records; analyzed for patients treated for MISC (as per WHO case definition) for a period of 11 months from 01 July 2020 to 31 July 2021.
Results: 30 patients (18 males) with median age of 7 years (IQR: 2 months – 12 years) were included. The proportion of children with gastrointestinal symptoms was 20 (64.5%), shock was a presenting feature in 15 (48%) and coronary ectasia and/or low ejection fraction was seen in 12 children (38.7%).
Conclusions: A high index of suspicion for the diagnosis of MIS-C in children presenting with fever and Kawasaki disease like symptoms or signs of shock is recommended; since early aggressive therapy with Intravenous Immunoglobulins and methylprednisolone can have favourable outcomes.
References
World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Scientific brief. 2020. Available at: https: //www.who.int/publications-detail/multi systeminflammatory-syndrome-in-children-andadolescents-with-covid-19. Accessed on 21 July 2022.
Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324(3):259-69.
McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, Treatment, and Long-term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017;135:e927-99.
Dhanalakshmi K, Venkataraman A, Balasubramanian S, Madhusudan M, Amperayani S, Putilibai S, Sadasivam K, Ramachandran B, Ramanan AV. Epidemiological and Clinical Profile of Pediatric Inflammatory Multisystem Syndrome - Temporally Associated with SARS-CoV-2 (PIMS-TS) in Indian Children. Indian Pediatr. 2020;57(11):1010-4.
Gupta Dch S, Chopra Md N, Singh Md A, Gera R, Chellani Md H, Pandey PhD R, Arora Md BS. Unusual Clinical Manifestations and Outcome of Multisystem Inflammatory Syndrome in Children (MIS-C) in a Tertiary Care Hospital of North India. J Trop Pediatr. 2021;67(1).
Sugunan S, Bindusha S, Geetha S, Niyas HR, Kumar AS. Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone. Indian Pediatr. 2021;58(8):718-22.
Jain S, Sen S, Lakshmivenkateshiah S, Bobhate P, Venkatesh S, Udani S, et al. Multisystem Inflammatory Syndrome in Children With COVID-19 in Mumbai, India. Indian Pediatr. 2020;57(11):1015-9.
Shobhavat L, Solomon R, Rao S, Bhagat I, Prabhu S, Prabhu S, et al. Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India. Indian J Crit Care Med. 2020;24(11):1089-94.
Balagurunathan M, Natarajan T, Karthikeyan J, Palanisamy V. Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital. Clin Exp Pediatr. 2021;64(10):531-7.
Maheshwari A, Mahto D, Kumar V, Gulati S, Pemde H, Saha A, et al. Comparison of clinical and laboratory profile of survivors and non-survivors of SARS-CoV-2-related multisystem inflammatory syndrome of childhood in India: An observational study. J Paediatr Child Health. 2022;58(1):136-40.
Angurana SK, Awasthi P, Thakur A, Randhawa MS, Nallasamy K, Kumar MR, et al. Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (MIS-C): Experience from North India. J Trop Pediatr. 2021;67(3).
Sachdeva M, Agarwal A, Sra HK, Rana M, Pradhan P, Singh M, Saini S, Singh M. Multisystem Inflammatory Syndrome Associated With COVID-19 in Children (MIS-C): A Systematic Review of Studies From India. Indian Pediatr. 2022;59(7):563-9.
Wang Z, Zhao S, Tang Y, Wang Z, Shi Q, Dang X, et al. Potentially effective drugs for the treatment of COVID-19 or MIS-C in children: a systematic review. Eur J Pediatr. 2022;1-12.