Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital

  • Received : 2021.03.30
  • Accepted : 2021.07.15
  • Published : 2021.10.15
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Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a new hyperinflammatory variant that evolved during the coronavirus disease 2019 pandemic. Although the precise pathophysiology of MIS-C is uncertain, it is thought to be due to immune dysregulation occurring after recovery from acute infection. Purpose: Our study aimed to analyze the clinical spectrum, laboratory parameters, imaging characteristics, treatment strategies, and short-term outcomes of children with a diagnosis of MIS-C. Methods: This retrospective and prospective observational study included children less than 16 years of age who were admitted to the pediatric unit of a tertiary care teaching hospital in south India between August 2020 to January 2021 with a diagnosis of MIS-C according to World Health Organization criteria. Results: Twenty-one children were included in the analysis; all had fever with variable combinations of other symptoms. The mean age was 6.9 years; 71.4% were male. Gastrointestinal (80.9%) and cardiovascular (80.9%) systems were the most commonly affected. The majority of children had elevated inflammatory markers, and 16 (76.2%) had echocardiographic abnormalities mimicking Kawasaki disease. Eleven children (52.4%) required intensive care admission, 3 (14.3%) required supplemental oxygen, and 4 (19%) required inotropes. Nine (42.9%) were treated with intravenous immunoglobulin alone, 6 (28.6%) with steroids alone, and 3 (14.3%) with steroids and immunoglobulin. The median hospital stay was 6 days; there were no fatalities. Overweight/obesity, elevated ferritin, and mucocutaneous involvement were significantly associated with a prolonged hospital stay (≥7 days). Sixteen children (76.2%) were followed up till now and all of them had no clinical concerns. Conclusion: MIS-C is an emerging disease with variable presentation. A high index of suspicion is necessary for its early identification and appropriate management. Further research is essential for developing optimal treatment strategies.

Keywords

Acknowledgement

Dr. Karthikeyan Shanmugam (Associate professor, Department of Community medicine) for his help in statistical analysis.

References

  1. WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. Geneva (Switzerland): World Health Organization; 2021 [cited 2021 Feb 24]. Available from: https://covid19.who.int/.
  2. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr 2020;174:882-9. https://doi.org/10.1001/jamapediatrics.2020.1467
  3. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutierrez-Ocampo E, Villamizar-Pena R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623. https://doi.org/10.1016/j.tmaid.2020.101623
  4. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109:1088-95. https://doi.org/10.1111/apa.15270
  5. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607-8. https://doi.org/10.1016/s0140-6736(20)31094-1
  6. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS) - guidance for clinicians [Internet]. London: Royal College of Paediatrics and Child Health; 2021 [cited 2021 Feb 24]. Available from: https://www.rcpch.ac.uk/resources/paediatricmultisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance.
  7. Emergency preparedness and response. Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2020 [cited 2021 Feb 24]. Available from: https://emergency.cdc.gov/han/2020/han00432.asp.
  8. Multisystem inflammatory syndrome in children and adolescents with COVID-19 [Internet]. Geneva (Switzerland): World Health Organization [cited 2021 Feb 24]. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.
  9. Kaushik S, Aydin SI, Derespina KR, Bansal PB, Kowalsky S, Trachtman R, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): a multi-institutional study from New York City. J Pediatr 2020;224:24-9. https://doi.org/10.1016/j.jpeds.2020.06.045
  10. 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;324:259-69. https://doi.org/10.1001/jama.2020.10369
  11. Dhanalakshmi K, Venkataraman A, Balasubramanian S, Madhusudan M, Amperayani S, Putilibai S, et al. Epidemiological and clinical profile of pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS) in Indian children. Indian Pediatr 2020;57:1010-4. https://doi.org/10.1007/s13312-020-2025-1
  12. Gupta Dch S, Chopra Md N, Singh Md A, Gera R, Chellani Md H, Pandey PhD R, et al. 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:fmaa127. https://doi.org/10.1093/tropej/fmaa127
  13. 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;383:334-6. https://doi.org/10.1056/NEJMoa2021680
  14. Torres JP, Izquierdo G, Acuna M, Pavez D, Reyes F, Fritis A, et al. Multisystem inflammatory syndrome in children (MIS-C): report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic. Int J Infect Dis 2020;100:75-81. https://doi.org/10.1016/j.ijid.2020.08.062
  15. Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 2020;369:m2094.
  16. Mamishi S, Movahedi Z, Mohammadi M, Ziaee V, Khodabandeh M, Abdolsalehi MR, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiol Infect 2020;148:e196. https://doi.org/10.1017/s095026882000196x
  17. Miller J, Cantor A, Zachariah P, Ahn D, Martinez M, Margolis KG. Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children that is related to coronavirus disease 2019: a single center experience of 44 cases. Gastroenterology 2020;159:1571-4.e2. https://doi.org/10.1053/j.gastro.2020.05.079
  18. 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;41:1391-401. https://doi.org/10.1007/s00246-020-02391-2