Corticosteroids, Hyperinflammation, Intravenous Immunoglobulin—IVIG, Kawasaki disease, Multisystem inflammatory syndrome in children (MIS-C), SARS-CoV-2
Citation Information :
Mehra B, Pandey M, Oberoi T, Jerath N, Sharma R, Lal N, Singha C, Malhotra B, Manocha V, Simalti AK, Arya Y, Dugaya SK, Kalra S, Chitkara AJ, Sachdev A. COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study. Indian J Crit Care Med 2021; 25 (10):1176-1182.
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic.
Materials and methods: Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India.
Results: We identified 120 patients [median age: 7 years (interquartile range (IQR): 4–10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (n = 63), MIS-C with Kawasaki disease (KD) (n = 23), and MIS-C without shock and KD (n = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5–212.5) and ferritin was 543 ng/mL (IQR, 225–1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity.
Conclusion: MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C.
Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Scientific brief: World Health Organization. 2020. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatorysyndrome-in-children-and-adolescents-with covid-19 [Accessed December18, 2020].
Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019. Centers for Disease Control and Prevention. Emergency preparedness and response: Health alert network. 2020. Available from: https://emergency.cdc.gov/han/2020/han00432.asp [Accessed December 15, 2020].
Balasubramanian S, Nagendran TM, Ramachandran B, Ramanan AV. Hyper-inflammatory syndrome in a child with COVID-19 treated successfully with intravenous immunoglobulin and tocilizumab. Indian Pediatr 2020;57(7):681–683. DOI: 10.1007/s13312-020-1901-z.
Acharyya BC, Acharyya S, Das D. Novel coronavirus mimicking Kawasaki disease in an infant Indian Pediatr 2020;57(8):753-754. DOI: 10.1007/s13312-020-1924-5.
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem inflammatory syndrome in US. children and adolescents. NEJM 2020;383:334–336. DOI: 10.1056/NEJMoa2021680.
Press Trust of India. Delhi added 64,000 fresh Covid-19 cases in June; 47,489 patients recovered. Business standard. 2020. Available from: https://www.business-standard.com/article/current-affairs/delhi-added-64-000-fresh-covid-19-cases-in-june-47-489-patients-recovered-120063001938_1.html.
McCrindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, et al. Pediatric Heart Network Investigators. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007;116(2):174–179. DOI: 10.1161/CIRCULATIONAHA.107.690875.
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):1771–1778. DOI: 10.1016/S0140-6736(20)31103-X.
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):259–269. DOI: 10.1001/jama.2020.10369.
Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet 2020;4(9):653–661. DOI: 10.1016/S2352-4642(20)30177-2.
Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int 2020;1–14. DOI: 10.1007/s00296-020-04749-4.
Allard N, Maruani A, Cret C, Ameri A. Acute hypothermia in Covid-19: a case report. eNeurological Sci 2020;20:100248. DOI: 10.1016/j.ensci.2020.100248.
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(11):1010–1014. DOI: 10.1007/s13312-020-2025-1.
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):1015–1019. DOI: 10.1007/s13312-020-2026-0.
Winant AJ, Blumfield E, Liszewski MC, Kurian J, Foust A, Lee EY. Thoracic imaging findings of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19: what radiologists need to know now. Radiol Cardiothorac Imaging 2020;2(4):e200346. DOI: 10.1148/ryct.2020200346.
Abdel-Mannan O, Eyre M, Löbel U, Bamford A, Eltze C, Hameed B, et al. Neurologic and radiographic findings associated with COVID-19 infection in children. JAMA Neurol 2020;77(11):1–6. DOI: 10.1001/jamaneurol.2020.2687.
Mehra B, Aggarwal V, Kumar P, Kundal M, Gupta D, Kumar A, Dugaya SK. COVID-19 associated severe multisystem inflammatory syndrome in children with encephalopathy and neuropathy in an adolescent girl with the successful outcome: an unusual presentation. Indian J Crit Care Med 2020;24(12):1276–1278. DOI: 10.5005/jp-journals-10071-23685.
Pandey M. Acute Meningoencephalitis in a Child Secondary to SARS-CoV-2 Virus. Indian Pediatr. 2021 Feb 15;58(2):183–184. DOI: 10.1007/s13312-021-2140-7. PMID: 33632955; PMCID: PMC7926067.
Fernandes DM, Oliveira CR, Guerguis S, Eisenberg R, Choi J, Kim M, et al. Severe acute respiratory syndrome coronavirus 2 clinical syndromes and predictors of disease severity in hospitalized children and youth. J Pediatr 2020:S0022-3476(20)31393-7. DOI: 10.1016/j.jpeds.2020.11.016.
Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis 2020;79(8):999–1006. DOI: 10.1136/annrheumdis-2020-217960.