Background Post‐COVID multisystem hyperinflammatory syndrome in children (MISC) has clinical and laboratory similarities with Kawasaki disease (KD). Inflammatory markers like C‐reactive protein (CRP), interleukin 6 (IL6) as well as N‐terminal probrain natriuretic peptide (NT‐proBNP) are elevated in both. This study attempts a comparative analysis of the 3 markers in an attempt at early differentiation for planning appropriate management. Methodology This analytical study conducted at the Institute of Child Health, Kolkata, India compared the levels of the above 3 markers at admission between 72 patients with KD, 30% of whom had coronary artery lesions (CALs) collected over a period of 18 months (Jan 2017‐June 2018), with 71 MISC patients over a period of 6 months (July 2020‐December 2020). The non‐parametric Mann‐Whitney U test was used to test for similarity in distributions of the samples of CRP, NT‐proBNP and IL6 in KD and MISC patients using correction factor for similar ranks. The 3 parameters were compared using receiver operating characteristic (ROC) curve analysis. Results Mean IL6 value in KD was 83.22 pg/mL and in MISC 199.91 pg/mL, which was not found to be statistically significant ( P = .322 > .05).However mean NT‐proBNP (914.91 pg/mL) with CRP level (96.32 mg/L) in KD was significantly lower ( P < .05 for both cases) than that in MISC (9141.16 pg/mL and 145.66 mg/L respectively). ROC analysis showed NT‐proBNP has the best sensitivity and specificity in predicting MISC. Conclusion NT‐proBNP and CRP are significantly higher among MISC patients; ROC analysis shows levels >935.7 pg/mL and >99.55 mg/L respectively might act as a guide to differentiate between them.

No abstract

Macrophage activation syndrome (MAS) is a potentially fatal complication of systemic inflammatory disorders first reported by Boone in 1976. In 1985, Hadchouel et al described this condition in seven patients with systemic juvenile idiopathic arthritis (sJIA). In 1992, the term "macrophage activation syndrome" was coined and Stephan et al were the first to use it in relation to juvenile arthritis. Since then, MAS has been widely described in rheumatic diseases, especially sJIA. However, it is being increasingly reported in association with systemic lupus erythematosus (SLE), Kawasaki disease (KD) and periodic fever syndromes. 1-3 Macrophage activation syndrome is characterized by uncontrolled activation and proliferation of T cells and macrophages, leading to a storm of inflammatory cytokines. Although the incidence of MAS remains unestablished, reports show that clinically overt MAS

100 hospital patients suffered from acute exacerbations of chronic bronchitis. 50 were treated with amoxycillin in a dose of 500 mg, three times a day for 10 days and the results compared with 50 patients treated with co-trimoxazole in a dose up to 480 mg trimethoprim and 2,400 mg of sulphamethoxazole daily in males, and two thirds of this dose in females. The trial was single-blind. During the acute phase of infection, both treatments were equally effective in clinical improvement, conversion of the sputum from purulent to mucoid, diminution of quantity and elimination of pathogenic bacteria. Amoxycillin was quicker in sputum conversion and gave less side effects, but the differences were not significant. During the 2–4 weeks following treatment, only a third of the patients who had received co-trimoxazole remained well and free from purulent relapse, as opposed to 72% who had received amoxycillin, a difference significant at the 2% level.

One hundred and thirty-two patients with purulent exacerbations of chronic bronchitis were randomly allotted to treatment in three groups. They received (a) amoxycillin 250 mg and pivmecillinam 200 mg; or (b) amoxycillin 500 mg; or (c) amoxycillin 500 mg and pivmecillinam 400 mg: three times daily for 10 days. By the 7th day of treatment there was significant improvement over amoxycillin alone for both groups given combined chemotherapy in conversion of sputum to mucoid and in general improvement; at the end of treatment results in patients given the higher doses of both antibiotics were still superior to amoxycillin alone. Patients were observed 2 to 4 weeks later, when those given amoxycillin alone relapsed much more frequently. The three treatments were well tolerated and succeeded equally in clearing potential pathogens from the sputum. Combined treatment may be superior due to synergy against Haemophilus influenzae or to the elimination of beta-lactamase producing organisms and should be investigated further.