Clinical characteristics and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection in Iran: A multicenter study

Abstract

Objectives This study aimed to assess the clinical characteristics, treatment and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 in five different geographical regions of Iran. Methods In this multicenter observational study, patients <21 years were included between March 2020 and October 2021. By Disease Control and Prevention (CDC) checklist, demographic characteristics, comorbidities, clinical signs and symptoms, laboratory and radiology findings, and treatment were collected. Statistical analysis was using Chi-square and t-test in STATA14. Results In total 225 patients with median age of 55 (26–96) months were included that 59.56% boys. 57.33% were admitted to the PICU with a median of 7 days (4–10). 95.56% of patients were discharged with recovery and the rest died. All of the patients in our study were included based on the MIS-C criteria. However, some patients had Kawasaki symptoms, so we compared the clinical and epidemiological characteristics of the two groups. Conjunctival injection, cervical lymphadenopathy>1.5 cm diameter, and strawberry tongue in Kawasaki-like MIS-C patients were higher than of MIS-C patients, and this difference was significant(p<0.001). The most common comorbidity was obesity (24.86%). Most patients tested for COVID-19 and about 60% of the patients had a positive test by serology or reverse transcription-polymerase chain reaction (RT-PCR). Gastrointestinal (88.89%) and hematologic signs (84.44%) were most common. Most drugs used in patients were IVIG and steroids. 88.07% and 61.29% of the patients had at least one problem in echocardiography and lung CT, respectively. Conclusions The best outcome was seen in patients who were treated with both IVIG and steroids on the first days of admission. Myocarditis was common in two groups of patients. According to most patients had echocardiography abnormal, screening of heart function is recommended for patients.

Clinical and laboratory characteristics of multisystem inflammatory syndrome in children associated with COVID‐19 in Egypt: A tertiary care hospital experience

“…Although there is a significant overlap between the definitions provided by WHO, CDC and the RCPCH in the UK, they are not identical 9 . In critically ill patients, diagnostic criteria for MIS‐C include fever, increased inflammatory markers, involvement of at least two organs, evidence of SARS‐CoV‐2 infection or exposure, and the exclusion of other aetiologies 10 …”

“…Through October 2022, the CDC documented 9006 MIS‐C cases, and 74 children died as a result of complications related to MIS‐C 13 . MIS‐C is currently being observed world‐wide, and various reports emerged from Iran 10 and India, 14,15 Turkey, 16 the USA, 17 the UK, 18 Italy, 19 Spain, 20 France 21 and China 22 …”

“…More data are required to understand the differences in MIS‐C burden, severity and outcomes in lower‐middle‐income countries (LMIC), as it is important to consider the regional, genetic and ethnic distributions of children with MIS‐C to establish the best diagnostic criteria and treatment recommendations 10,15,23–26 . In addition, published literature from Egypt regarding MIS‐C associated with COVID‐19 in hospital settings is limited.…”

“…9 In critically ill patients, diagnostic criteria for MIS-C include fever, increased inflammatory markers, involvement of at least two organs, evidence of SARS-CoV-2 infection or exposure, and the exclusion of other aetiologies. 10 One or more of the following biomarkers are indicative of inflammation in the laboratory test results of patients with MIS-C: increased erythrocyte sedimentation rate (ESR), increased Creactive protein (CRP), procalcitonin, fibrinogen, D-dimer, ferritin, lactic acid dehydrogenase (LDH), reduced lymphocytes, low albumin and increased neutrophils. 11 Patients with MIS-C have a history of SARS-CoV-2 infection or exposure (positive SARS-CoV-2 by RT-PCR, antigen test or positive SARS-CoV-2 antibodies).…”

“…22 More data are required to understand the differences in MIS-C burden, severity and outcomes in lower-middle-income countries (LMIC), as it is important to consider the regional, genetic and ethnic distributions of children with MIS-C to establish the best diagnostic criteria and treatment recommendations. 10,15,[23][24][25][26] In addition, published literature from Egypt regarding MIS-C associated with COVID-19 in hospital settings is limited. Therefore, the current study characterised the clinical manifestations, laboratory test results and mortality outcomes of 45 children who met the CDC criteria for MIS-C associated with COVID-19 at a tertiary care hospital in Egypt.…”