Clinical Features of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in Indonesia

Abstract

Background While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia. Methods This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021. Results The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors. Conclusions Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Multisystem inflammatory syndrome in children (MIS-C) showing disseminated aspergillosis, cytomegalovirus reactivation and persistent SARS-COV-2: Case report with autopsy review

“…For the small number of patients who do not survive, in most studies, the causes of death are either not provided [3] , [5] , [6] , [10] or based on clinical impressions [11] . Given the relative novelty of MIS-C, post mortem examination can provide valuable information about this incompletely understood condition.…”

“…Even less well understood is why there is an apparent preferential occurrence of MIS-C in black and Hispanic populations [2] , [3] , [5] , [6] , [8] , [16] and why Asian populations seem relatively spared, especially in Asian countries, where there are so few reports of MIS-C cases [11] , [20] , [21] , [22] , [23] . These racial differences may be related to reporting procedures, health care disparities, environmental factors or possibly genetic differences that influence inflammatory and immune responses [16] , [17] .…”

“…With treatment, the majority of patients survive [3] , [4] , [6] , [9] . Depending on the study, the mortality rate is low, in the range of 1.5–2.2 %, but rates of 15–25 % has been reported by some [2] , [10] , [11] . Most of the larger studies have not reported the causes of death.…”

“…Attention was initially drawn to that fact that MIS-C was not seen in Asian countries [3] , [5] . This has proven to be incorrect, as there are now reports, albeit very few, documenting MIS-C in patients in Asia, including Japan, South Korea, Indonesia, VietNam and India [10] , [11] , [20] , [21] , [22] , [23] .…”

A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

“…Although the pandemic originated from East Asia, MIS-C patients were mostly reported in children who live in western countries [6–8,18–20]. Black and Hispanic ethnicities were previously shown to be at higher risk for developing MIS-C [21,22 ▪ ].…”