First Tunisian cluster admissions of critically ill patients with multisystem inflammatory syndrome in children (MIS-C)

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a new serious emerging disease that is temporally related to previous exposure to coronavirus infection disease (COVID-19). 
 Aim: To describe the clinical features, laboratory findings, therapies and outcomes for the first Tunisian cluster admissions of critically ill children with severe MIS-C.
 Methods: Retrospective study conducted between 01 November and 30 November 2020
 We included 8 children aged less than 15 years who were admitted to our pediatric intensive care and met the criteria for MIS-C according to the WHO definition case. We reviewed the medical records of all patients to collect demographic and clinical data, severity scores, laboratory test results, echocardiographic findings, treatment, and outcomes.
 Results: All children were previously fit and well. Seven patients were boys. Known exposure to COVID-19 was reported in 4 cases. Fever and gastrointestinal symptoms were reported in all cases. Five patients had marked abdominal pain and were examined by the surgeon for a possible appendicitis. Seven patients had diarrhea. On examination, we found a rash (n=7), a conjunctivitis (n=7), a cheilitis (n=5) and a meningism (n=3). We reported cardiac dysfunction in 7 cases and a shock with hypotension in 3 cases. All patients received immunoglobulins, methyl prednisolone and a low dose of aspirine. No deaths occurred.
 Conclusion: We reported here the first Tunisian cluster admissions of 8 critically ill children with MIS-C to highlight the increase of a new severe emerging disease with an evidence of prior COVID-19 infection in older children.

Ocular Manifestations in Children with COVID-19: Systematic Review and Meta-Analysis

“…After removing duplicates, we found 1,510 studies in the database; among which 19 were approved for systematic review, including six case reports [13][14][15][16][17][18], seven case series [7,[19][20][21][22][23][24], and six cross-sectional [8,[25][26][27][28][29] (Fig. 1).…”

Abdominal pain and appendicitis in children during the COVID-19 pandemic – do we need to be especially careful?

“…Abdominal ultrasound was performed in three cases, and CT of the abdomen showed mesenteric lymphadenitis in two cases. Seven patients had diarrhoea (56) . Lee et al presented a patient who developed MIS-C approximately three weeks after an initial diagnosis of COVID-19.…”

“…Nevertheless, it should be considered that MIS-C might well encompass complications (e.g. appendicitis, segmental intestinal ischaemia) which need swift surgical treatment Al Lawati et al (2021) (55) Given the risk of severity and rapid deterioration of children with MIS-C, we recommend that surgeons, emergency physicians and paediatricians have a high index of MIS-C suspicion when managing children and adolescents with fever and acute abdomen during the current pandemic Borgi et al (2021) (56) A patient with MIS-C is considered to have a refractory disease when the child has persistent fever and/or significant end-organ involvement despite initial immunomodulatory treatment Lee et al (2021) (57) Early recognition by disease awareness and prompt management are key to saving the lives of children affected by MIS-C. The benefits of immunomodulatory therapy have been suggested in both MIS-C and severe paediatric COVID-19 patients, even though no guidelines support the use of one immunomodulatory therapy over another Lishman et al (2020) (58) Paediatricians that diagnose MIS-C should be vigilant and continue to carefully evaluate children for surgical complications, including appendicitis and perforation, particularly if abdominal pain is part of the presenting complaint (59) Normal leukocyte count, low platelets, significantly raised inflammatory markers, and echocardiographic changes can confirm MIS-C Al Maskari et al (2021) (60) Early diagnosis and referral to centres equipped with the required subspecialties are recommended.…”

Comparative Analysis of Clinical and Laboratory Data in Children With Multisystem Inflammatory Syndrome Associated With Sars-Cov-2 in the Republic of Kazakhstan

“…The severity of the MIS-C course in 2021 confirms higher values of inflammation markers: ferritin, procalcitonin, ESR, leukocytes, and neutrophils. One of the important indicators of the complete blood count, which characterizes the severe course of the hyperinflammatory syndrome, is lymphopenia, 25 , 26 which was also characteristic of children who came down with the disease in 2021. According to the Centres for Disease Control and Prevention, a paper has been published comparing the differences in clinical and laboratory data of children with MIS-C registered after three waves of COVID-19, which specifies that there was an increase in the number of cases of MIS-C with severe hematological and gastrointestinal intestinal lesions (P<0.001) after the appearance of the Delta variant of SARS-CoV-2.…”