Multisystem Inflammatory Syndrome Associated With COVID-19 in Children (MIS-C): A Systematic Review of Studies From India

Abstract

Background With wide clinical spectrum, multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) in children (MIS-C) is a relatively novel condition occurring weeks to months’ post SARS-CoV-2 infection. The aim was to systematically review data on clinical features, laboratory parameters and therapeutics of MIS-C from India. Methods This systematic review was done as per the PRISMA guidelines, and quality assessment was done using NIH tool for case-series. A systematic search through databases yielded studies whose data was pooled to calculate the mean frequencies with standard deviation using GraphPad software. Results Screening of 2548 articles published till December, 2021, yielded 11 case-series. World Health Organization case definition was used widely. There was a slight preponderance of males (57%), median (IQR) age was 7 (6,7) years, 63% ( n =305) required intensive care unit admissions, and mortality rate was 10% ( n =261). Clinical features included fever, mucocutaneous features (72%), and gastrointestinal problems (62%) in majority. Widely used treatment was corticosteroids (76%) and intravenous immunoglobulin (62%) with other options depending on patient’s state. An increased level of inflammatory markers and derangement in other parameters corroborated with disease status. Kawasaki disease like features, not reported in many studies, ranged from 4-76% of patients. Conclusion MIS-C presents with a wide spectrum clinical features, increased inflammatory markers and managed as per the disease course and presentation. Future studies monitoring the long-term effects of MIS-C are recommended.

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

“…[29][30][31] It was also higher than that reported in India (10%), Turkey (6.9%) and Mexico City (7.1%). 15,16,23 In addition, there were no reported deaths among hospitalised children with MIS-C in Cape Town, South Africa, according to Butters et al 24 The increased mortality rate observed in our study could be attributed to the following factors: first, the majority of these patients were referred from other health-care facilities and had a serious spectrum of illnesses at the time of enrolment (64.4% had respiratory manifestations, 48.9% had coma, 44.4% had shock, 33.3% had seizures, 22.2% had cerebrovascular stroke, 26.7% had evidence of myocarditis, 6.7% had recent dilated cardiomyopathy, 2.2% had coronary artery aneurysm and 2.2% had pericardial effusion); second, asymptomatic cases and patients with mild clinical manifestations who could be treated in primary care were not included in this study; third, the mortality rate in our study could have been reduced if we had used ECMO, which is not currently available at our hospital; and fourth, patients with MIS-C overlapping severe acute COVID-19 had evidence of respiratory involvement, as our study results showed, and the majority of these children had a positive PCR for SARS-CoV-2 with negative serology, and their mortality rate was higher. We hypothesise that early identification of patients and the availability of resources are critical for timely health-care delivery.…”

“…The newer ACR guidelines are continuously updated as more cases are diagnosed, and our understanding of MIS-C pathogenesis and treatment improves. 12 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.…”

“…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.…”

Emergence of a unique SARS‐CoV‐2 Delta sub‐cluster harboring a constellation of co‐appearing non‐Spike mutations

“…During our efforts to track the emerging SARS‐CoV‐2 mutations in India, we have identified a unique Delta subcluster which harbored a signature constellation of eight non‐Spike co‐appearing mutations, predominant among the adults while also infecting the pediatric patients. There are a very limited number of studies on the phylodynamic of SARS‐CoV‐2 variants among the pediatric population 14 . Recent studies revealed that children are comparatively more susceptible to infection by the emerging SARS‐CoV‐2 variants like Delta and Omicron than the ancestral strain (Wuhan‐type) 15 .…”

“…There are a very limited number of studies on the phylodynamic of SARS‐CoV‐2 variants among the pediatric population. 14 Recent studies revealed that children are comparatively more susceptible to infection by the emerging SARS‐CoV‐2 variants like Delta and Omicron than the ancestral strain (Wuhan‐type). 15 The impact of the co‐appearing mutations might vary across populations (pediatric as well as adult) and geographical locations due the changing host immuno‐genetic landscape.…”