Multisystem Inflammatory Syndrome in Children: An International Survey

Bautista‐Rodriguez, Carles; Sanchez‐de‐Toledo, Joan; Clark, Bradley C.; Herberg, Jethro; Bajolle, Fanny; Randanne, Paula Cecilia; Salas-Mera, Diana; Foldvari, Sandrine; Chowdhury, Devyani; Muñoz, Ricardo; Bianco, Francesco; Singh, Yogen; Levin, Michael; Bonnet, Damien; Fraisse, Alain

doi:10.1542/peds.2020-024554

Cited by 117 publications

(171 citation statements)

References 28 publications

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Section: Discussionmentioning

confidence: 99%

“…In one multinational survey of 183 pediatric patients with MIS-C, fever was present in 100% of cases [ 35 ]. Shock was present in 43.2% and was more common in older children (mean 9 years vs 7 years) [ 35 ]. A meta-analysis demonstrated similar results with 100% of patients presenting with fever, followed by 73.3% patients presenting with diarrhea or abdominal pain, and 68.3% patients presenting with vomiting [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Elevated inflammatory markers are common, with 92% of patients having at least 4 of the following abnormalities: elevated ESR (75–80%), elevated D-dimer (67–100%), elevated CRP (90–100%), lymphocytopenia (80–95%), neutrophilia (68–90%), elevated ferritin (55–76%), hypoalbuminemia (48–95%), anemia (70%), thrombocytopenia (31–80%), or increased liver enzymes (62–70%) [ 10 , 19 , 35 , [44] , [45] , [46] , [47] ]. One large study found that inflammatory markers were higher and platelets were lower among those presenting in shock [ 35 ]. Cardiovascular involvement is commonly seen, with elevations in BNP/pro-BNP (73–95%) and troponin (50–93%) [ 10 , 19 , 31 , 35 , [44] , [45] , [46] ].…”

Section: Discussionmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children with COVID-19

Gottlieb

Bridwell

Ravera

et al. 2021

The American Journal of Emergency Medicine

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Background Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19. Objective The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting. Discussion MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit. Conclusion MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children with COVID-19

Gottlieb

Bridwell

Ravera

et al. 2021

The American Journal of Emergency Medicine

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“…In contrast to adult data, complete blood counts are usually normal in children with COVID-19 although lymphopenia, leucopenia, and leukocytosis were reported in some case series (8,9,14,20) . The frequency of C-reactive protein (CRP) or procalcitonin elevation has been reported between 10-30% (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) . In our study, the most common abnormality in the leukocyte counts was lymphopenia (21%).…”

Section: Discussionmentioning

confidence: 99%

“…Current evidence show that children of all ages are susceptible to be infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms compared to the adults (4)(5)(6)(7)(8)(9) . However, lifethreatening severe manifestations such as multisystem inflammatory syndrome in children (MIS-C), severe pneumonia, acute respiratory distress syndrome (ARDS), myocarditis, shock, coagulation dysfunction, and death can rarely occur (8)(9)(10)(11) . As experience and data on COVID-19 have been increasing worldwide, new signs and symptoms are being identified other than fever and respiratory findings.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in children: A single center experience from Istanbul, Turkey

Besli¹,

Demir²,

Girit³

et al. 2021

BMJ

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Objective: We aimed to evaluate the demographic, epidemiological, and clinical characteristics of children with coronavirus disease‐2019 (COVID-19), and to determine variations of the clinical presentation of the disease by age. Method: A total of 104 confirmed COVID-19 patients aged between 0-18 years were retrospectively analyzed. The study period was between March 15, 2020 and July 1, 2020. A confirmed COVID-19 was defined as a child who has positive real-time reverse transcription-polymerase chain reaction (rRT-PCR). The patients were analyzed in terms of demographic, epidemiological, clinical, laboratory and imaging features, and clinical outcomes. Results: The median age (inter-quartile range) of the patients was 11.8 (8.4) years, and 53 (51%) were male. Ninety-eight (94%) of the patients had an epidemiological risk factor. The most frequent symptoms were cough (62%), fever (42%), and fatigue (33%). Seven patients (7%) were asymptomatic, 84 (81%) were mild, 9 (9%) were moderate, and 4 (4%) were in severe or critical condition. Ninety-eight (94%) of the patients underwent a chest x-ray, and 12% had pneumonia. The patients younger than 5 years were more likely to have fever (p = 0.019), rhinorrhea (p = 0.041), and diarrhea (p = 0.035). Muscle/join pain (26%), loss of smell/taste (20%), and headache (19%) were striking extra-pulmonary symptoms in older patients. Only 8% of the patients were hospitalized, and 4% were admitted to the intensive care unit. No death occurred. Conclusion: The most of the pediatric COVID-19 cases have mild symptoms without pneumonia. They may not present with fever or cough which are considered characteristic symptoms of the disease and the frequency of signs and symptoms may vary by age. Children younger than 5 years old are more likely to have fever, rhinorrhea, and diarrhea. School-age children and adolescents may present with extra-pulmonary symptoms such as muscle/join pain, smell/taste loss, and headache.

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Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Khoury,

Harahsheh,

Raghuveer

et al. 2023

JAMA Netw Open

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ImportanceObesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.ObjectiveTo compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.Design, Setting, and ParticipantsIn this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.Main Outcomes and MeasuresPatient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI &lt;85th percentile), overweight (BMI ≥85th to &lt;95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.ResultsOf 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P &lt; .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.Conclusions and RelevanceIn this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.

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Multisystem Inflammatory Syndrome in Children: An International Survey

Cited by 117 publications

References 28 publications

Multisystem inflammatory syndrome in children with COVID-19

Multisystem inflammatory syndrome in children with COVID-19

COVID-19 in children: A single center experience from Istanbul, Turkey

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

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