Multisystem inflammatory syndrome in children during the COVID-19 pandemic in Turkey: first report from the Eastern Mediterranean

Abstract

Objective We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with multisystem inflammatory syndrome in children (MIS-C) and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country. Methods Children (aged <18 years) who diagnosed with MIS-C and severe/critical pediatric cases with COVID-19 and were admitted to hospital between March 26 and November 3, 2020 were enrolled in the study. Results A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C, were included in the study. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only three deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral. Conclusion Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count are reliable diagnostic parameters for MIS-C cases. Keywords Kawasaki disease. Pediatrics. Hyperinflammation. Multisystem inflammatory syndrome in children (MIS-C). Multisystem inflammatory syndrome in adults (MIS-A) Key Points • MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe/critical pediatric cases with COVID-19. • Higher CRP and low total WBC count are the independent predictors for the diagnosis of MIS-C. • MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19.

Clinical features and outcomes of 76 patients with COVID-19-related multi-system inflammatory syndrome in children

“…Given the recent data suggesting that geographical circumstances may influence the development of the disease, large cohort studies from every single country are required for better understanding. This study is the third reported cohort from Turkey, and owing to its larger sample size, it may present contributions to the previous ones [18,19]. Demographic findings of our study such as male predominance, prominently affected age group and survival rates were consistent with the current literature.…”

“…Although studies describing MIS-C patients so far present a wide variability of clinical signs, most of the cases had cardiac dysfunction and gastrointestinal symptoms [18,29]. Consistent with the previous reports, the two most common systemic involvements in our study were cardiac and gastrointestinal.…”

“…Although SARS-CoV-2 pandemic is originated from East Asia, most of the MIS-C cases were reported from Europe and the USA [16]. Similar to their geographical locations, Middle East and West Asia are in the middle of the line between East Asia and Western world regarding the number of reported cases [16][17][18]. Given the recent data suggesting that geographical circumstances may influence the development of the disease, large cohort studies from every single country are required for better understanding.…”

Clinical and laboratory findings of multisystem inflammatory syndrome in children (MIS-C) below age 1

“…We read the article by Ozsurekci and colleagues with great interest [1]. The article examines the clinical and laboratory characteristics of 30 multisystem inflammatory syndrome in children (MIS-C) cases and provides valuable data for the literature.…”

“…The article's discussion part refers to the literature, which describes that MIS-C develops a few weeks following exposure [1]. It is speculated that SARS-CoV-2 could have a more symptomatic course in infants below the age of 5.…”