On the Issue of Differential Diagnosis of Bacterial Infections and Pediatric Multisystem Inflammatory Syndrome During the Covid-19 Pandemic

Abstract

During the COVID-19 pandemic, it is necessary to be wary of the development of pediatric multisystem inflammatory syndrome in children (PMIS) who have had a COVID-19 and had antibodies to the SARS-CoV-2 virus. The aim of this work is to describe two clinical cases in children with antibodies to SARS-CoV-2 against the background of yersiniosis in a 12-year-old child and salmonellosis in a 3-year-old child, which proceeded with a pronounced inflammatory reaction and required a differential diagnosis with multisystem inflammatory syndrome. These bacterial infections proceeded with severe intoxication and fever, had a polymorphic clinical picture with exanthema syndrome, conjunctivitis/scleritis, swelling of the palms/feet, diarrhea and toxic kidney damage, with a pronounced systemic inflammatory reaction – high leukocytosis with neutrophilia and lymphopenia, a significant increase in C-reactive protein, procalcitonin, hypercoagulability (increased fibrinogen, D-dimer). Etiotropic antibiotic therapy led to recovery in both cases. Conclusions: During the COVID-19 pandemic, if antibodies to the SARS-CoV-2 virus are detected in children in the presence of signs of systemic inflammation and corresponding symptoms, the alertness of doctors and a timely comprehensive examination are necessary to exclude bacterial infections, also characterized by signs of systemic inflammation, for the purpose of differential diagnosis of PMIS.

Multisystem Inflammatory Syndrome in Children Course Amid Covid-19 Pandemic in the Rebublic of Belarus

“…According to the literature sources, lymphopenia occurs from 80-95%, neutrophilia – 68-90%, anemia of mild degree – 70% and thrombocytopenia – 31-80%, which is consistent with the data of our study [4, 6, 13, 23, 35-37].…”

“…There were no differences between the groups in other indicators of biochemical analysis. According to literature data, laboratory markers of inflammation correlate with the severity of the disease [35][36][37]. In a number of research, increased markers of inflammation were observed, such as CRPfrom 90 to 100%, accelerated ESRfrom 75 to 80%, high levels of D-dimersfrom 67 to 100%, fibrinogenfrom 80 to 100%, ferritinfrom 55 to 76%, procalcitoninfrom 80 to 95% and interleukin-6 (IL-6)from 80 to 100% [4,16,18,21,23,31,35].…”

“…According to literature data, laboratory markers of inflammation correlate with the severity of the disease [35][36][37]. In a number of research, increased markers of inflammation were observed, such as CRPfrom 90 to 100%, accelerated ESRfrom 75 to 80%, high levels of D-dimersfrom 67 to 100%, fibrinogenfrom 80 to 100%, ferritinfrom 55 to 76%, procalcitoninfrom 80 to 95% and interleukin-6 (IL-6)from 80 to 100% [4,16,18,21,23,31,35]. In our research, children in all groups had high rates of CRP of 162 mg/l [130; 245]; 130 mg/l [90; 160]; 130 mg/l [106; 149], p=0,052), respectively, while patients of 1st group were distinguished.…”

Clinical and Epidemiological Characteristics of Multisystem Inflammatory Syndrome in Children amid the COVID-19 Pandemic

“…Мы не выявили статистич ески значимых отличий в гемограмме в зависимости от текущей пандемии COVID-19. Согласно данным литературных источников, лимфопения встречается от 80 до 95% случаев, нейтрофилия -от 68 до 90%, анемия легкой степени -70%, тромбоцитопения -от 31 до 80%, что согласуется с данными нашего исследования [4,6,13,23,[35][36][37].…”

“…Согласно литературным данным, лабораторные маркеры воспаления коррелируют с тяжестью заболевания [35][36][37]. В ряде исследований наблюдали повышенные маркеры воспаления, такие как СРБ -от 90 до 100%, СОЭ -от 75 до 80%, высокий уровень D-димеров -от 67 до 100%, фибриногена -от 80 до 100%, ферритина -от 55 до 76%, прокальцитонина -от 80 до 95% и интерлейкина-6 (IL-6) -от 80 до 100% [4,16,18,21,23,31,35] По данным рентгенографии / компьютерной томографии органов грудной клетки у 28 (44%) детей регистрировались изменения в легких в виде интерстициальных изменений или пневмонии. Из них 5 (17%) детей имели признаки дыхательной недостаточности 2-й степени и нуждались в кислородотерапии средней длительностью 3 (1-5) дня.…”