Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): a Brazilian cohort

Abstract

Background Paediatric inflammatory multisystem syndrome (PIMS) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described since mid-April 2020 with the first reports coming from Europe. Our objective was to describe the characteristics of patients among the Brazilian population. Methods A multicenter retrospective study was conducted with the participation of five pediatric rheumatology centers in Brazil during the period from March to November 2020. Children and adolescents with PIMS temporally associated with SARS-CoV-2 (TS) who met the definition criteria for the disease according to the Royal College of Paediatrics and Child Health were included. Demographic, clinical, laboratory, therapeutic characteristics and molecular and serological diagnosis of SARS-CoV-2 infection were described. Results Fifty-seven children and adolescents with PIMS-TS were evaluated, 54% female, with a median age of 8 (3–11) years. Most (86%) were previously healthy, with asthma being the main comorbidity, present in 10% of the patients. Fever was the main manifestation, present in all patients, followed by mucocutaneous and gastrointestinal features, present in 89% and 81% of the patients, respectively. Myocarditis occurred in 21% of the patients and in 68% of them required intensive care. The Kawasaki disease phenotype occurred in most patients (77%). All patients had elevated inflammatory markers, with elevated CRP being the most found (98%). Anemia and lymphopenia were present in 79% and 72%, respectively. Laboratory evidence of SARS-CoV-2 was found in 77% of the patients, with 39% positive RT-PCR and 84% positive serology for SARS-CoV-2. An immunomodulatory treatment was performed in 91% of the patients, with 67% receiving intravenous immunoglobulin (IVIG) associated with glucocorticoid, 21% receiving IVIG, and 3.5% receiving glucocorticoid. The median length of hospitalization was 10 days. Conclusions This study showed a high morbidity of PIMS-TS in Brazilian children, with a prolonged length of hospitalization and a high rate of admission to pediatric intensive care unit. Multicenter prospective studies are needed to assess the morbidity of the disease in the medium and long term.

Multisystem inflammatory syndrome in children during the first two years of the COVID-19 pandemic in Luxembourg

“…In two different meta-analysis involving in total 1,700 MIS-C cases ( 3 , 23 ) gastrointestinal symptoms occurred in 71% and 87% of the patients, and abnormal echocardiogram/myocardial dysfunction in 59% and 55% of the cases. Concerning other demographic and clinical characteristics of our national cohort, findings are also comparable to other published cohorts with most affected children being previously healthy ( 2 , 5 , 15 ), developing high rate of cardiac complications but evolving favourably in most of the cases with relatively short hospital stay (<10 days) ( 1 , 5 , 14 , 15 ,). With prompt diagnosis and treatment, 100% of our patients had an excellent evolution with no permanent organ failure.…”

“…This unusual inflammatory disease has now been reported worldwide. It is manifested by different clinical symptoms like high persisting fever, skin rash, multiple organ involvement and dysfunction including heart failure (3)(4)(5)(6)(7). Since first MIS-C cases were published, different scientific societies [Center for Disease Control and Prevention (CDC), Royal College of Pediatrics and Child Health…] have developed diagnostic criteria and case definitions.…”

Differentiating abdominal pain due to COVID-19 associated multisystem inflammatory syndrome from children with acute appendicitis: a score system

“…Changes in the blood count were most apparent in the presence of lymphopenia and thrombocytopenia in patients with MIS-C [25,26]. There were no significant differences in lymphopenia or thrombocytopenia between groups.…”

Clinical profile of multisystem inflammatory syndrome in children associated with COVID-19 in a rural medical college

“…Only few studies found girls to be affected more. 2,3,8,[13][14][15][16][17] Most of the cases recovered. Only 4 (6%) patients died in this study.…”