COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis

Abstract

Background Multisystem inflammatory syndrome in children (MIS‐C) associated with coronavirus disease 2019 has been increasingly recognized. However, the clinical features of MIS‐C and the differences from Kawasaki disease remain unknown. The study aims to investigate the epidemiology and clinical course of MIS‐C. Methods PubMed and EMBASE were searched through August 30, 2020. Observational studies describing MIS‐C were included. Data regarding demographic features, clinical symptoms, laboratory, echocardiography and radiology findings, treatments, and outcomes were extracted. Study‐specific estimates were combined using one‐group meta‐analysis in a random‐effects model. Results A total of 27 studies were identified including 917 MIS‐C patients. The mean age was 9.3 (95% confidence interval [CI], 8.4–10.1). The pooled proportions of Hispanic and Black cases were 34.6% (95% CI, 28.3–40.9) and 31.5% (95% CI, 24.8–38.1), respectively. The common manifestations were gastrointestinal symptoms (87.3%; 95% CI, 82.9–91.6) and cardiovascular involvement such as myocardial dysfunction (55.3%; 95% CI, 42.4–68.2), coronary artery aneurysms (21.7%; 95% CI, 12.8–30.1) and shock (65.8%; 95% CI, 51.1–80.4), with marked elevated inflammatory and cardiac markers. The majority of patients received intravenous immunoglobulin (81.0%; 95% CI, 75.0–86.9), aspirin (67.3%; 95% CI, 48.8–85.7), and corticosteroids (63.6%; 95% CI, 53.4–73.8) with a variety of anti‐inflammatory agents. Although myocardial dysfunction improved in 55.1% (95% CI, 33.4–76.8) at discharge, the rate of extracorporeal membrane oxygenation use was 6.3% (95% CI, 2.8–9.8) and the mortality was 1.9% (95% CI, 1.0–2.8). Conclusion Our findings suggest that MIS‐C leads to multiple organ failure, including gastrointestinal manifestations, myocardial dysfunction and coronary abnormalities, and has distinct features from Kawasaki disease.

Clinical Patterns and Morphology of COVID-19 Dermatology

“…In addition, children with MIS-C experience more gastrointestinal symptoms and less than 50% meet formal criteria for KD. 122 , 123 …”

COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves

“…Critical care evaluation and management is warranted in most cases [ 10 , 11 , 37 , 66 ]. Early recognition of a shock state (vasoplegic vs cardiogenic), proper and judicious fluid resuscitation, early establishment of invasive monitoring, intubation and mechanical ventilation, optimization of oxygen delivery (DO 2 ), minimization of oxygen consumption (VO 2 ), and appropriate initiation of inotropes and vasopressors are key factors to successful and favorable outcomes [ 11 , 67 , 68 ].…”

“…Extracorporeal therapies like plasmapheresis (therapeutic plasma exchange) [ 70 ] and ECMO [ 11 , 66 ] may have a role in treating and supporting these patients especially in cases of severe inflammation, refractory ventricular arrhythmia, refractory vasoplegia, cardiogenic and septic shock. An earlier report from Switzerland and France supports such an approach [ 11 ].…”

Cervical abscess caused by methicillin-susceptible Staphylococcus aureus in an infant infected with SARS-CoV-2: Diagnostic dilemma

“…Coronavirus disease 2019 (COVID- 19) was first reported in Wuhan, China in December 2019. Then, COVID-19 spread rapidly all over the world and became a global threat.…”