COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis

Abstract

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19.
 This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: (“novel coronavirus” Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates.
 Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%).
 The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

COVID-19 Infection in Spinal Muscular Atrophy Associated with Multisystem Inflammatory Syndrome

“…Kaushik et al [26] found similar imaging abnormalities in 90 (13.7%) of the patients, which resembled the findings in our case. A complete blood count tends to show elevated neutrophils and reduced lymphocytes which were replicated in our findings [24][25][26]. e laboratory findings in MIS-C uniformly indicate ≥4 elevated inflammatory markers such as erythrocyte sedimentation rate, C-reactive protein, procalcitonin, and ferritin, with a simultaneous rise in the International Normalized Ratio, fibrinogen, D-dimer, alanine aminotransferase, lactate dehydrogenase, interleukin-6 and interleukin-8, and cardiac markers (B-type natriuretic peptide, N-terminal proBtype natriuretic peptide, and troponin) [14,[27][28][29].…”

“…In three systematic reviews and meta-analyses of MIS-C, the pulmonary radiological features were described as infiltrates or opacities which were reported by Yasuhara et al among 131 subjects (38.3% [95% CI, 29.7–46.9]) [ 24 ]. Badaradan et al [ 25 ] found across 8 studies that 45.9% (95% CI, 34.1%–58.2%) of the patients had abnormalities on chest X-ray or computed tomography which included ground-glass opacity, interstitial abnormalities, or local patchy shadowing. Kaushik et al [ 26 ] found similar imaging abnormalities in 90 (13.7%) of the patients, which resembled the findings in our case.…”

Vitamin D in Corona Virus Disease 2019 (COVID-19) Related Multisystem Inflammatory Syndrome in Children (MIS-C)

“…It has been reported that the prevalence of severe or critical disease is 10.6, 7.3% and about 4% in children aged <1 year, 1-5years and 6-15 year, respectively (11). Few months after the onset of the pandemic, a series of reports around the world described clusters of children and adolescents presenting with a lifethreatening, hyperinflammatory syndrome, named Kawasakilike syndrome (8,12), Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) (13) or Multisystem Inflammatory Syndrome in Children (MIS-C) (14). The pathogenesis of MIS-C is still unknown, although it has been suggested that this syndrome occurs while the immune system is activated against the SARS-CoV-2 virus (15).…”

Ocular and Systemic Manifestations in Paediatric Multisystem Inflammatory Syndrome Associated with COVID-19

“…However, the United Kingdom's National Health Service alerted paediatricians regarding a new outbreak of a Kawasaki-like disease, which was temporally associated with COVID-19 and revealed clinical evidence of SARS-CoV-2 infection [5,6]. Affected children appear to have severe illness, including fever and multi-organ inflammation (shock, cardiac, respiratory, renal, gastrointestinal, or neurological symptoms) similar to the cytokine storm in Kawasaki disease (KD) [7][8][9].…”