Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new phenomenon reported worldwide with temporal association with Covid-19. The objective of this paper is to evaluate reported cases in children and adolescents. From 1726 papers, 35 documented papers related to MIS-C cases identified 783 individual cases of MIS-C between March-June 2020; with 55% being male ( n = 435) and a median age of 8.6 years (IQR, 7–10 years; range 3 months–20 years). Patients with MIS-C were noted to have a high frequency of gastrointestinal symptoms (71%) including abdominal pain (34%) and diarrhea (27%). Cough and respiratory distress were reported in 4.5% and 9.6% cases respectively. Blood parameters showed neutrophilia in 345/418 (83%) of cases and a high CRP in 587/626 (94%). 362/619 (59%) cases were SARS-CoV-2 infection positive (serology or PCR) however only 41% demonstrated pulmonary changes on chest imaging. Severity of illness was high with 68% cases requiring intensive care admission; 63% requiring inotropic support; 244/783 (28%) cases needing some form of respiratory support (138 mechanically ventilated), and 31 required extra-corporeal membrane oxygenation. Treatment strategies included intravenous immunoglobulin (63%) and intravenous steroids (44%). 29 cases received Infliximab, 47 received IL1 (interleukin) receptor antagonist, and 47 received IL6-receptor antagonist. 12/783 (1.5%) children died. In summary, a higher incidence of gastrointestinal symptoms were noted in MIS-C. In contrast to acute Covid-19 infection in children, MIS-C appears to be a condition of higher severity with 68% of cases having required critical care support.

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

“…As mentioned previously, two systematic reviews have been recently published that include patients with MIS-C [10,12]. However, this scoping review provides additional insight into this rapidly evolving condition as it includes several studies not included in either previous review, with MIS-C data through October 5, 2020 (compared to May 31, 2020 and June 20, 2020 in previous reviews).…”

“…Data on symptomatic management of MIS-C patients is rapidly emerging. There exists at least one systematic review on MIS-C which included data through June 2020 from 35 articles relating to 783 patients [10]. Roughly half of the primary studies included in the systematic review by Radia et al are reported in further detail here, as many did not meet eligibility criteria of this present study or did not report quantitative laboratory data.…”

Acute Kidney Injury in Multisystem Inflammatory Syndrome in Children (MIS-C)

“…We also want to emphasize that renal involvement has been reported too rarely, even not reported in several MIS-C series [ 3 – 6 ]. We are not sure how reliable it would be to suggest that an extremely rarely reported entity is caused by MIS-C before all possible diagnoses have been ruled out.…”

Coronavirus Desease 2019 (COVID-19) in Children: Lessons from Pediatric Rheumatology

“…MIS-C развивается через 2-4 недели после заражения SARS-CoV-2 [15], клинические проявления характеризуется большим разнообразием [16][17][18][19][20][21][22] (табл. 2).…”

“…Пандемия коронавирусной болезни 2019 (coronavirus disease -COVID- 19), этиологически связанной с вирусом SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), привлекла внимание к новым клиническим и фундаментальным проблемам иммунопатологии заболеваний человека у взрослых [1] и детей [2] в целом и иммуновоспалительных ревматических заболеваний (ИВРЗ) в частности [3]. У взрослых клинические проявления COVID-19 варьируют от бессимптомного носительства до развития острого респираторного дистресс-синдрома (ОРДС), микрососудистой коагулопатии, макротромбозов и полиорганной недостаточности, ассоциирующихся с высокой летальностью [1].…”