Multisystem inflammatory syndrome in children associated with COVID‐19 in 101 cases from Turkey (Turk‐MISC study)

Abstract

Aim Multisystem inflammatory syndrome in children (MIS‐C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS‐C in 25 different hospitals in Turkey. Methods The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis. Results The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6–9.3); 51 (50.5%) were boys. Reverse‐transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS‐CoV‐2. The predominant complaints were fever (100%), fatigue ( n = 90, 89.1%), and gastrointestinal symptoms ( n = 81, 80.2%). Serum C‐reactive protein (in 101 patients, median 165 mg/L; range 112–228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30–84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58–20.2) were elevated. Thirty‐eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin ( n = 92, 91%) and glucocorticoids ( n = 59, 58.4%). Seven patients (6.9%) died. Conclusion The clinical spectrum of MIS‐C is broad, but clinicians should consider MIS‐C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS‐C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS‐C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS‐C. Prompt diagnosis and prompt treatment are essential for optimal management.

Intestinal microbiota composition of children with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome (MIS-C)

“…However, COVID-19 can cause long-term complications, such as multiple systemic inflammatory syndrome in children (MIS-C) and long-COVID [ 6 – 9 ]. MIS-C is a severe disease condition which characterized by fever, rash, conjunctivitis, gastrointestinal symptoms, and shock due to myocardial dysfunction in children who have SARS-COV-2 positivity or a history of exposure approximately 4–6 weeks before the onset of symptoms [ 2 , 10 ]. Although genetic and immune system-related risk factors are thought to play a role in the pathogenesis of MIS-C, they have not been fully elucidated and the underlying etiology appears to be multifactorial.…”

Which Findings Make multisystem Inflammatory Syndrome in Children Different from the Pre-Pandemic Kawasaki Disease?

“…Gastrointestinal findings were among the most remarkable clinical findings in the majority of the MIS-C group and were significantly different from patients diagnosed with Kawasaki disease [18,20,21]. In the studies conducted by Ciftdogan et al [13,22], it was stated that gastrointestinal symptoms were more dominant at presentation in MIS-C patients. When classified according to the age groups of these patients, it was noted that gastrointestinal complaints such as nausea were primarily detected in older children.…”

A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

“…Following the disease definition, fever, rash, cardiac, and GIS involvement signs were reported to be the most common clinical findings of MIS-C, in several cohort studies [14,15 & ,47, [55][56][57][58]. We tried to summarize the main characteristics of MIS-C patients in Table 1 There are also other miscellaneous cases whose cardinal signs have been uncommon such as acute pancreatitis, encephalopathy, cerebellitis, diabetic ketoacidosis, hepatitis, acute appendicitis, mesenteric lymphadenopathy, ocular myasthenia, and papilledema [70][71][72][73][74][75][76][77][78].…”