Multisystem inflammatory syndrome in children in South Africa

Webb, Kate; Abraham, Deepthi Raju; Faleye, Ayodele; McCulloch, Mignon; Rabie, Helena; Scott, Christiaan; MISC-Team, Cape Town

doi:10.1016/s2352-4642(20)30272-8

Cited by 78 publications

(111 citation statements)

References 3 publications

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“…MIS-C cases started appearing around 1 month after COVID-19 peak in the population. Forty-eight percent (456 out of 948) had antibodies [ 6 – 13 , 15 , 16 , 19 – 22 ], while RT-PCR was positive in 263 out of 948 (28%) patients. Twenty-three percent had both RT-PCR and Serology positive [ 6 , 7 , 12 – 14 , 16 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-three percent had both RT-PCR and Serology positive [ 6 , 7 , 12 – 14 , 16 , 21 ]. Out of 743 cases, 76 (10%) patients had contact history with COVID patients [ 6 , 9 , 11 , 12 , 15 – 18 , 21 , 22 ]. Fever was the most common reported symptom in 95%, followed by gastrointestinal (78%), cardiovascular (75.5%), respiratory system (55.3%), and CNS (30.6%) involvement, while 19.6% patients had acute kidney injury.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Emerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection: a Systematic Review with Meta-analysis

Sood

Sharma

Sood

et al. 2021

SN Compr. Clin. Med.

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With the increased spread of severe acute respiratory syndrome coronavirus 2 infection, more patients with multisystem inflammatory syndrome in children (MIS-C) are being reported worldwide. This systematic review with meta-analysis aims to analyse the clinical features, proposed pathogenesis and current treatment options for effective management of children with this novel entity. Electronic databases (Medline, Google Scholar, WHO, CDC, UK National Health Service, LitCovid, and other databases with unpublished preprints) were extensively searched, and all articles on MIS-C published from January 1, 2020, to October 10, 2020, were retrieved. English language studies were included. This systematic review analysed 17 studies with 992 MIS-C patients from low-income and middle-income countries (LMICs) and developed countries (France, the UK, Italy, Spain, Chile and the US CDC data). Fever (95%) was the most common clinical manifestation followed by gastrointestinal (78%), cardiovascular (75.5%), and respiratory system (55.3%) involvement. Laboratory or epidemiologic evidence of inflammation and SARS-CoV-2 infection was present. Though the exact pathogenesis remains elusive, virus-induced post-infective immune dysregulation appears to play a predominant role. Features resembling Kawasaki disease, toxic shock syndrome or macrophage activation syndrome were present; 49% had shock; 32% had myocarditis; 18% had coronary vessel abnormalities and 9% had congestive cardiac failure. Sixty-three percent of the patients were admitted in paediatric intensive care unit (PICU); 63% received intravenous immunoglobulin, 58% received corticosteroids and 19% received alternate agents like tocilizumab; there were 22 (2.2%) deaths. Only 9/144 children in LMICs received tocilizumab that was significantly less than children in developed countries (p < 0.0001). This systematic review delineates and summarises recently published data on MIS-C from LMICs and developed countries. Although most needed PICU admission and received treatment with IVIG and steroids, most of the patients survived. Significantly fewer patients in developing countries received tocilizumab therapy than those in developed countries. It is crucial for clinician to recognise MIS-C, to differentiate it from other defined inflammatory conditions and initiate early treatment. Further studies are needed for long-term prognosis, especially relating to cardiac complications of MIS-C. Keywords COVID-19. Hemophagocytic lympho-histiocytosis. Kawasaki disease. SARS-CoV-2. Macrophage activation syndrome. Multisystem inflammatory syndrome in children (MIS-C). Toxic shock syndrome This article is part of the Topical Collection on Covid-19

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Emerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection: a Systematic Review with Meta-analysis

Sood

Sharma

Sood

et al. 2021

SN Compr. Clin. Med.

View full text Add to dashboard Cite

show abstract

“…Cardiac dysfunction appears the hallmark describing PIMS patients and includes coronary artery dilatation or aneurysms, myocarditis, left ventricular dysfunction, pericardial effusion, and even shock. Most of them were admitted to the PICU and required inotrope or vasoactive support (13,19,45,46).…”

Section: Cardiac Dysfunctionmentioning

confidence: 99%

Pediatric Inflammatory Multisystem Syndrome and Rheumatic Diseases During SARS-CoV-2 Pandemic

2020

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Globally, the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appeared to have a milder clinical course in children compared to adults. As severe forms of COVID-19 in adults included an aberrant systemic immune response, children with chronic systemic inflammatory diseases were cautiously followed. No evidence for a specific susceptibility was identified in this pediatric population. European and US Pediatricians started to notice cases of myocarditis, sharing some features with toxic shock syndrome, Kawasaki disease, and macrophage activation syndrome in otherwise healthy patients. Multisystem Inflammatory Syndrome in Children (MIS-C) and Pediatric Inflammatory Multisystem Syndrome (PIMS) have designated this new entity in the US and Europe, respectively. The spectrum of severity ranged from standard hospitalization to pediatric intensive care unit management. Most patients had a clinical history of exposure to COVID-19 patients and/or SARS-COV2 biological diagnosis. Clinical presentations include fever, cardiac involvement, gastro-intestinal symptoms, mucocutaneous manifestations, hematological features, or other organ dysfunctions. The temporal association between the pandemic peaks and outbreaks of PIMS seems to be in favor of a post-infectious, immune-mediated mechanism. Thus, SARS-CoV2 can rarely be associated with severe systemic inflammatory manifestations in previously healthy children differently from adults highlighting the specific need for COVID-19 research in the pediatric population.

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“…[5] The Western Cape, being the initial epicentre of COVID-19 infections within South Africa, had their first MIS-C cases at the beginning of June 2020. [6] Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and MIS-C are synonymous names given to this syndrome. [7][8][9] Despite the differing names and minor differences in case definitions, they include children who present with fever, evidence of inflammation and multi-organ involvement after SARS-CoV-2 exposure.…”

Section: Editorialmentioning

confidence: 99%