Multisystem inflammatory syndrome in children: A systematic review

Abstract

Background Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome, is a new dangerous childhood disease that is temporally associated with coronavirus disease 2019 (COVID-19). We aimed to describe the typical presentation and outcomes of children diagnosed with this hyperinflammatory condition. Methods We conducted a systematic review to communicate the clinical signs and symptoms, laboratory findings, imaging results, and outcomes of individuals with MIS-C. We searched four medical databases to encompass studies characterizing MIS-C from January 1st, 2020 to July 25th, 2020. Two independent authors screened articles, extracted data, and assessed risk of bias. This review was registered with PROSPERO CRD42020191515. Findings Our search yielded 39 observational studies ( n = 662 patients). While 71·0% of children ( n = 470) were admitted to the intensive care unit, only 11 deaths (1·7%) were reported. Average length of hospital stay was 7·9 ± 0·6 days. Fever (100%, n = 662), abdominal pain or diarrhea (73·7%, n = 488), and vomiting (68·3%, n = 452) were the most common clinical presentation. Serum inflammatory, coagulative, and cardiac markers were considerably abnormal. Mechanical ventilation and extracorporeal membrane oxygenation were necessary in 22·2% ( n = 147) and 4·4% ( n = 29) of patients, respectively. An abnormal echocardiograph was observed in 314 of 581 individuals (54·0%) with depressed ejection fraction (45·1%, n = 262 of 581) comprising the most common aberrancy. Interpretation Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. With prompt recognition and medical attention, most children will survive but the long-term outcomes from this condition are presently unknown. Funding Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study

Immune Mechanisms in Cardiovascular Diseases Associated With Viral Infection

“…Also, a case series analysis of 58 hospitalized children with SARS-CoV-2 has shown 22% with Kawasaki disease and 14% coronary artery dilatations (172). Another systemic review from 39 observational studies from 662 patients showed that the patients presented with gastrointestinal symptoms and abnormal inflammatory, coagulation, cardiac markers, and ECG with decreased heart ejection fraction (173). These data demonstrate aberrant systemic inflammatory responses in children due to MIS-C with COVID-19.…”

COVID-19 Infection in a Child Presenting With Functional Intestinal Obstruction

“…While COVID-19 infection affects all age groups and most children seem to be asymptomatic, the infection may also cause lifethreatening illnesses, especially in infants aged less than one year and in children with underlying health problems [4,5,6]. COVID-19 infection in children manifests as diverse clinical findings among which fever and cough are the most commonly reported symptoms [5,6]. However, gastrointestinal (GI) symptoms may occur without respiratory symptoms [5].…”

“…COVID-19 infection in children manifests as diverse clinical findings among which fever and cough are the most commonly reported symptoms [5,6]. However, gastrointestinal (GI) symptoms may occur without respiratory symptoms [5]. Diarrhea, vomiting, and abdominal pain are the most common GI symptoms reported in children [4,5].…”

“…However, gastrointestinal (GI) symptoms may occur without respiratory symptoms [5]. Diarrhea, vomiting, and abdominal pain are the most common GI symptoms reported in children [4,5].…”

“…In April 2020, pediatricians in the UK reported cases of pediatric COVID-19 with presentations including toxic shock syndrome or incomplete Kawasaki disease [7]. Since the emergence of the pandemic, there have been increased reports of similar symptoms worldwide [5,6]. On May 14, 2020, the US Centers for Disease Control and Prevention (CDC) termed this life-threatening complication of pediatric COVID-19 as multisystem inflammatory syndrome in children (MIS-C) [8].…”