Multisystem inflammatory syndrome in children during the coronavirus disease 2019 (COVID-19) pandemic: a systematic review of published case studies

Abstract

Background: Many cases have been reported recently on multisystem inflammatory syndrome in children (MIS-C), a newly emerged disease that seemed to correlate with coronavirus disease 2019 . The aim of this review was to describe the clinical features, treatment and outcomes of MIS-C, as well as to assess the risk of bias of published case studies, analyzing their reporting quality. Methods:We searched all articles reporting on multisystem inflammatory condition in children and adolescents in the context of COVID-19 through MEDLINE (via PubMed), Web of Science, China Biology Medicine disc (CBM) and China National Knowledge Infrastructure (CNKI) from their inception to June 17, 2020. We used CARE and IHE checklists to evaluate the risk of bias and quality of the included studies.We combined the data of clinical manifestations, imaging findings, treatments and outcomes using STATA version 15.Results: Twenty-four studies were included, with a total of 270 participants. Most cases were from Europe and the United States, and the terms of MIS-C in different articles were varied. Fever and gastrointestinal symptoms were the most experienced symptoms. Shock, rash, conjunctivitis, lips or oral cavity changes, hand and feet anomalies, and lymphadenopathy were observed, while respiratory symptoms seemed relatively infrequent. Seventy-eight percent to 100% of patients had evidence of SARS-CoV-2 infection, and patients positive for SARS-CoV-2 by serology [86% (95% CI: 78%, 95%)] were more than those by RT-PCR [36% (95% CI: 26%, 46%)]. Most patients had one or more increased inflammatory markers including C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), ferritin, interleukin-6 (IL-6), and D-dimer, accompanied by neutrophilia and lymphopenia. Impaired cardiac function was seen from elevated biomarkers and abnormal echocardiography. Intravenous immunoglobulin (IVIG), anticoagulants, inotropic agents and glucocorticoids were the main treatments, along with other intensive supportive care. Overall, the outcomes of MIS-C were favorable, and only one death was recorded. In terms of the quality assessment of included studies, most of the case studies did not follow the standard reporting checklist, so that they failed to get higher scores in the risk of bias assessment. Conclusions: Patients with MIS-C present with symptoms more severe than children with COVID-19, 122 Tang et al. A systematic review of MIS-C case studies

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

“…The five most prevalent systemic manifestations in our MIS-C patients were fever (96.4%), gastrointestinal s/s (76.7%), shock (61.5%), rash (57.1%), and neurological s/s (36.8%). Several meta-analyses supported our findings, with similar prevalence [6][7][8]52,59,60,62]. It is worth noting that the frequencies of gastrointestinal s/s and rash in MIS-C were higher than those in typical adult COVID-19 [52,63,64], demonstrating possible differences in the underlying mechanism between MIS-C and adult COVID-19.…”

Clinical features and outcomes of 76 patients with COVID-19-related multi-system inflammatory syndrome in children

“…Although SARS-CoV-2 pandemic is originated from East Asia, most of the MIS-C cases were reported from Europe and the USA [16]. Similar to their geographical locations, Middle East and West Asia are in the middle of the line between East Asia and Western world regarding the number of reported cases [16][17][18]. Given the recent data suggesting that geographical circumstances may influence the development of the disease, large cohort studies from every single country are required for better understanding.…”

Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

“…Moreover, all 21 patients had gastrointestinal symptoms such as vomiting and abdominal pain, 16 (76%) developed myocarditis, 17 (81%) were admitted to an intensive care unit, and 11 (52%) required mechanical ventilation; these findings suggest a pathology that is distinct from Kawasaki disease. Moreover, there have been many reports of MIS-C from Europe and the United States ( 11 ), as well as reports of disease among individuals of Afro-Caribbean and Hispanic ethnicities ( 4 , 5 ). To the best of our knowledge, reports from Asia are rare, with only one report from India ( 12 ) and three reports from Korea ( 13 ).…”