Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems

Ruvinsky, Silvina; Voto, Carla; Roel, Macarena; Fustiñana, Ana; Veliz, Natalia; Brizuela, Martín; Rodríguez, Susana; Ulloa‐Gutiérrez, Rolando; Bardach, Ariel

doi:10.3389/fped.2022.881765

Cited by 17 publications

(20 citation statements)

References 56 publications

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“…They were “wuhan strains” (February 2020 - February 2021), “alpha” (February 2021 - July 2021), “delta” (July 2021 – December 2021). The first cases of MIS-C in children began to be registered approximately 2,7 months after the outbreak of the epidemic in the country and a month after the detection of severe COVID-19 in children, which is quite consistent with the data of other studies [16, 37, 38]. The largest number of patients – 40 (66,7%), were admitted to inpatient treatment during the circulation of the “wuhan strains” of SARS-CoV-2.…”

Section: Discussionsupporting

confidence: 91%

Multisystem Inflammatory Syndrome in Children Course Amid Covid-19 Pandemic in the Rebublic of Belarus

Романова

Коломиец

Savitski

et al. 2022

Preprint

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Resume. In first two years of COVID-19 pandemic, children usually had a mild or asymptomatic form of the disease. However, in rare cases, after suffering COVID-19, children had clinical manifestations similar to incomplete Kawasaki Disease (CD) or toxic shock syndrome. This condition is known as multisystem inflammatory syndrome in children (MIS-C). The purpose of this research was to study clinical and laboratory features and outcomes of multisystem inflammatory syndrome in children who were hospitalized during COVID-19 pandemic. Materials and methods. In 19 months (May 2020 - December 2021) 63 patients with a diagnosis of Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 were observed in the departments of Anesthesiology and Intensive Care of the Healthcare Institution "City Children's Infectious Clinical Hospital" in Minsk, Republic of Belarus. MIS-C was diagnosed on criteria of CDC/WHO, 2020. All calculations were carried out in the statistical package R, version 4.1. The results of the analysis were considered statistically significant with p<0,05. The results of the study. All of 63 children with MIS-C didnt have an acute coronavirus infection. Therefore, it was impossible to determine which strain of SARS-CoV-2 patient exactly had. However, we formed 3 groups of patients based on circulation of the dominant strain of SARS-CoV-2 in Belarus at different times. The 1st group included 40 patients (63,5%) received treatment from 05.25.2020 to 02.21.2021 ("wuhan strains"); the 2nd group - 9 children (14,3%) from 02.23.2021 to 06.13.2021 ("alpha"); the 3rd group - 14 children (22,2%) from 07.01.2021 to 11.19.2021 ("delta"). 47 (74,6%) patients had complete and incomplete Kawasaki Disease phenotype of MIS-C. Nonspecific phenotype was observed in 16 (25,4%) children. It manifested as signs of shock. The mean age didnt differ in study groups. All children had hyperthermic syndrome. Fever reached febrile numbers 3-4 times a day. Average fever duration was 3,2 [1-15] days. The course of MIS-C in children also didnt depend on the circulating strain of the virus. For instance, gastrointestinal dysfunction was observed in all three groups with equal frequency (73%, 78% and 57%, respectively). The only a statistically significant increase was in the number of children with cheilitis. In the 2nd group 8 children (89%) and the 3rd group 13 children (93%) had cheilitis, respectively, p=0,002. Neurological disorders such as headache, hyperesthesia, hallucinations, photophobia were more often observed in the 1st group of children - 19 (48%) cases and less frequently in the 2nd and 3rd group (in 11% and 14% of cases), p=0,022. Pathological blood flow regurgitation was the most common disorder (68-71%). Several biochemical markers of inflammation levels, such as C-reactive protein (CRP) and procalcitonin (PCT), were high. CRP levels were 162 mg/l [130; 245]; 130 mg/l [90; 160]; 130 mg/l [106; 149] in 3 study groups, respectively. In children of the 1st group CRP level was significantly higher, p=0.052. PCT level was higher in patients of the 3rd group (4.2 ng/ml [2,4; 8,8]; 3.9 ng/ml [3,2; 11,9]; 8.7 ng/ml [3,4; 14,1], p=0.625). Conclusion. As a result of the research there wasnt found notable connection between clinical or laboratory features of MIS-C and the dominant circulating strain of SARS-CoV-2 in given time periods. During the circulation of "alpha" and "delta" strains, the only significant differences were decrease of the number of patients with neurological disorders and increase in the frequency of cheilitis, p=0,002. The remaining indicators of organ dysfunction were similar in three groups of children. There was 1 (1,6%) fatal outcome in our study.

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Section: Discussionsupporting

confidence: 91%

Multisystem Inflammatory Syndrome in Children Course Amid Covid-19 Pandemic in the Rebublic of Belarus

Романова

Коломиец

Savitski

et al. 2022

Preprint

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“…In a cohort of 557 severe and critical COVID-19 pediatric patients from North America, Latin America, and Europe, the overall hospital mortality was 10%, but 15% in children <2 years (OR 1.89; 95% CI, 1.05-3.39); 50% of the patients had comorbidity and 83% received antibiotics. Those with MIS-C had a lower mortality risk (OR 0.26; 95% CI, 0.11-0.64) (26) in contrast with other reviews from Latin America that found an overall case fatality ratio of 4% in 592 MIS-C cases (30). In a systematic review and meta-analysis that included 83 studies, 57 (21,549 patients) in the meta-analysis (of which 22 provided individual patient data) and 26 studies in the narrative synthesis, the authors found that hospitalized children and young people at the greatest vulnerability to severe disease or death with SARS-CoV-2 infection are infants, teenagers, those with cardiac or neurological conditions, or 2 or more comorbid conditions, and those who are significantly obese (31).…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation of pediatric patients with symptomatic SARS-CoV-2 infection during the first months of the COVID-19 pandemic in a single center in Mexico City

et al. 2022

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BackgroundThe clinical spectrum of COVID-19 is broad, from asymptomatic to severe cases and death. The objective of this study is to analyze the clinical course of patients attended during the first months of the SARS-CoV-2 pandemic in a third-level pediatric hospital.MethodsDesign: prospective cohort study. Patients with viral respiratory disease or suspected cases of COVID-19 were evaluated at the Pediatric Hospital, National Medical Center XXI Century, Mexico City, from 21 March 2020 to 13 January 2021. Statistical analysis: Chi-square test and Fisher’s exact test were used for comparisons; a logistic regression model was constructed to identify clinical or laboratory characteristics associated with critical disease. A p-value < 0.05 was considered statistically significant.ResultsA total of 697 patients met the operational definition of viral respiratory disease or suspected cases of COVID-19 and underwent real-time reverse transcription polymerase chain reaction (rRT-PCR) SARS-CoV-2 testing. Patients with a positive result were included. Of the 181 patients (26%), 121 (66.8%) had mild disease and were treated as outpatients and 60 (33.1%) were hospitalized. A total of six patients met the criteria for multisystem inflammatory syndrome in children (MIS-C). Of the 60 inpatients, 65% were males, and 82% had one or more comorbidities. The main comorbidities were cancer (42%) and overweight (15%). The median hospital stay was 9 days. The inpatients had a higher frequency of fever, general malaise, dyspnea, chills, polypnea, and cyanosis than the outpatients (p < 0.05). Only 21.4% of the outpatients had one or more comorbidities, which were lower than in the hospitalized patients (p < 0.001). Laboratory data at admission were similar between critically ill and those with moderate and severe disease. The patients who developed pneumonia were at higher risk of critical disease, while older age was associated with a better prognosis. A total of 13 of the 60 inpatients died (mortality 7.1%). All but one had one or more comorbidities: four had cancer, four congenital heart disease, one chronic kidney disease and epilepsy, one Epstein–Barr virus-induced hemophagocytic lymphohistiocytosis, one obesity, and one diabetes mellitus.ConclusionHospital mortality is high, especially in children with comorbidities. Despite 2 years having passed since the beginning of the COVID-19 pandemic, the epidemiological and clinical data on children are still helpful to improve their prognosis.

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“…It is relevant and essential to examine the clinical characteristics, disease management, and outcomes of MIS-C due to the potentially severe consequences such as death (16)(17)(18), damage to coronary arteries, and the toll on healthcare resources necessary for its management. The present cohort's mortality rate was 4.6%, which exhibited high heterogeneity across the centers, ranging from 0% to 13.5%.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Multisystem Inflammatory Syndrome in Children: A Multicenter, Retrospective, Observational Cohort Study in Mexico

González-García

Yamazaki‐Nakashimada

Márquez-González

et al. 2023

Preprint

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Multisystem inflammatory syndrome in children temporally associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysm were found in 5.7% and 13.2% of the patients, respectively. The rate of mortality due to SARS-CoV-2-related factors was 4.6%. Delay of ≥10 days in hospital admission was associated with coronary artery aneurysm or dilatation (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2- 2.0). Age ≥ 10 years (OR 5.6, 95% CI 1.4- 2.04), severe underlying condition (OR 9.3, 95% CI 2.8- 31.0), platelet count < 150,000/mm3 (OR 4.2, 95% CI 1.2- 14.7), international normalized ratio > 1.2 at admission (OR 3.8, 95% CI 1.05- 13.9), and serum ferritin concentration > 1500 mg/dL (OR 52, 95% CI 5.9- 463) were risk factors for death.

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Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems

Cited by 17 publications

References 56 publications

Multisystem Inflammatory Syndrome in Children Course Amid Covid-19 Pandemic in the Rebublic of Belarus

Multisystem Inflammatory Syndrome in Children Course Amid Covid-19 Pandemic in the Rebublic of Belarus

Clinical presentation of pediatric patients with symptomatic SARS-CoV-2 infection during the first months of the COVID-19 pandemic in a single center in Mexico City

Characteristics and Outcomes of Multisystem Inflammatory Syndrome in Children: A Multicenter, Retrospective, Observational Cohort Study in Mexico

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