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Multisystem Inflammatory Syndrome in Children With COVID-19 in Mumbai, India
Shreepal Jain1, Supratim Sen2, Srinivas Lakshmivenkateshiah3
1Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
Insights
Multisystem inflammatory syndrome in children (MIS-C) in India presented with shock in 65% of cases. Steroids and IVIg were common treatments, with a good outcome and only one death in 23 pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Cardiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is a serious condition requiring prompt recognition and management.
- Limited data exists on MIS-C presentation and outcomes in the Indian subcontinent.
Purpose of the Study:
- To describe the clinical presentation, treatment strategies, and outcomes of pediatric patients diagnosed with MIS-C in the Mumbai metropolitan area.
- To identify clinical and laboratory factors associated with severe disease presentation in MIS-C.
Main Methods:
- An observational study was conducted involving 23 pediatric patients diagnosed with MIS-C according to WHO criteria.
- Data on demographics, clinical symptoms, laboratory markers, treatments, and outcomes were collected retrospectively from hospital records.
- Statistical analysis was performed to compare characteristics between patients with and without shock.
Main Results:
- 23 children (median age 7.2 years) were included; 39.1% had positive COVID-19 RT-PCR and 30.4% had positive antibody tests.
- 65% of patients presented in shock, associated with higher age, myocarditis, elevated cardiac biomarkers, and specific white blood cell count abnormalities.
- Coronary artery dilation occurred in 26% of patients. Treatment predominantly involved steroids (96%) and intravenous immunoglobulin (IVIg) (65%).
Conclusions:
- This study provides initial insights into MIS-C in India, highlighting a high prevalence of shock and cardiac involvement.
- Steroid and IVIg therapy appeared effective, leading to a favorable outcome with a single mortality.
- Further research and extended surveillance are crucial for refining diagnostic, treatment, and monitoring guidelines for MIS-C.
Objective:
We describe the presentation, treatment and outcome of children with multisystem inflammatory syndrome with COVID-19 (MIS-C) in Mumbai metropolitan area in India.
Method:
This is an observational study conducted at four tertiary hospitals in Mumbai. Parameters including demographics, symptomatology, laboratory markers, medications and outcome were obtained from patient hospital records and analyzed in patients treated for MIS-C (as per WHO criteria) from 1 May, 2020 to 15 July, 2020.
Results:
23 patients (11 males) with median (range) age of 7.2 (0.8-14) years were included. COVID-19 RT-PCR or antibody was positive in 39.1% and 30.4%, respectively; 34.8% had a positive contact. 65% patients presented in shock; these children had a higher age (P=0.05), and significantly higher incidence of myocarditis with elevated troponin, NT pro BNP and left ventri-cular dysfunction, along with significant neutrophilia and lympho-penia, as compared to those without shock. Coronary artery dilation was seen in 26% patients overall. Steroids were used most commonly for treatment (96%), usually along with intra-venous immunoglobulin (IVIg) (65%). Outcome was good with only one death.
Conclusion:
Initial data on MIS-C from India is presented. Further studies and longer surveillance of patients with MIS-C are required to improve our diagnostic, treatment and surveillance criteria.
