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Published on: February 14, 2019
Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter,
Fernanda Lima-Setta1, Maria Clara de Magalhães-Barbosa2, Gustavo Rodrigues-Santos2
1Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Instituto Fernandes Figueira, Unidade de Pacientes Graves, Fiocruz, Rio de Janeiro, RJ, Brazil.
Insights
Pediatric patients with multisystem inflammatory syndrome (MIS-C) often presented with gastrointestinal issues and cardiac dysfunction. While most recovered, long-term cardiac monitoring is crucial for children with MIS-C.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Cardiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition linked to SARS-CoV-2 infection.
- Understanding the clinical spectrum and outcomes of MIS-C is vital for timely diagnosis and management.
Purpose of the Study:
- To characterize the clinical, laboratory, and radiological features of pediatric patients diagnosed with MIS-C.
- To describe the treatment strategies and short-term outcomes for children with MIS-C.
Main Methods:
- A multicenter, prospective cohort study was conducted in 17 pediatric intensive care units across Brazil.
- Consecutive patients aged 1 month to 19 years meeting MIS-C diagnostic criteria were enrolled between March and July 2020.
Main Results:
- Fifty-six patients were included, presenting with conditions such as Kawasaki-like disease, incomplete Kawasaki disease, and acute cardiac dysfunction.
- Gastrointestinal symptoms (71%) and shock (59%) were common; 55% had confirmed SARS-CoV-2 infection.
- Elevated d-dimer (80%) and cardiac dysfunction markers (75%) were frequent. Most received immunoglobulin therapy, with low rates of invasive ventilation and a 1.8% mortality rate.
Conclusions:
- Clinical characteristics of MIS-C in this cohort were comparable to international findings.
- The study highlights the significant impact of MIS-C on pediatric cardiac function and the need for ongoing surveillance.
- Long-term follow-up is essential to ascertain potential chronic cardiac sequelae in children recovering from MIS-C.
Objective:
To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C.
Method:
Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively.
Results:
Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. d-Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%).
Conclusions:
Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.
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