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Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review
Insights
Multisystem Inflammatory Syndrome (MIS-C) in children is a rare but serious condition linked to SARS-CoV-2. Early diagnosis and treatment, often involving IVIG and inotropic support, are crucial for managing this potentially life-threatening manifestation.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The COVID-19 pandemic caused by SARS-CoV-2 has led to significant global health challenges.
- While most pediatric SARS-CoV-2 infections are mild, a subset can develop Multisystem Inflammatory Syndrome in Children (MIS-C).
- Understanding MIS-C is vital for timely intervention in vulnerable pediatric populations.
Purpose of the Study:
- To conduct a scoping review of MIS-C in pediatric patients related to SARS-CoV-2.
- To synthesize current knowledge on the epidemiology, clinical presentation, and management of MIS-C.
- To inform early diagnosis and treatment strategies for MIS-C.
Main Methods:
- Scoping review following Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines.
- Searched PubMed and Scopus for primary studies meeting CDC criteria for MIS-C (Dec 2019 - Oct 2020).
- Included 57 studies encompassing 875 pediatric patients from 15 countries.
Main Results:
- MIS-C affected 875 children globally, with 57% males and a median age of 9 years.
- Common symptoms included fever, conjunctivitis, and gastrointestinal issues; 45% had comorbidities like obesity.
- Elevated inflammatory biomarkers (CRP, ESR, IL-6, ferritin) and cardiac markers (troponin I, NT-proBNP) were prevalent; treatment often involved IVIG and inotropic support.
Conclusions:
- MIS-C is a distinct, potentially severe manifestation of SARS-CoV-2 in children.
- Prompt medical intervention is frequently required for MIS-C management.
- Further research can refine understanding and treatment protocols for pediatric MIS-C.
Purpose:
The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 43 million people resulting in over 1 million deaths. Approximately 2% of cases in the United States are children, and in most cases the child is either asymptomatic or has mild symptoms. However, some pediatric cases can present with Multisystem Inflammatory Syndrome (MIS-C). Understanding the epidemiology, clinical presentation, and management of MIS-C related to SARS-CoV-2 will help to streamline early diagnosis and treatment, particularly in pediatric patients with complex medical conditions.
Methods:
This scoping review adopted methods from the Joanna Briggs Institute (JBI) manual for evidence synthesis and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies of patients meeting the Centers for Disease Control and Prevention (CDC) criteria for MIS-C from December 31st, 2019 to Oct 5th, 2020 were identified using PubMed and Scopus. Articles were screened for eligibility, and data collection was conducted on those fulfilling inclusion criteria.
Results:
Of 417 studies identified, 57 met inclusion criteria, accounting for 875 patients from 15 countries. Globally, 57% of children affected with MIS-C were males. The median age was 9 years old, ranging from 6 months to 21 years. Forty-five percent of the patients had underlying comorbidities including obesity and lung disease. Fever, conjunctivitis and GI symptoms were common. Most MIS-C patients had high biomarkers including troponin I, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), interleukin 6 (IL-6), procalcitonin, and ferritin. The treatment for most patients included IVIG and inotropic support.
Conclusion:
MIS-C can be a unique and potentially life-threatening manifestation of SARS-CoV-2 in children and often requires medical intervention.
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