Distinguishing active pediatric COVID-19 pneumonia from MIS-C
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Published on: March 6, 2019
Daniel D Reiff1, Melissa L Mannion1, Nichole Samuy2
1Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave. S., CPPN #G10, Birmingham, AL, 35233-1711, USA.
Insights
Distinguishing pediatric COVID-19 pneumonia from MIS-C is crucial for effective treatment. This study highlights key differences in symptoms, demographics, and lab results to aid diagnosis in children.
Area of Science:
- Pediatric infectious diseases
- Critical care medicine
- Epidemiology
Background:
- Pediatric COVID-19 pneumonia and Multisystem Inflammatory Syndrome in Children (MIS-C) require distinct management strategies.
- Accurate differentiation between these conditions is essential for timely and appropriate patient care.
Purpose of the Study:
- To identify distinguishing features between active pediatric COVID-19 pneumonia and MIS-C.
- To utilize presenting signs, symptoms, patient characteristics, and laboratory values for differential diagnosis.
Main Methods:
- Retrospective review of 111 pediatric patients hospitalized with COVID-19 pneumonia or MIS-C.
- Analysis of demographics, clinical presentation, SARS-CoV-2 testing, laboratory data, and echocardiography findings.
- Verification of cases using CDC diagnostic criteria.
Main Results:
- MIS-C patients commonly presented with fever, rash, conjunctivitis, and gastrointestinal symptoms, while COVID-19 pneumonia patients exhibited predominantly respiratory symptoms.
- MIS-C patients were more likely to be healthy at baseline, whereas COVID-19 patients often had underlying illnesses.
- Significant differences in laboratory values (e.g., CRP, ESR, d-dimer, procalcitonin, LDH) and echocardiographic findings (coronary artery changes) were observed between the two groups.
Conclusions:
- This study provides critical insights into differentiating pediatric COVID-19 pneumonia and MIS-C.
- Observed differences in presentation, demographics, and laboratory markers can assist healthcare providers in distinguishing these conditions.
- Early and accurate diagnosis is vital for guiding treatment protocols and improving outcomes in pediatric patients.
Importance:
Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols.
Objective:
To distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics, and laboratory values.
Design:
Patients diagnosed and hospitalized with active COVID-19 pneumonia or MIS-C at Children's of Alabama Hospital in Birmingham, AL from April 1 through September 1, 2020 were identified retrospectively. Active COVID-19 and MIS-C cases were defined using diagnostic codes and verified for accuracy using current US Centers for Disease Control case definitions. All clinical notes were reviewed for documentation of COVID-19 pneumonia or MIS-C, and clinical notes and electronic medical records were reviewed for patient demographics, presenting signs and symptoms, prior exposure to or testing for the SARS-CoV-2 virus, laboratory data, imaging, treatment modalities and response to treatment.
Findings:
111 patients were identified, with 74 classified as mild COVID-19, 8 patients as moderate COVID-19, 8 patients as severe COVID-19, 10 as mild MIS-C and 11 as severe MIS-C. All groups had a male predominance, with Black and Hispanic patients overrepresented as compared to the demographics of Alabama. Most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis, and gastrointestinal symptoms were predominant in the MIS-C population whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients.
Conclusions And Relevance:
This study is one of the first to directly compare COVID-19 and MIS-C in the pediatric population. The significant differences found between symptoms at presentation, demographics, and laboratory findings will aide health-care providers in distinguishing the two disease entities.
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