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Published on: May 25, 2022
Ocular and Systemic Manifestations in Paediatric Multisystem Inflammatory Syndrome Associated with COVID-19
Tzu-Chen Lo1,2, Yu-Yen Chen2,3,4,5
1Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Insights
Multisystem inflammatory syndrome in children (MIS-C) following COVID-19 often presents with fever, gastrointestinal issues, and shock. Many MIS-C cases share features with Kawasaki disease (KD), suggesting immune dysregulation plays a key role.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition following COVID-19.
- Understanding its epidemiological and clinical features is crucial for timely diagnosis and management.
Purpose of the Study:
- To elucidate the epidemiological and clinical characteristics of MIS-C in children post-COVID-19.
- To compare MIS-C features with Kawasaki disease (KD).
Main Methods:
- A systematic literature search of PubMed and Embase (December 2019–March 2021) was conducted.
- Peer-reviewed clinical studies and case series on MIS-C were included.
- Pooled analysis of data from 32 studies involving 1458 patients.
Main Results:
- Fever (96.4%), gastrointestinal symptoms (76.7%), shock (61.5%), and rash (57.1%) were common.
- Conjunctivitis was observed in approximately half of patients.
- One-third met criteria for complete Kawasaki disease; 82.2% tested positive for SARS-CoV-2 antibodies versus 37.0% for RT-PCR.
Conclusions:
- MIS-C exhibits features overlapping with Kawasaki disease.
- Epidemiological and serological data suggest post-infectious immune dysregulation is a primary driver.
- Further research is needed to fully understand MIS-C pathogenesis.
Abstract:
This study aimed to achieve a better understanding of the epidemiological and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). We searched PubMed and Embase between December 2019 and March 2021 and included only peer-reviewed clinical studies or case series. The proportions of patients who had conjunctivitis, systemic symptoms/signs (s/s), Kawasaki disease (KD), and exposure history to suspected/confirmed COVID-19 cases were obtained. Moreover, positive rates of the nasopharyngeal real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serum antibody for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recorded. Overall, 32 studies with 1458 patients were included in the pooled analysis. Around half of the patients had conjunctivitis. The five most common systemic manifestations were fever (96.4%), gastrointestinal s/s (76.7%), shock (61.5%), rash (57.1%), and neurological s/s (36.8%). Almost one-third presented complete KD and about half had exposure history to COVID-19 cases. The positivity of the serology (82.2%) was higher than that of the nasopharyngeal RT-PCR (37.0%). MIS-C associated with COVID-19 leads to several features similar to KD. Epidemiological and laboratory findings suggest that post-infective immune dysregulation may play a predominant role. Further studies are crucial to elucidate the underlying pathogenesis.
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