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Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study)
Dilek Yilmaz Ciftdogan1,2, Yildiz Ekemen Keles2, Adem Karbuz3
1Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) presents with fever, fatigue, and gastrointestinal issues, often mimicking Kawasaki disease. Early diagnosis and treatment with immunoglobulins and steroids are crucial for managing this severe condition in children.
Area of Science:
- Pediatric infectious diseases
- Pediatric critical care
- Rheumatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition that can lead to shock and death.
- Understanding the clinical features and outcomes of MIS-C is vital for timely intervention.
Purpose of the Study:
- To describe the clinical features, laboratory characteristics, and outcomes of children diagnosed with MIS-C.
- To analyze MIS-C cases across 25 hospitals in Turkey.
Main Methods:
- Retrospective study of 101 pediatric patients diagnosed with MIS-C between April and October 2020.
- Data collected from medical records, including clinical presentation, laboratory results, and treatment.
- Multivariate logistic regression used for comparisons across different demographic groups.
Main Results:
- Predominant symptoms included fever (100%), fatigue (89.1%), and gastrointestinal symptoms (80.2%).
- Elevated inflammatory markers (CRP, ESR, procalcitonin) were observed in most patients.
- Kawasaki disease was diagnosed in 69.3% of cases; 37.6% required intensive care, and 6.9% of patients died.
Conclusions:
- MIS-C exhibits a broad clinical spectrum, often presenting with fever, fatigue, and GI symptoms.
- Prompt diagnosis and management, including immunomodulatory treatments like IVIG and glucocorticoids, are essential.
- Most MIS-C patients were previously healthy, highlighting the importance of considering MIS-C in the differential diagnosis.
Aim:
Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey.
Methods:
The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.
Results:
The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.
Conclusion:
The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
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