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Eastern India Collaboration on Multisystem Inflammatory Syndrome in Children (EICOMISC): A Multicenter Observational
Snehamayee Nayak1, Prakash Chandra Panda2, Basudev Biswal3
1SCB Medical College, Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics (SVPPGIP), Cuttack, India.
Insights
Multisystem inflammatory syndrome in children (MIS-C) presents with diverse symptoms. Key mortality predictors include comorbidities, lymphopenia, thrombocytosis, hyponatremia, elevated LDH, and hypoalbuminemia.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Limited data exists on multisystem inflammatory syndrome in children (MIS-C) epidemiology and outcomes, especially from resource-poor settings.
- Multi-center studies on MIS-C are scarce, particularly within the Indian context.
Purpose of the Study:
- To investigate the epidemiology, clinical features, and outcomes of MIS-C in children.
- To identify factors associated with mortality in MIS-C cases.
Main Methods:
- A retrospective collaborative study involving 134 children (≤15 years) diagnosed with MIS-C across five tertiary care hospitals in Eastern India.
- Data collection focused on clinical presentation, comorbidities, treatment, and mortality, adhering to WHO criteria for MIS-C.
- Primary outcome measure was mortality; secondary outcomes included coronary artery abnormalities and treatment response.
Main Results:
- Fever was universal; common symptoms included conjunctivitis (71%), gastro-intestinal (50.7%), and respiratory (39.6%) issues. Shock occurred in 35% of cases.
- Mortality was 11.2%, with comorbidities, lymphopenia, thrombocytosis, hyponatremia, elevated LDH, and hypoalbuminemia significantly linked to increased mortality.
- Coronary abnormalities resolved in most cases; immunomodulation choice (steroids, IVIg) did not significantly impact outcomes.
Conclusions:
- MIS-C exhibits a wide range of clinical manifestations.
- Specific laboratory findings and comorbidities are critical predictors of mortality in MIS-C.
- Coronary artery abnormalities are generally reversible, and current immunomodulatory treatments show no significant difference in outcomes.
Background:
Few single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-center studies on the same is lacking including from Indian setting.
Methods:
This retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤ 15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was mortality.
Results:
A total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 50.7% and 39.6% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Fifteen (11.2%) children died. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were the factors significantly associated an increased mortality.
Conclusions:
MIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with an increased mortality. No difference in outcome was noted with either steroid or IVIg or both. Coronary artery abnormalities resolved in nearly all cases.
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