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Published on: April 28, 2019
Comparison of Multisystem Inflammatory Syndrome (MIS-C) and Dengue in Hospitalized Children
Manjinder Singh Randhawa1, Suresh Kumar Angurana1, Karthi Nallasamy2
1Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Insights
Distinguishing Multisystem Inflammatory Syndrome in Children (MIS-C) from dengue in febrile children is crucial. Mucocutaneous features and high CRP suggest MIS-C, while petechiae and hepatomegaly may indicate dengue.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) presents with overlapping symptoms to other febrile illnesses, complicating early diagnosis.
- Differentiating MIS-C from locally prevalent diseases like dengue is essential for timely and appropriate management.
Purpose of the Study:
- To compare the clinical and laboratory profiles of children admitted with MIS-C and dengue.
- To identify key features that can help distinguish between MIS-C and dengue at the onset of illness.
Main Methods:
- A retrospective study was conducted on children aged 12 years or younger admitted with either MIS-C (WHO definition) or laboratory-confirmed dengue.
- Data was collected from August 2020 to January 2021 at a tertiary care center in North India.
Main Results:
- Eighty-four children (40 MIS-C, 44 dengue) were analyzed. MIS-C cases more frequently exhibited rash, conjunctival injection, oral mucocutaneous changes, and gallop rhythm.
- Dengue cases were more associated with petechiae, myalgia, headache, and hepatomegaly. Significantly higher C-reactive protein and interleukin-6 levels were observed in MIS-C.
- Dengue patients showed higher hemoglobin, lower platelet counts, and greater elevation in aspartate and alanine aminotransferases. Hospital stay was longer for MIS-C, but PICU stay and mortality were comparable.
Conclusions:
- Mucocutaneous manifestations and significantly elevated C-reactive protein levels can help differentiate MIS-C from dengue in hospitalized children with acute febrile illness.
- The presence of petechiae, hepatomegaly, and hemoconcentration may suggest a diagnosis of dengue over MIS-C.
Objective:
Multisystem inflammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profile of children admitted with MIS-C and dengue were compared to understand their presentation at the outset.
Methods:
This was a retrospective study of children ≤ 12 y admitted with MIS-C (WHO definition) or laboratory-confirmed dengue between August 2020 and January 2021 at a tertiary center in North India.
Results:
A total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had significantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140 × 109/L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable.
Conclusion:
In hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.
