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Comparison of the course of multisystem inflammatory syndrome in children during different pandemic waves
Katarzyna Ptak1, Izabela Szymońska2, Anna Olchawa-Czech2
1Department of Pediatrics, Jagiellonian University Medical College, ul. Wielicka 265, 30-663, Cracow, Poland. katarzyna.1.ptak@uj.edu.pl.
Insights
Multisystem inflammatory syndrome in children (MIS-C) following COVID-19 showed similar clinical courses across variants, but incidence appears to be decreasing. Management and symptoms remained consistent, with respiratory symptoms noted more in later variants.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- The clinical presentation of COVID-19 has evolved, with Multisystem Inflammatory Syndrome in Children (MIS-C) emerging as a significant complication.
- Subsequent pandemic waves have seen continued cases of MIS-C, necessitating an understanding of its changing characteristics.
- The incidence of MIS-C appears to be decreasing, posing diagnostic challenges during periods of lower prevalence.
Purpose of the Study:
- To evaluate the incidence, clinical presentation, and management strategies for MIS-C during distinct COVID-19 variant dominance periods.
- To compare MIS-C cases during the original/Alpha variant period versus the Delta/Omicron variant periods.
Main Methods:
- Retrospective analysis of prospectively collected data from 108 eligible pediatric patients.
- Comparison of MIS-C incidence and clinical features between two groups based on dominant COVID-19 variants (Original/Alpha vs. Delta/Omicron).
- Assessment of demographic data, clinical symptoms, laboratory findings, treatment modalities, and patient outcomes.
Main Results:
- No significant differences in patient age, sex, or SARS-CoV-2 antibody positivity were observed between variant periods.
- Fever duration and the prevalence of mucocutaneous, circulatory, neurological, and gastrointestinal symptoms were similar across groups.
- Respiratory symptoms were more frequent during the Delta/Omicron variant period (p=0.015), while intensive care unit admission rates and mortality were comparable. Higher methylprednisolone doses were used in the Delta/Omicron group (p=0.03).
Conclusions:
- The clinical course and management of MIS-C demonstrate remarkable similarity across different COVID-19 variant waves.
- A potential decrease in MIS-C incidence may be occurring in later pandemic phases.
- While overall clinical presentation is consistent, increased respiratory symptoms were noted with later variants.
Abstract:
The purpose of this study is to assess the rate, clinical picture, and management of multisystem inflammatory syndrome in children (MIS-C) during the different COVID-19 variants of concern (VOC) domination periods. This was a retrospective analysis of prospectively collected data. The incidence and clinical picture of MIS-C during the original/Alpha (group 1) and Delta/Omicron (Group 2) variant domination periods were compared. Among 108 eligible patients, 74 (68.5%) were hospitalized during the group 1 domination period, and 34 (31.5%) were hospitalized during the group 2 domination period. The median (Me) patient ages were 76 months (interquartile range [IQR] 35-130) and 73 months (IQR 45-118), and 61% and 65% of patients were male, respectively. There was no significant difference in the presence of positive SARS-CoV 2 antibody test results (IgM or IgG) between the groups (84 vs. 90%; p = 0.54).No differences between groups were observed in fever duration prior to admission (Me [IQR]: 5 days [3-6] vs. 5 days [4-6]; p = 0.26) or the presence of mucocutaneous (95 vs. 100%; p = 0.41), circulatory (70.3 vs. 61.8%; p = 0.86), neurological (6.8 vs. 2.9%; p = 0.662), or gastrointestinal symptoms (84 vs. 79%; p = 0.59). Respiratory symptoms were more common in group 2 (70 vs. 91%; p = 0.015). The need for intensive care unit admission was similar in both groups (16.2 vs. 17.6%, p = 1.0). No deaths occurred in the entire cohort. The studied children were characterized by high C-reactive protein and procalcitonin levels, concentrations of ferritin within normal limits, lymphopenia, moderate hypoalbuminemia, and high B-type natriuretic peptide/brain natriuretic peptide (NT-proBNP) concentrations; however, there were no differences between the groups. Intravenous immunoglobulins were administered as a first-line treatment for almost all patients. There was no significant difference in corticosteroid administration between the groups (87% vs. 74%; p = 0.11); however, the summary dose of methylprednisolone was higher in group 2 (Me [IQR]″ 12.6 mg/kg [10.5-17.8] vs. 16.4 mg/kg [13.3-19.5]; p = 0.03). The median length of stay was 11 days [IQR]: [9-14] and 10 days [8-12], respectively (p = 0.065).
Conclusion:
The clinical course of MIS-C is similar in subsequent pandemic waves; however, the incidence of MIS-C seems to be decreasing.
What Is Known:
• The clinical picture of COVID-19 is evolving. Multisystem inflammatory syndrome in children (MIS-C) is a relatively new serious disease connected with SARS-CoV-2 infection, and in subsequent waves of the pandemic, new cases of the disease have been recorded.
What Is New:
• The clinical picture of MIS-C is not specific, but the course is still severe. • The incidence of MIS-C during the different pandemic waves is decreasing and the diagnosis in the period of lower prevalance is challenging.
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