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Rickettsia rickettsii and Rickettsia typhi in hospitalized children diagnosed with Pediatric Multisystemic
Karla Dzul-Rosado1, Dayana Guadalupe Lavín-Sánchez1, Gerardo Álvarez Hernández2
1Hideyo Noguchi Regional Investigation Center, Faculty of Medicine, Autonomous University of Yucatan, Mérida, México.
Insights
Multisystem Inflammatory Syndrome in Children (MIS-C) can mimic other illnesses. Consider rickettsial diseases in the differential diagnosis for MIS-C, especially in endemic areas.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic led to an increased incidence of Multisystem Inflammatory Syndrome in Children (MIS-C).
- MIS-C is characterized by fever, fatigue, elevated inflammatory markers, and SARS-CoV-2 exposure or antibodies.
- Differential diagnosis of MIS-C can be complicated by co-existing infections and regional endemic diseases.
Observation:
- Children hospitalized with various illnesses may have SARS-CoV-2 antibodies unrelated to MIS-C.
- Non-specific symptoms and elevated inflammatory markers are common in both MIS-C and other infections.
- Rickettsial diseases are endemic in many regions and share overlapping symptoms with MIS-C.
Findings:
- Systematic inclusion of rickettsiosis in the differential diagnosis for MIS-C is desirable.
- This approach aids in accurate diagnosis for children presenting with fever, non-specific symptoms, and elevated inflammatory markers.
- Recognizing rickettsiosis can prevent diagnostic delays and ensure appropriate treatment.
Implications:
- Clinicians should consider rickettsiosis in the differential diagnosis of MIS-C, particularly in endemic areas.
- Accurate diagnosis is crucial for effective management and preventing complications of both MIS-C and rickettsial infections.
- This highlights the importance of considering regional endemic diseases in the context of global pandemics.
Abstract:
Multisystem Inflammatory Syndrome in Children (MIS-C) presents with fever, fatigue, elevated inflammatory markers (acute phase reactants), and a history of exposure to SARS-CoV-2 or positive antibodies to SARS-CoV-2. As the COVID-19 pandemic unfolded, the risk of MIS-C in the pediatric population increased. However, exposure to other viruses and the presence of SARS-CoV-2 positive antibodies in children hospitalized for various pathogen-associated illnesses will also remain common and may complicate differential diagnoses with diseases endemic to the region such as rickettsial diseases. The objective was to highlight the desirability of medical personnel systematically incorporating rickettsiosis as a differential diagnosis for MIS-C when studying a child with fever, non-specific symptoms, and elevated inflammatory markers. In conclusion MIS-C should be considered in children with elevated inflammatory markers when there is a history of COVID-19 and they also meet criteria that have already been established by international agencies, such as CDC and WHO.
