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Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional

Anggraini Alam1, Fina Meilyana Andriyani2, Stanza Uga Peryoga2

  • 1Infection & Tropical Diseases Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia. anggraini.alam@unpad.ac.id.

International Journal of Emergency Medicine
|July 11, 2024
PubMed

Insights

Distinguishing severe multisystem inflammatory syndrome in children (MIS-C) from severe dengue is crucial. Key differences in age, symptoms like rash, and lab values such as platelet count, AST, and D-dimer levels aid in diagnosis.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Differentiating severe multisystem inflammatory syndrome in children (MIS-C) from severe dengue presents diagnostic challenges in endemic regions, especially during the COVID-19 pandemic.
  • Both conditions share overlapping symptoms like fever, multiorgan involvement, and shock, complicating early identification and management.
  • Accurate distinction is vital for appropriate clinical intervention and patient outcomes.

Purpose of the Study:

  • To identify key clinical and laboratory differences between severe MIS-C and severe dengue in pediatric patients.
  • To provide guidance for clinicians managing febrile illnesses with potential overlap between MIS-C and severe dengue.
  • To improve diagnostic accuracy in resource-limited settings during concurrent epidemics.

Main Methods:

  • A retrospective analysis of medical records for children under 18 hospitalized with severe MIS-C or severe dengue.
  • Inclusion criteria focused on patients admitted to the Pediatric Intensive Care Unit (PICU) between December 2020 and July 2022.
  • Comparative and descriptive statistical analyses were employed to assess differences between the two patient groups.

Main Results:

  • The study included 17 severe dengue patients and 4 severe MIS-C patients.
  • Severe MIS-C patients were older (average 11.5 years) than severe dengue patients (average 6.2 years) (p=0.034).
  • Significant differences were observed in the presence of rash (p=0.049), nonpurulent conjunctivitis (p=0.035), platelet counts (p=0.006), AST levels (p=0.026), D-dimer levels (p=0.025), and cardiac abnormalities (100% in MIS-C vs. 5.9% in dengue).

Conclusions:

  • Age, specific symptoms (rash, nonpurulent conjunctivitis), and laboratory markers (platelet count, AST, D-dimer) are valuable in differentiating severe MIS-C from severe dengue.
  • Cardiac involvement is a prominent feature in severe MIS-C, distinguishing it from severe dengue.
  • These findings can aid clinicians in the differential diagnosis of these critical pediatric conditions.
Abstract

Keywords:
Clinical manifestationsLaboratory parametersSevere MIS-CSevere dengue

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