Clinical and laboratory characteristics of multisystem inflammatory syndrome in children associated with COVID-19 in Egypt: A tertiary care hospital experience

Evaluation of clinical and laboratory findings in MIS-C patients associated with COVID-19: An experience from the Northwest of Iran

This study aimed to evaluate the range of clinical and laboratory findings of multisystem inflammatory syndrome in children (MIS-C) with COVID-19 in a tertiary children's hospital in Northwest Iran during 2020-2022. According to the CDC guidelines, this cross-sectional study included 300 pediatric patients diagnosed with MIS-C. Data were collected retrospectively from medical records, focusing on symptoms, organ involvement, laboratory findings, and outcomes. Statistical analysis was performed using SPSS software, with significance set at p-values <0.05. The study population had a median age of 3 years, with a slight male predominance (57.3%). The most affected systems in MIS-C disease were hematological (87%), gastrointestinal (85%), and respiratory (67%). Laboratory analysis highlighted elevated inflammatory markers such as D-dimer (83.3%), ferritin (71.4%), and CRP (49.7%). Abnormal urinalysis was observed in 151 patients (50.3%), with glucosuria in 83 cases (27.7%) and proteinuria in 29 cases (9.7%). The study found a significant correlation between cardiovascular issues and elevated blood platelets, ESR, CRP, and troponin levels (P ≤ 0.01) but not with ferritin, albumin, or D-dimer levels. Also, the examination of disease outcomes in this study revealed that 81.7% of MIS-C patients were isolated during their hospital stay, 18.3% needed ICU care, and 1% died in hospital. We have presented an experience with distinct clinical and laboratory manifestations in MIS-C. Given the lower median age in this study compared to previous studies, reporting clinical and laboratory manifestations of MIS-C in pediatrics with a younger age is valuable for the diagnosis and treatment course. Some laboratory factors were risk factors for cardiovascular involvement, and consequently, echocardiography is recommended in MIS-C patients with these laboratory indications. Given the lack of a specific diagnostic test for this emerging disease, studies focusing on investigating clinical symptoms and findings are valuable.

Short-term outcomes of South African children with multisystem inflammatory syndrome in children: a prospective cohort study

BACKGROUND

Despite the life-threatening presentation of multisystem inflammatory syndrome in children (MIS-C), the overall prognosis is favourable in centres with access to appropriate supportive care. In this study, we investigate the short-term outcomes in children with MIS-C in Cape Town, South Africa.

METHODS

This prospective observational cohort study included children <13 years who fulfilled the WHO case definition of MIS-C and were admitted to Tygerberg Hospital in Cape Town, South Africa between 1 June 2020 and 31 October 2021. Clinical features were recorded at baseline and at follow-up at the 6-week cardiology and 3-month rheumatology-immunology clinics, respectively.

FINDINGS

Fifty-three children with a median age of 7.4 years (IQR 4.2-9.9) were included. There was a slight male predominance (30/53; 56.6%) and the majority was of mixed ancestry (28/53; 52.83%) or black African ancestry (24/53; 45.3%). Fourteen children (14/53; 26.4%) had comorbid disease. The median length of hospital stay was 8 days (IQR 6-10). All children had an echocardiogram performed at baseline of which 39 were abnormal (39/53; 73.6%). All children were discharged alive. The median days from discharge to cardiology follow-up was 39 days (IQR 33.5-41.5) and for rheumatology-immunology clinic was 70.5 days (IQR 59.5-85.0). Eleven children (11/41; 26.8%) had a persistently abnormal echocardiogram at cardiology follow-up. Systemic inflammation and organ dysfunction resolved in most.

INTERPRETATION

Although the short-term outcomes of MIS-C in our cohort were generally good, the cardiac morbidity needs further characterisation and follow-up.

Pediatric coronavirus disease 2019 in Africa

PURPOSE OF REVIEW

Three years into the coronavirus disease 2019 (COVID-19) pandemic, data on pediatric COVID-19 from African settings is limited. Understanding the impact of the pandemic in this setting with a high burden of communicable and noncommunicable diseases is critical to implementing effective interventions in public health programs.

RECENT FINDINGS

More severe COVID-19 has been reported in African settings, with especially infants and children with underlying comorbidities at highest risk for more severe disease. Data on the role of tuberculosis and HIV remain sparse. Compared to better resourced settings more children with multisystem inflammatory disease (MISC) are younger than 5 years and there is higher morbidity in all settings and increased mortality in some settings. Several reports suggest decreasing prevalence and severity of MIS-C disease with subsequent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variant waves. Whether this decrease continues remains to be determined. Thus far, data on long-COVID in African settings is lacking and urgently needed considering the severity of the disease seen in the African population.

SUMMARY

Considering the differences seen in the severity of disease and short-term outcomes, there is an urgent need to establish long-term outcomes in children with COVID-19 and MIS-C in African children, including lung health assessment.