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Rassi CE, Zareef R, Honeini R, Latouf C, Bitar F, Arabi M. Multisystem inflammatory syndrome in children: another COVID-19 sequel. Cardiol Young 2023; 33:1418-1428. [PMID: 37409933 DOI: 10.1017/s1047951123001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
With the rapid expansion of the COVID-19 pandemic, the disease burden and its consequences on the paediatric population has been progressively recognised. Although COVID-19 infection in children presents as asymptomatic to mild illness, instances of hyperinflammation and multi-organ involvement following the viral infection have been described. This condition, known as the multisystem inflammatory syndrome in children (MIS-C), has gained a wide global attention. Despite the global efforts to uncover the disease characteristics and management, a clear pathogenesis and a unified treatment regimen have not been reached yet. This paper tackles the epidemiology of the MIS-C, discusses its suggested pathogenesis, drives through its varying clinical presentations, and evaluates the different treatment regimens employed in managing MIS-C.
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Affiliation(s)
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawan Honeini
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Latouf
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
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Sai BVK, Kumar H, Arun Babu T, Chaitra R, Satapathy D, Kalidoss VK. Clinical profile and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection: a single-center observational study from South India. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [PMCID: PMC9867992 DOI: 10.1186/s43054-022-00156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious sequelae of acute COVID-19 infection affecting children. This study was done over a period of 12 months from December 2020 to November 2021 to describe the clinical presentation, laboratory abnormalities, and outcome of children with MIS-C.
Methods
Seventy-eight children below 12 years of age who satisfied the WHO diagnostic criteria for MIS-C were included in the study. Clinical parameters were recorded at admission. Relevant laboratory investigations, radiological studies, and outcome were documented.
Results
The most commonly affected age group was 6–12 years with a female predominance. COVID RTPCR was negative in all patients. Most cases presented 2–6 weeks after the onset of acute COVID-19 infection. Lethargy, poor feeding, vomiting, abdominal pain, loose stools, cough, and cold are common symptoms of MIS-C syndrome in children and the common signs were rash, conjunctival congestion, hypotension, tachycardia, tachypnea, and hypoxemia. Gastrointestinal system was the commonly affected followed by the hepatic, renal, and cardiovascular systems. Coronary artery abnormalities were seen in 20% of cases. IVIg was the mainstay of therapy used in 95% of patients. Mortality was 1.3%. Cases responded well to IVIg and steroids.
Conclusion
Overall, the short-term outcome was favorable with low mortality in our study cohort. One-fifth of children had coronary artery abnormalities during acute phase underscoring the need for long-term follow-up.
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Sokunbi O, Akinbolagbe Y, Akintan P, Oyeleke G, Kusimo O, Owowo U, Olonade E, Ojo O, Ikhazobor E, Amund O, Ogbuokiri E, Funsho-Adebayo M, Adeniyi O, Uzodimma C, Lamina M, Animashaun A, Osinaike B, Ekure E, Okoromah C. Clinical presentation and short-term outcomes of multisystemic inflammatory syndrome in children in Lagos, Nigeria during the COVID-19 pandemic: A case series. EClinicalMedicine 2022; 49:101475. [PMID: 35747195 PMCID: PMC9156979 DOI: 10.1016/j.eclinm.2022.101475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/06/2023] Open
Abstract
Background Multisystemic inflammatory syndrome in children (MIS-C) has increasingly been documented globally with the progression of the COVID-19 pandemic and a significant proportion of cases have been noted in children of Black descent. There has been a noticeable discrepancy in the presentation and outcomes of COVID-19 infection in sub-Saharan Africa compared to the rest of the world. We documented the demography, clinical features, laboratory and imaging findings, therapeutic management, and short-term outcomes of paediatric patients with MIS-C diagnosed during the COVID-19 pandemic in Lagos, Nigeria. Methods We carried out a retrospective review of MIS-C cases seen in nine public and private hospitals in Lagos from July 10, 2020 to July 30, 2021. Data on clinical presentation, laboratory investigations, therapy as well as outcomes at 2 weeks, 6 weeks, 3 months and 6 months were analyzed. Findings 28 children and adolescents with median age of 7·5 (IQR 2·3 - 9·4) years were diagnosed with MIS-C. MIS-C was suspected in 24 patients (85·7%) at initial clinical evaluation and mucocutaneous, gastrointestinal and cardiovascular manifestations were identified in 75·0%, 71·4% and 89·3% of patients respectively. Acute kidney injury and aseptic meningitis were noted in 32·1% and 17·9% of patients respectively. Cardiac manifestations at presentation included coronary dilatation and pericardial effusion in 46·4% each, ventricular dysfunction (32·1%), atrioventricular valve regurgitation (25·0%), prolonged QTc interval (40·0%) and first-degree atrioventricular block (16·0%). Therapy included aspirin in 89·3%, steroids in 75·0% and intravenous immunoglobulin (IVIG) infusion in 60·7%. All patients survived and were discharged after a mean of 11·14 (SD 5·65) days. Frequency of coronary dilatation had reduced from 46·4% to 7·1% by 3 months follow up and prolonged QTc interval persisted until the 6 week follow up in 4.5% of patients. Echocardiogram and electrocardiogram findings were normal in all patients assessed at 6 months follow up. Interpretation MIS-C is an important diagnosis in children presenting with prolonged fever during the COVID-19 pandemic. Cardiovascular manifestations occurred in several children with MIS-C and improved by 6 months follow up. Early diagnosis and prompt institution of a combination of antiplatelet therapy, steroids and IVIG appear to be beneficial. Funding None.
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Affiliation(s)
- Ogochukwu Sokunbi
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Yeside Akinbolagbe
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Patricia Akintan
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Gabriel Oyeleke
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Olusola Kusimo
- The Reddington Multispecialist Hospital, Victoria Island, Lagos, Nigeria
| | - Uchenna Owowo
- Lifeline Children's Hospital, Surulere, Lagos, Nigeria
| | - Eyitayo Olonade
- The Reddington Multispecialist Hospital, Ikeja, Lagos, Nigeria
| | - Olajide Ojo
- The Reddington Multispecialist Hospital, Victoria Island, Lagos, Nigeria
| | | | - Oluwatosin Amund
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | | | | | | | | | - Moriam Lamina
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Adeola Animashaun
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
- Department of Paediatrics, College of Medicine, Lagos State University, Ikeja, Lagos, Nigeria
| | - Babayemi Osinaike
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Ekanem Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Christy Okoromah
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
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