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J Pediatr Intensive Care 2023; 12(01): 037-043
DOI: 10.1055/s-0041-1733943
Original Article

Multisystem Inflammatory Syndrome in Children Admitted to a Tertiary Pediatric Intensive Care Unit

Emrah Gün 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Tanıl Kendirli 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Edin Botan 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Nazmiye Türker 
2   Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
,
Anar Gurbanov 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Burak Balaban 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Ali Genco Gencay 
1   Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
,
Gül Arga 
3   Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
,
Selen Karagözlü 
4   Department of Pediatric Cardiology, Ankara University School of Medicine, Ankara, Turkey
,
Mehmet Gökhan Ramoglu 
4   Department of Pediatric Cardiology, Ankara University School of Medicine, Ankara, Turkey
,
Halil Özdemir 
3   Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
,
Tayfun Ucar 
4   Department of Pediatric Cardiology, Ankara University School of Medicine, Ankara, Turkey
,
Ercan Tutar 
4   Department of Pediatric Cardiology, Ankara University School of Medicine, Ankara, Turkey
,
Ergin Ciftci 
3   Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
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Abstract

Background Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU).

Materials and Methods Clinical and laboratory findings and treatment of the patients admitted to the PICU with MIS-C between April 2020 and January 2021 were recorded, and their outcomes were evaluated.

Results Nineteen patients with a median age of 12.5 years (interquartile range (IQR): 5.8–14.0 years) were admitted. Eleven (57.8%) were males. The most frequent clinical and laboratory features were fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), diarrhea (47.3%), seizure (10.5%), cardiac dysfunction (52.6%), acute kidney injury (26.3%), lymphopenia (84.2%), and thrombocytopenia (36.8%). However, 8 patients needed mechanical respiratory support, 11 patients needed inotropes, 2 patients needed plasma exchange, and 1 patient needed continuous renal replacement therapy. All patients received corticosteroids, 17 patients (89.2%) received intravenous immunoglobulin, 2 patients received anakinra, 10 patients received acetylsalicylic acid, and 6 patients received enoxaparin. Median PICU length of stay was 3 days (IQR: 2–5) and only one patient died.

Conclusion In conclusion, MIS-C may present with a variety of clinical manifestations, and it can lead to life-threatening critical illness. Most children need intensive care and the response to immunomodulation is usually favorable.

Keywords

multisystem inflammatory syndrome in children - COVID-19 - children - pediatric intensive care

Note

Ethics committee approval was obtained.


Authors' Contributions

T.K., M.G.R., S.K., E.B., B.B., A.G., A.G.G., E.G., and G.A. involved in the conception and design of the study, or acquisition of data, or analysis and interpretation of data. E.C., E.T., T.U., T.K., and E.G. dedicated to the drafting the article or revising it critically for important intellectual content. E.C., E.T., T.U., T.K., H.O., and E.G. supported in the final approval of the version to be submitted.




Publication History

Received: 01 April 2021

Accepted: 06 July 2021

Article published online:
11 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Diorio C, Henrickson SE, Vella LA. et al. Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2. J Clin Invest 2020; 130 (11) 5967-5975
    CrossrefPubMedGoogle Scholar
  • 2 Consiglio CR, Cotugno N, Sardh F. et al; CACTUS Study Team. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell 2020; 183 (04) 968-981.e7
    CrossrefPubMedGoogle Scholar
  • 3 Blumfield E, Levin TL, Kurian J, Lee EY, Liszewski MC. Imaging findings in multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19). Am J Roentgenol 2021; 216 (02) 507-517
    CrossrefPubMedGoogle Scholar
  • 4 García-Salido A, de Carlos Vicente JC, Belda Hofheinz S. et al; Spanish Pediatric Intensive Care Society working group on SARS-CoV-2 infection. Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain. Crit Care 2020; 24 (01) 666
    CrossrefPubMedGoogle Scholar
  • 5 Matsubara D, Kauffman HL, Wang Y. et al. Echocardiographic Findings in Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 in the United States. J Am Coll Cardiol 2020; 76 (17) 1947-1961
    CrossrefPubMedGoogle Scholar
  • 6 CDC Health Alert Network. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease. 2019 (COVID-19). Accessed October 22, 2020 at: https://emergency.cdc.gov/han/2020/han00432.asp
    PubMedGoogle Scholar
  • 7 Jonat B, Gorelik M, Boneparth A. et al. Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 in a children's hospital in New York City: patient characteristics and an institutional protocol for evaluation, management, and follow-up. Pediatr Crit Care Med 2021; 22 (03) e178-e191
    CrossrefPubMedGoogle Scholar
  • 8 Pollack MM, Dean JM, Butler J. et al. The ideal time interval for critical care severity-of-illness assessment. Pediatr Crit Care Med 2013; 14 (05) 448-453
    CrossrefPubMedGoogle Scholar
  • 9 Clouser KN, Gadhavi J, Bhavsar SM. et al. Short term outcomes after MIS-C treatment. J Pediatric Infect Dis Soc 2020
    PubMedGoogle Scholar
  • 10 Godfred-Cato S, Bryant B, Leung J. et al; California MIS-C Response Team. COVID-19-associated multisystem inflammatory syndrome in children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (32) 1074-1080
    CrossrefPubMedGoogle Scholar
  • 11 Henderson LA, Canna SW, Friedman KG. et al. American College of Rheumatology. Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 and Hyperinflammation in COVID-19. Version 2. Arthritis Rheumatol 2020; DOI: 10.1002/art.41616.
    CrossrefPubMedGoogle Scholar
  • 12 Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children (Basel) 2020; 7 (07) E69
    PubMedGoogle Scholar
  • 13 Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J 2020; 39 (11) e340-e346
    CrossrefPubMedGoogle Scholar
  • 14 Dufort EM, Koumans EH, Chow EJ. et al; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020; 383 (04) 347-358
    CrossrefPubMedGoogle Scholar
  • 15 Aronoff SC, Hall A, Del Vecchio MT. The natural history of SARS-Cov-2 related multisystem inflammatory syndrome in children (MIS-C): a systematic review. J Pediatric Infect Dis Soc 2020
    PubMedGoogle Scholar
  • 16 Feldstein LR, Rose EB, Horwitz SM. et al; Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383 (04) 334-346
    CrossrefPubMedGoogle Scholar
  • 17 Radia T, Williams N, Agrawal P. et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev 2021; 38: 51-57
    CrossrefPubMedGoogle Scholar
  • 18 Felsenstein S, Willis E, Lythgoe H. et al. Presentation, treatment response and short-term outcomes in paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS). J Clin Med 2020; 9 (10) E3293
    CrossrefPubMedGoogle Scholar
  • 19 DeLaroche AM, Stankovic C, Ehrman RR. et al. Emergency department screening for multisystem inflammatory syndrome (MIS-C) in children. Am J Emerg Med 2020; S0735-6757 (20)30873-1
    PubMedGoogle Scholar
  • 20 Lishman J, Kohler C, de Vos C. et al. Acute appendicitis in multisystem inflammatory syndrome in children with COVID-19. Pediatr Infect Dis J 2020; 39 (12) e472-e473
    CrossrefPubMedGoogle Scholar
  • 21 Khesrani LS, Chana K, Sadar FZ, Dahdouh A, Ladjadj Y, Bouguermouh D. Intestinal ischemia secondary to Covid-19. J Pediatr Surg Case Rep 2020; 61: 101604
    CrossrefPubMedGoogle Scholar
  • 22 Jackson RJ, Chavarria HD, Hacking SM. A Case of multisystem inflammatory syndrome in children mimicking acute appendicitis in a COVID-19 pandemic area. Cureus 2020; 12 (09) e10722
    PubMedGoogle Scholar
  • 23 Rostad CA, Chahroudi A, Mantus G. et al. Quantitative SARS-CoV-2 serology in children with multisystem inflammatory syndrome (MIS-C). Pediatrics 2020; 146 (06) e2020018242
    CrossrefPubMedGoogle Scholar
  • 24 Sancho-Shimizu V, Brodin P, Cobat A. et al; MIS-C@CHGE. SARS-CoV-2-related MIS-C: a key to the viral and genetic causes of Kawasaki disease?. J Exp Med 2021; 218 (06) e20210446
    CrossrefPubMedGoogle Scholar
  • 25 Gruber CN, Patel RS, Trachtman R. et al. Mapping systemic inflammation and antibody responses in multisystem inflammatory syndrome in children (MIS-C). Cell 2020; 183 (04) 982-995.e14
    CrossrefPubMedGoogle Scholar
  • 26 Schvartz A, Belot A, Kone-Paut I. Pediatric inflammatory multisystem syndrome and rheumatic diseases during SARS-CoV-2 pandemic. Front Pediatr 2020; 8: 605807
    CrossrefPubMedGoogle Scholar
  • 27 Shields AM, Burns SO, Savic S, Richter AG. UK PIN COVID-19 Consortium. COVID-19 in patients with primary and secondary immunodeficiency: the United Kingdom experience. J Allergy Clin Immunol 2021; 147 (03) 870-875.e1
    CrossrefPubMedGoogle Scholar
  • 28 Bhattacharjee S, Banerjee M, Pal R. COVID-19 associated hemophagocytic lymphohistiocytosis and coagulopathy: targeting the duumvirate. Indian Pediatr 2020; 57 (09) 827-833
    CrossrefPubMedGoogle Scholar