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J Pediatr Infect Dis 2023; 18(04): 171-177
DOI: 10.1055/s-0043-1769122
Original Article

Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: Clinical Presentation and Outcome

Ritesh Kumar Agrawal 
1   Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Rewati Sharma 
1   Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Arpita Mishra 
1   Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Ashok Singh 
1   Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Raghvendra Narayan 
1   Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Om Prakash Mishra 
1   Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Abstract

Objective In the midst of the COVID-19 pandemic, many children presenting with persistent fever, rashes, conjunctivitis, abdominal pain, respiratory distress, and shock were reported and diagnosed with multisystem inflammatory syndrome in children (MIS-C). The aim of the study was to observe the clinical presentation and outcome of MIS-C treated at a tertiary care hospital.

Methods Eighteen children, aged 24 days to 18 years, with suspected MIS-C were admitted. Their clinical presentation, laboratory parameters, radiological investigations, management, and outcomes were recorded.

Results Median age was 8 years (interquartile range [IQR]: 0.5, 14), and the male-to-female ratio was 1:1. Fever, tachycardia, respiratory distress, hypotension, and seizures with altered sensorium were present in 94.4, 88.8, 83.3, 44.4, and 44.4% of the cases, respectively. Median erythrocyte sedimentation rate, C-reactive protein, serum ferritin, and d-Dimer levels were 21 mm/h, 151 mg/L (1,14.2, 319), 1,091 µg/L (737.4, 1,456), and 3,094 ng/mL (990, 4,300), respectively. Methylprednisolone was given to all patients. Low molecular weight heparin and intravenous immunoglobulin (IVIG) were instituted in 83.3 and 38.8% cases, respectively. Seventeen patients (94.4%) required oxygen therapy and 44.4% needed mechanical ventilation. Fourteen patients (77.7%) recovered completely and four cases (22.2%) expired during the hospital stay. The need for ventilation and the presence of shock adversely affected the outcome.

Conclusion Chief clinical presentations in the patients of MIS-C were fever, respiratory distress, hypotension, and altered sensorium. Among admitted patients, 87.8% cases were managed successfully by systemic corticosteroids with or without IVIG. Need for mechanical ventilation, shock, and central nervous system symptoms at admission appear to be important factors that can lead to mortality.

Keywords

children - COVID-19 - MIS-C - outcome - survival


Publication History

Received: 21 December 2022

Accepted: 18 April 2023

Article published online:
23 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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