Systematic review on the clinical presentation and management of the COVID-19 associated multisystem inflammatory syndrome in children (MIS-C)

Marah Shaikh Yousef; Nur Syazana Idris; Charles Yap; Abdulaziz Abdullah Alsubaie; Pramath Kakodkar; Marah Shaikh Yousef; Nur Syazana Idris; Charles Yap; Abdulaziz Abdullah Alsubaie; Pramath Kakodkar

doi:10.3934/Allergy.2021004

AIMS Allergy and Immunology

2021, Volume 5, Issue 1: 38-55. doi: 10.3934/Allergy.2021004

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Review Topical Sections

Systematic review on the clinical presentation and management of the COVID-19 associated multisystem inflammatory syndrome in children (MIS-C)

School of Medicine, National University of Ireland Galway, Galway City, Republic of Ireland

Received: 22 November 2020 Accepted: 20 January 2021 Published: 25 January 2021

Firstly, we collated the vast repository of MIS-C cases and presented them in a simplified, condensed, and comprehensive format. Secondly, we explored the clinical presentation, and efficacy of the management options. Additionally, we briefly discussed the pathophysiology and addressed the variance in the jargon and criteria relating to this condition.

Methods
A systematic literature review was conducted on the 17th of October 2020 in accordance with PRISMA (2015) guidelines. The search terms: ‘MIS-C’, ‘Kawasaki-like Disease’, ‘PIMS-TS’, and ‘COVID-19’ were queried on Medline and Embase databases. Publications that fulfilled the inclusion criteria were included and were assessed for parameters pertaining to the clinical course and management.

Results
From December 2019 to October 2020, 131 publications were identified. Of these, 56 publications (n = 646 patients) fit the inclusion criteria. Median age was 10 years (range: 0.5–17 years), 52.2% (n = 337/646) were male, and 33.5% (n = 128/382) were of African ethnicity. SARS-CoV-2 reverse transcriptase PCR and serology were positive in 42% (n = 142/426), and 85.3% (n = 300/352) of cases respectively. Presenting complaint(s) were predominately gastrointestinal: 77.6% (n = 436/562) generalized abdominal pain, 76.4% (n = 386/505) vomiting, and 63.2% (n = 203/321) diarrhea. Hypotensive shock was also commonly observed at admission. Additionally, laboratory data revealed elevated neutrophils and inflammatory markers. Echocardiogram findings indicated reduced left ventricular ejection fraction and myocarditis in 22.6% (n = 85/376) and 22.3% (n = 84/376) of cases, respectively. Immunoglobulins and intravenous steroids were predominantly used in 76% (n = 433/571) and 51% (n = 317/618) of cases, respectively. Majority of the patients (97%, n = 418/431) were discharged home. A combination treatment of tocilizumab and IVIG had a mean length of stay of 7 ± 3 days and 95.5% (n = 21/22) discharge rate with low complications in comparison to either of the treatments alone.

Conclusion
MIC-S syndrome is a pediatric hyperinflammatory condition that has an association with COVID-19 background exposure. MIS-C has a heterogeneous multisystem presentation that can be associated with life threatening cardiac complications. There is a need to further explore its long-term morbidity.
- COVID-19,
- pediatrics,
- multisystem inflammatory syndrome in children (MIS-C),
- pediatric inflammatory multisystem syndrome (PIMS),
- Kawasaki like disease
Citation: Marah Shaikh Yousef, Nur Syazana Idris, Charles Yap, Abdulaziz Abdullah Alsubaie, Pramath Kakodkar. Systematic review on the clinical presentation and management of the COVID-19 associated multisystem inflammatory syndrome in children (MIS-C)[J]. AIMS Allergy and Immunology, 2021, 5(1): 38-55. doi: 10.3934/Allergy.2021004

Related Papers:

Abstract

Firstly, we collated the vast repository of MIS-C cases and presented them in a simplified, condensed, and comprehensive format. Secondly, we explored the clinical presentation, and efficacy of the management options. Additionally, we briefly discussed the pathophysiology and addressed the variance in the jargon and criteria relating to this condition.

Methods

A systematic literature review was conducted on the 17th of October 2020 in accordance with PRISMA (2015) guidelines. The search terms: ‘MIS-C’, ‘Kawasaki-like Disease’, ‘PIMS-TS’, and ‘COVID-19’ were queried on Medline and Embase databases. Publications that fulfilled the inclusion criteria were included and were assessed for parameters pertaining to the clinical course and management.

Results

From December 2019 to October 2020, 131 publications were identified. Of these, 56 publications (n = 646 patients) fit the inclusion criteria. Median age was 10 years (range: 0.5–17 years), 52.2% (n = 337/646) were male, and 33.5% (n = 128/382) were of African ethnicity. SARS-CoV-2 reverse transcriptase PCR and serology were positive in 42% (n = 142/426), and 85.3% (n = 300/352) of cases respectively. Presenting complaint(s) were predominately gastrointestinal: 77.6% (n = 436/562) generalized abdominal pain, 76.4% (n = 386/505) vomiting, and 63.2% (n = 203/321) diarrhea. Hypotensive shock was also commonly observed at admission. Additionally, laboratory data revealed elevated neutrophils and inflammatory markers. Echocardiogram findings indicated reduced left ventricular ejection fraction and myocarditis in 22.6% (n = 85/376) and 22.3% (n = 84/376) of cases, respectively. Immunoglobulins and intravenous steroids were predominantly used in 76% (n = 433/571) and 51% (n = 317/618) of cases, respectively. Majority of the patients (97%, n = 418/431) were discharged home. A combination treatment of tocilizumab and IVIG had a mean length of stay of 7 ± 3 days and 95.5% (n = 21/22) discharge rate with low complications in comparison to either of the treatments alone.

Conclusion

MIC-S syndrome is a pediatric hyperinflammatory condition that has an association with COVID-19 background exposure. MIS-C has a heterogeneous multisystem presentation that can be associated with life threatening cardiac complications. There is a need to further explore its long-term morbidity.

Abbreviations

CRP

C-reactive protein

gastrointestinal

PCR

polymerase chain reaction

interleukin

creatine kinase

LDH

lactate dehydrogenase

ECHO

echocardiogram

ECG

electrocardiogram

CXR

chest x-ray

Abdo U/S

abdominal ultrasound

computed tomography

ESR

erythrocyte sedimentation rate

pro-BNP

pro-b-type natriuretic peptide

BNP

b-type natriuretic peptide

IL-6

Interleukin-6

IL-8

Interleukin-8

TNF Alpha

tumor necrosis factor alpha

INR

international normalized ratio

BUN

blood urea nitrogen

AST

aspartate transaminase

ALT

alanine transaminase

length of stay

LOS

standard deviation

ICH

intracerebral hemorrhage

heart failure

MOF

multi-organ failure

respiratory failure

N/A

not available

HCQ

hydroxychloroquine

Conflict of interest

All authors declare no conflicts of interest in this paper.

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