tetano
Editor, Senior Moderator
Am J Trop Med Hyg
. 2022 Feb 16;tpmd210801.
doi: 10.4269/ajtmh.21-0801. Online ahead of print.
Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India
Puspraj Awasthi[SUP] 1 [/SUP], Vijay Kumar[SUP] 1 [/SUP], Sanjeev Naganur[SUP] 2 [/SUP], Karthi Nallasamy[SUP] 1 [/SUP], Suresh Kumar Angurana[SUP] 1 [/SUP], Arun Bansal[SUP] 1 [/SUP], Rohit Kumar Manoj[SUP] 2 [/SUP], Muralidharan Jayashree[SUP] 1 [/SUP]
Affiliations
Abstract
Multisystem inflammatory syndrome in children (MIC-S) is a hyperinflammatory manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Information on the long-term outcome of MIS-C is limited. This study was conducted to describe the long-term outcome of MIS-C from a tertiary care center in North India. Children admitted with MIS-C from September 2020 to January 2021 were followed up after discharge until June 2021. The details during the acute phase (clinical features, investigations, treatment, and outcome) and follow-up (symptoms, echocardiographic findings, ongoing treatment, and outcome) were collected retrospectively. During the acute phase, 40 children presented at median (interquartile range [IQR]) age of 7 (5-10) years with fever, mucocutaneous, gastrointestinal, and respiratory symptoms. The majority (66.7%) of the children had positive SARS-CoV-2 serology and elevated inflammatory markers (C-reactive protein, procalcitonin, ferritin, D-dimer, and fibrinogen), lymphopenia, and thrombocytopenia. Eighty percent had shock, 72.5% had myocardial dysfunction (left ventricular ejection fraction <55%), and 22.5% had coronary artery dilatation or aneurysm. Treatment included pediatric intensive care unit admission (85%), intravenous immunoglobulin (100%), steroids (85%), aspirin (80%), vasoactive drugs (72.5%), and invasive mechanical ventilation (22.5%). Two (5%) children died because of refractory shock. Thirty-four children were followed up with until a median (IQR) of 5 (3-6) months. During the follow-up, a majority were asymptomatic, myocardial function returned to normal in all, and only one had coronary artery aneurysm. Prednisolone and aspirin were given for a median (IQR) of 3 (2-4) weeks and 4 (4-6) weeks after discharge, respectively. There was one readmission and no death during the follow-up. To conclude, the long-term outcome of MIS-C is generally favorable with resolution of cardiovascular manifestations (myocardial dysfunction and coronary artery changes) in the majority of children during follow-up.
. 2022 Feb 16;tpmd210801.
doi: 10.4269/ajtmh.21-0801. Online ahead of print.
Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India
Puspraj Awasthi[SUP] 1 [/SUP], Vijay Kumar[SUP] 1 [/SUP], Sanjeev Naganur[SUP] 2 [/SUP], Karthi Nallasamy[SUP] 1 [/SUP], Suresh Kumar Angurana[SUP] 1 [/SUP], Arun Bansal[SUP] 1 [/SUP], Rohit Kumar Manoj[SUP] 2 [/SUP], Muralidharan Jayashree[SUP] 1 [/SUP]
Affiliations
- PMID: 35172274
- DOI: 10.4269/ajtmh.21-0801
Abstract
Multisystem inflammatory syndrome in children (MIC-S) is a hyperinflammatory manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Information on the long-term outcome of MIS-C is limited. This study was conducted to describe the long-term outcome of MIS-C from a tertiary care center in North India. Children admitted with MIS-C from September 2020 to January 2021 were followed up after discharge until June 2021. The details during the acute phase (clinical features, investigations, treatment, and outcome) and follow-up (symptoms, echocardiographic findings, ongoing treatment, and outcome) were collected retrospectively. During the acute phase, 40 children presented at median (interquartile range [IQR]) age of 7 (5-10) years with fever, mucocutaneous, gastrointestinal, and respiratory symptoms. The majority (66.7%) of the children had positive SARS-CoV-2 serology and elevated inflammatory markers (C-reactive protein, procalcitonin, ferritin, D-dimer, and fibrinogen), lymphopenia, and thrombocytopenia. Eighty percent had shock, 72.5% had myocardial dysfunction (left ventricular ejection fraction <55%), and 22.5% had coronary artery dilatation or aneurysm. Treatment included pediatric intensive care unit admission (85%), intravenous immunoglobulin (100%), steroids (85%), aspirin (80%), vasoactive drugs (72.5%), and invasive mechanical ventilation (22.5%). Two (5%) children died because of refractory shock. Thirty-four children were followed up with until a median (IQR) of 5 (3-6) months. During the follow-up, a majority were asymptomatic, myocardial function returned to normal in all, and only one had coronary artery aneurysm. Prednisolone and aspirin were given for a median (IQR) of 3 (2-4) weeks and 4 (4-6) weeks after discharge, respectively. There was one readmission and no death during the follow-up. To conclude, the long-term outcome of MIS-C is generally favorable with resolution of cardiovascular manifestations (myocardial dysfunction and coronary artery changes) in the majority of children during follow-up.