tetano
Editor, Senior Moderator
Pediatr Infect Dis J
. 2023 Jan 1;42(1):e9-e14.
doi: 10.1097/INF.0000000000003759. Epub 2022 Dec 6.
Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection in KwaZulu-Natal, South Africa
Kogielambal Chinniah[SUP] 1 2 [/SUP], Rajendra Bhimma[SUP] 1 3 [/SUP], Kimesh Loganathan Naidoo[SUP] 1 4 [/SUP], Moherndran Archary[SUP] 1 4 [/SUP], Prakash Jeena[SUP] 1 4 [/SUP], Ebrahim Hoosen[SUP] 1 3 [/SUP], Shivani Singh[SUP] 1 3 [/SUP], Melissa Lawler[SUP] 1 5 [/SUP], Fathima Naby[SUP] 1 6 [/SUP], Refiloe Masekela[SUP] 1 4 [/SUP]
Affiliations
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa.
Objective: To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal.
Methods: Retrospective multicenter study of children (0-13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C.
Results: Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP (P = 0.01), ferritin (P < 0.001), troponin-T (P = 0.02), B-type natriuretic peptide (BNP) (P = 0.01), and lower platelets (P = 0.01). Acute kidney injury (P = 0.01), cardiac involvement (P = 0.02), and altered levels of consciousness (P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7-19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069-1650) ng/mL versus 540 (IQR 181-1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7-191.5; P = 0.005).
Conclusions: Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation.
. 2023 Jan 1;42(1):e9-e14.
doi: 10.1097/INF.0000000000003759. Epub 2022 Dec 6.
Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection in KwaZulu-Natal, South Africa
Kogielambal Chinniah[SUP] 1 2 [/SUP], Rajendra Bhimma[SUP] 1 3 [/SUP], Kimesh Loganathan Naidoo[SUP] 1 4 [/SUP], Moherndran Archary[SUP] 1 4 [/SUP], Prakash Jeena[SUP] 1 4 [/SUP], Ebrahim Hoosen[SUP] 1 3 [/SUP], Shivani Singh[SUP] 1 3 [/SUP], Melissa Lawler[SUP] 1 5 [/SUP], Fathima Naby[SUP] 1 6 [/SUP], Refiloe Masekela[SUP] 1 4 [/SUP]
Affiliations
- PMID: 36476527
- DOI: 10.1097/INF.0000000000003759
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa.
Objective: To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal.
Methods: Retrospective multicenter study of children (0-13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C.
Results: Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP (P = 0.01), ferritin (P < 0.001), troponin-T (P = 0.02), B-type natriuretic peptide (BNP) (P = 0.01), and lower platelets (P = 0.01). Acute kidney injury (P = 0.01), cardiac involvement (P = 0.02), and altered levels of consciousness (P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7-19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069-1650) ng/mL versus 540 (IQR 181-1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7-191.5; P = 0.005).
Conclusions: Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation.