Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation

Trisha Radia, Nia Williams, Pankaj Agrawal, Katharine Harman, Jonathan Weale, James Cook, Atul Gupta, Trisha Radia, Nia Williams, Pankaj Agrawal, Katharine Harman, Jonathan Weale, James Cook, Atul Gupta

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new phenomenon reported worldwide with temporal association with Covid-19. The objective of this paper is to evaluate reported cases in children and adolescents. From 1726 papers, 35 documented papers related to MIS-C cases identified 783 individual cases of MIS-C between March-June 2020; with 55% being male (n = 435) and a median age of 8.6 years (IQR, 7-10 years; range 3 months-20 years). Patients with MIS-C were noted to have a high frequency of gastrointestinal symptoms (71%) including abdominal pain (34%) and diarrhea (27%). Cough and respiratory distress were reported in 4.5% and 9.6% cases respectively. Blood parameters showed neutrophilia in 345/418 (83%) of cases and a high CRP in 587/626 (94%). 362/619 (59%) cases were SARS-CoV-2 infection positive (serology or PCR) however only 41% demonstrated pulmonary changes on chest imaging. Severity of illness was high with 68% cases requiring intensive care admission; 63% requiring inotropic support; 244/783 (28%) cases needing some form of respiratory support (138 mechanically ventilated), and 31 required extra-corporeal membrane oxygenation. Treatment strategies included intravenous immunoglobulin (63%) and intravenous steroids (44%). 29 cases received Infliximab, 47 received IL1 (interleukin) receptor antagonist, and 47 received IL6-receptor antagonist. 12/783 (1.5%) children died. In summary, a higher incidence of gastrointestinal symptoms were noted in MIS-C. In contrast to acute Covid-19 infection in children, MIS-C appears to be a condition of higher severity with 68% of cases having required critical care support.

Keywords: COVID-19; Critically unwell; MIS-C; Multi-system inflammatory Syndrome; PIMS-TS; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Conflict of interest statement

Conflict of interest No conflict of interest.

Copyright © 2020 Elsevier Ltd. All rights reserved.

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