Main Article Content
SARS-CoV-2 infection, Multisystem Inflammatory Syndrome (MIS-C), infants, children, treatment, Qatar.
Introduction: World Health Organization (WHO) is encouraging reporting of children with Multisystem Inflammatory Syndrome (MIS-C) associated with SARS-CoV-2 infection for better understanding and management of the disease. Methodology: This retrospective study included the first 15 pediatrics patient with a confirmed diagnosis of MIS-C associated with SARS-CoV-2 infection in the state of Qatar. We studied and analyzed their demographic data, clinical manifestations, laboratory tests, treatment, and outcome. Results: A total of 15 children were studied (mean age 3.5 ± 2.7year). Recent severe acute respiratory syndrome coronavirus 2 infection was identified in all of them (100%). The majority of these patients had 4 or more systems involvement. Nine of the 15 presented with Kawasaki disease - picture and all had gastrointestinal symptoms (vomiting and diarrhea). Five required Pediatrics Intensive Care Unit (PICU) admission. Lab investigations revealed high D-Dimer, hyponatremia, and hypoalbuminemia in all. Low hemoglobin (Hb) , thrombocytopenia, and sterile pyuria occurred in 86.6%, 60% and 75% of them, respectively. Treatment with combined anti-inflammatory medications (intravenous immunoglobulin, corticosteroids) was used in along with immunomodulatory agents (Anakinra) in a selected group of refractory patients. No mortality happened.Conclusion: Our young children who presented with MIS-C related to SARS-CoV-2 infection had significantly higher Kawasaki-disease picture compared to other reports. One third of them required PICU admission but no mortality occurred.
2. Guidance: Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 Available at: https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf.
3. Levin M. Childhood multisystem inflammatory syndrome: A new challenge in the pandemic. N Engl J Med. 2020; 383:393–5.
4. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19Available at: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-. syndrome-in-children-and-adolescents-with-covid-19.
5. MIS and COVID-19 , Available at: https://www.cdc.gov/mis-c/hcp/.
6. COVID-19: Multisystem inflammatory syndrome in children (MIS-C) clinical features, evaluation, and diagnosis. Available at: Centers for Disease Control and Prevention Health Alert Network (HAN) Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Available at https://emergency. cdc.gov /han/ 2020/han00432.asp accessed on 5 November 2020.
7. Goldenberg NA, Sochet A, Albisetti M, Biss T, Bonduel M, Jaffray J, et al; the Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee of the ISTH SSC. Consensus‐based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID‐19–related illness. J Thromb Haemost. 2020;18: 3099– 3104.
8. Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, et al. COVID-19-Associated multisystem inflammatory syndrome in children: United States, March–July 2020. Morb Mortal Wkly Rep.2020; 69:1074–80.
9. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M,et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study. Lancet. 2020;395:1771–8.
10. Abrams JY, Godfred-Cato SE, Oster ME, Chow EJ, Koumans EH, Bryant B, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: A systematic review. J Pediatr. 2020; 226:45-54.
11. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020; 383:334–46.
12. Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalmedicine 2020;26:100527.
13. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020; 324:259–69.
14. Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020; 383:347–58.
15. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet.2020; 395:1607–8.
16. Mamishi S, Movahedi Z, Mohammadi M, Ziaee V, Khodabandeh M, Abdolsalehi MR, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: A first report from Iran. Epidemiol Infect. 2020;148:e196.
17. Ng KF, Kothari T, Bandi S, Bird PW, Goyal K, Zoha M, et al. COVID-19 multisystem inflammatory syndrome in three teenagers with confirmed SARS-CoV-2 infection. J Med Virol. 2020;92:2880–6.