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Method Article
Arpita Chattopadhyay
Chacha Nehru Bal Chikitsalaya
Corresponding Author
License:
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Objective: We aim to describe our experience in terms of clinical and laboratory attributes in children with Multi – inflammatory syndrome in children temporally related to COVID-19 (MISC) presenting amidst other prevalent tropical infections.
Design: Prospective case series.
Setting: A tertiary care hospital pediatric intensive care unit (PICU).
Patients: Seventeen children with severe MIS-C managed in PICU.
Methods: We did a prospective case series of children (aged ≤ 12 years), admitted to PICU between
May 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analysed routinely collected demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors.
Results: 17 critically ill children with no previous comorbidities fulfilled the WHO/CDC classification of MIS-C. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammation markers were highly raised - median C- reactive protein (mg/L) showed serial reduction in levels - from (median/IQR) 210 (132.6, 246.9) at admission to PICU to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n=12) was 690 (203, 1324), serum LDH (IU/L) (n=12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n=7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Although neutrophilia was seen in 16 patients [Mean (SD) - 14,952.9/μl (7175.2)], lymphopenia was uncommon and seen in only 4/17, median (IQR) [3000/μl (2245, 4508)]. 12 patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six patients expired.
Conclusions: With our case series we wish to highlight the pattern of clinical and laboratory features in a cohort of severe MISC who were positive for SARSCOV2 antibody. We suggest refining the spectra of phenotypes of MIS-C for tropical countries keeping other exanthematous infections that present with fulminant myocarditis and refractory shock in perspective.
Keywords
Multi-inflammatory syndrome in children temporally related to COVID-19 (MISC), Shock, Inflammatory markers, SARSCOV 2 Antibody, myocardial dysfunction
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Method Article
Arpita Chattopadhyay
Chacha Nehru Bal Chikitsalaya
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 02 Jun, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objective: We aim to describe our experience in terms of clinical and laboratory attributes in children with Multi – inflammatory syndrome in children temporally related to COVID-19 (MISC) presenting amidst other prevalent tropical infections.
Design: Prospective case series.
Setting: A tertiary care hospital pediatric intensive care unit (PICU).
Patients: Seventeen children with severe MIS-C managed in PICU.
Methods: We did a prospective case series of children (aged ≤ 12 years), admitted to PICU between
May 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analysed routinely collected demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors.
Results: 17 critically ill children with no previous comorbidities fulfilled the WHO/CDC classification of MIS-C. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammation markers were highly raised - median C- reactive protein (mg/L) showed serial reduction in levels - from (median/IQR) 210 (132.6, 246.9) at admission to PICU to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n=12) was 690 (203, 1324), serum LDH (IU/L) (n=12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n=7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Although neutrophilia was seen in 16 patients [Mean (SD) - 14,952.9/μl (7175.2)], lymphopenia was uncommon and seen in only 4/17, median (IQR) [3000/μl (2245, 4508)]. 12 patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six patients expired.
Conclusions: With our case series we wish to highlight the pattern of clinical and laboratory features in a cohort of severe MISC who were positive for SARSCOV2 antibody. We suggest refining the spectra of phenotypes of MIS-C for tropical countries keeping other exanthematous infections that present with fulminant myocarditis and refractory shock in perspective.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
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