Multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 infection in the state of Qatar: Association with Kawasaki-like Illness

Samar  Magboul; Ahmed Khalil; Manasik Hassan; Basel  Habra; Ahmad  Alshami; Shabina Khan; Khaled Ellithy; Hossamaldein Ali; Abdulla  AlHothi; Eman AlMaslamani; Mohamed  AlAmri; Vincenzo De Sanctis; Ashraf T Soliman

doi:10.23750/abm.v92i6.11991

Multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 infection in the state of Qatar: Association with Kawasaki-like Illness

Authors

Samar Magboul Hamad Medical Corporation, Academic General Pediatric Department, Doha (Qatar)
Ahmed Khalil Hamad Medical Corporation, Clinical Pharmacy Department, Doha (Qatar)
Manasik Hassan Hamad Medical Corporation, Academic General Pediatric Department, Doha (Qatar) and Weill Cornell Medical College, Clinical Pediatric Department, Doha (Qatar)
Basel Habra Hamad Medical Corporation, Pediatric Pulmonology, Doha (Qatar)
Ahmad Alshami Hamad Medical Corporation, Pediatric Emergency Department, Doha (Qatar) and Weill Cornell Medical College, Clinical Pediatric Department, Doha (Qatar)
Shabina Khan Hamad Medical Corporation, Academic General Pediatric Department, Doha (Qatar)
Khaled Ellithy Hamad Medical corporation, Pediatric Intensive Care Unit, Doha (Qatar)
Hossamaldein Ali Hamad Medical Corporation, Clinical Pharmacy Department, Doha (Qatar)
Abdulla AlHothi Weill Cornell Medical College, Clinical Pediatric Department, Doha (Qatar)
Eman AlMaslamani Sidra Medicine, Pediatric Infectious Diseases Department, Doha (Qatar)
Mohamed AlAmri Hamad Medical Corporation, Pediatric Emergency Department, Doha (Qatar)
Vincenzo De Sanctis Quisisana Hospital, Ferrara
Ashraf T Soliman Hamad Medical Corporation, Pediatric Endocrinology Department, Doha (Qatar)

DOI: https://doi.org/10.23750/abm.v92i6.11991

Keywords:

SARS-CoV-2 infection, Multisystem Inflammatory Syndrome (MIS-C), infants, children, treatment, Qatar.

Abstract

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.

References

The current COVID-19 situation, Available at: https://www.who.int/countries/qat/.

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.

Levin M. Childhood multisystem inflammatory syndrome: A new challenge in the pandemic. N Engl J Med. 2020; 383:393–5.

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.

MIS and COVID-19 , Available at: https://www.cdc.gov/mis-c/hcp/.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet.2020; 395:1607–8.

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.

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.