Volume 27, Number 5—May 2021
Dispatch
Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020
Carmen Niño-Taravilla
, Hugo Otaola-Arca, Natalie Lara-Aguilera, Yuri Zuleta-Morales, and Paula Ortiz-Fritz
, Hugo Otaola-Arca, Natalie Lara-Aguilera, Yuri Zuleta-Morales, and Paula Ortiz-Fritz
Table 1
Characteristics of 26 children with multisystem inflammatory syndrome associated with coronavirus disease, Chile, May–August 2020*
| Characteristic | Value |
|---|---|
| Median age, y (IQR) |
6.5 (2.0–10.5) |
| Sex | |
| M | 15 (57.7) |
| F |
11 (42.3) |
| Concurrent conditions | |
| No | 20 (76.9) |
| Obesity/overweight | 3 (11.5) |
| Preterm | 1 (3.8) |
| Acute lymphoblastic leukemia, Down syndrome |
1 (3.8) |
| Nationality | |
| Chilean | 19 (73.1) |
| Venezuelan | 3 (11.5) |
| Peruvian | 2 (7.7) |
| Colombian | 1 (3.8) |
| Haitian |
1 (3.8) |
| Contact with SARS-CoV-2–positive patient |
10 (38.5) |
| SARS-CoV-2 PCR results | |
| Negative | 18 (69.2) |
| Positive | 7 (26.9) |
| Indeterminate |
1 (3.8) |
| SARS-CoV-2 serologic assay results | |
| Negative | 3 (16.7) |
| IgM– IgG+ | 9 (50.0) |
| IgM+ IgG+ |
6 (33.3) |
| Positive PCR results for other co-infections | |
| Rhinovirus | 1 (3.8) |
| Rhinovirus and adenovirus |
1 (3.8) |
| Signs and symptoms | |
| Fever | 26 (100.0) |
| Cough | 7 (26.9) |
| Diarrhea | 16 (61.5) |
| Vomiting | 12 (46.2) |
| Abdominal pain | 17 (65.4) |
| Conjunctivitis | 15 (57.7) |
| Rash | 16 (61.5) |
| Shock | 24 (92.3) |
| Vasoplegic | 18 (75.0) |
| Cardiogenic | 1 (4.2) |
| Mixed | 5 (20.8) |
| Myocarditis |
12 (46.2) |
| Treatments | |
| Invasive mechanical ventilation | 10 (38.5) |
| Vasoactive drugs | 13 (50.0) |
| Hyperimmune plasma | 1 (3.8) |
| Corticoids | 23 (88.5) |
| Intravenous immunoglobulin, doses | |
| 1 | 20 (76.9) |
| 2 | 2 (7.7) |
| Tocilizumab | 3 (11.5) |
| Infliximab | 1 (3.8) |
| Acetylsalicylic acid | 19 (73.1) |
| Low molecular weight heparin | 19 (73.1) |
| Not used | 7 (26.9) |
| Prophylaxis | 17 (65.4) |
| Treatment | 2 (7.7) |
| High-flow hemofiltration |
1 (3.8) |
| Deaths | 0 |
| Median intensive care unit admission, d (IQR) | 5 (2.0–7.0) |
| Median hospitalization duration, d (IQR) |
10 (7.3–16.8) |
| Echocardiogram results | |
| Normal | 8 (30.8) |
| LV systolic dysfunction† | 4 (15.4) |
| Pericardial effusion | 3 (11.5) |
| LV systolic dysfunction and pericardial effusion | 3 (11.5) |
| Hyperdynamic | 1 (3.8) |
| Mild LV diastolic dysfunction‡ | 2 (7.7) |
| Coronary alterations§ | 5 (19.2) |
*Values are no. (%), except as indicated. IQR, interquartile range; LV, left ventricle; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. †Defined as LV ejection <55%. ‡Defined as decreased E wave. §Defined as: Z-score 2–2.5, dilatation; Z-score 2.5–5, small aneurysm; Z-score 5–10, medium aneurysm; Z-score >10; giant aneurysm (14).
References
- Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80:656–65. DOIPubMedGoogle Scholar
- Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088–95. DOIPubMedGoogle Scholar
- Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607–8. DOIPubMedGoogle Scholar
- Royal College of Paediatrics and Child Health. Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19. 2020 [cited 2020 Aug 30]. https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf
- Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al.; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334–46. DOIPubMedGoogle Scholar
- 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. DOIPubMedGoogle Scholar
- Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094. DOIPubMedGoogle Scholar
- Cabrero-Hernández M, García-Salido A, Leoz-Gordillo I, Alonso-Cadenas JA, Gochi-Valdovinos A, González Brabin A, et al. Severe SARS-CoV-2 infection in children with suspected acute abdomen: a case series from a tertiary hospital in Spain. Pediatr Infect Dis J. 2020;39:e195–8. DOIPubMedGoogle Scholar
- Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al.; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324:259–69. DOIPubMedGoogle Scholar
- Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children (Basel). 2020;7:69. DOIPubMedGoogle Scholar
- Prata-Barbosa A, Lima-Setta F, Santos GRD, Lanziotti VS, de Castro REV, de Souza DC, et al.; Brazilian Research Network in Pediatric Intensive Care, (BRnet-PIC). Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J). 2020;96:582–92. DOIPubMedGoogle Scholar
- Torres JP, Izquierdo G, Acuña M, Pavez D, Reyes F, Fritis A, et al. Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic. Int J Infect Dis. 2020;100:75–81. DOIPubMedGoogle Scholar
- Minesterio de Salud . Protocolo Síndrome Inflamatorio Multisistémico en niños, niñas y adolescentes con SARS-CoV-2. 2020 [cited 2021 March 4]. https://www.minsal.cl/wp-content/uploads/2020/07/Si%CC%81ndromeInflamatorio-Multisiste%CC%81mico.pdf
- McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al.; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135:e927–99. DOIPubMedGoogle Scholar
- Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): a systematic review of clinical features and presentation. Paediatr Respir Rev. 2020 Aug 11 [Epub ahead of print].
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Page updated: April 22, 2021
Page reviewed: April 22, 2021
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