Clinical and Epidemiological Analysis of Patients with Pediatric Multisystem Inflammatory Syndrome (MIS-C) in the years 2020 and 2021 in a Reference Hospital in Southern Brazil
Main Article Content
Abstract
Introduction: Pediatric Multisystem Inflammatory Syndrome
temporally associated with COVID-19 (MIS-C) is a post-infectious
inflammatory condition that elicits high concerns in pediatric
patients infected by SARS-CoV 2, due to its risk of causing shock and
death. Objective: Describe clinical and epidemiological aspects
of patients with MIS-C in a tertiary pediatric hospital in southern
Brazil. Methods: Observational, descriptive, and individualized
study. Clinical and epidemiological data from 33 medical records
of children and adolescents hospitalized with MIS-C in a pediatric
hospital in the years 2020 and 2021 were evaluated. The study was
approved by the Research Ethics Committee of the hospital. Results:
Most patients were white (90.8%), males (54.5%), with a median
age of 6 years and 7 months, with predominance of gastrointestinal
symptoms. Only 9% of the cases had comorbidities, 51.5% required
intensive care and all received echocardiographic evaluation. The
most frequent echocardiographic finding was laminar pericardial
effusion, without hemodynamic repercussions [N=6 (18.2%)]. The
most common outcome was complete recovery [N=25 (75.8%)],
although deaths [N=2 (6.1%)] occurred. Conclusion: The article
showed agreement between the epidemiological profile of the
analyzed patients and the findings described in other national and
international studies. The symptoms presented at admission are
also coherent with the most recent studies, due to a predominance
of gastrointestinal symptoms. The outcomes are also aligned with
those registered in the country in the period of the study.
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References
1. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020;382(17):1663-1665. doi:10.1056/NEJMc2005073
2. González-García N, Miranda-Lora AL, Garduño-Espinosa J, et al. International heterogeneity in coronavirus disease 2019 pediatric mortality rates. Bol Med Hosp Infant. Mex. 2021 [acesso em 2022 set 29]; 78(1):24-28. Disponível em: https://pubmed.ncbi. nlm. nih.gov/33690595/. 3. Kawasaki, T., Naoe, S. History of Kawasaki disease. Clin Exp Nephrol 18, 301–304 (2014). https://doi.org/10.1007/s10157-013-0877-6
4. Pouletty M, Borocco C, Ouldali N, et alPaediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Annals of the Rheumatic Diseases 2020;79:999-1006.
5. Boletim Epidemiológico Especial: COVID-19 da Semana Epidemiológica 22 de 2023. https://www.gov.br/saude/pt-br/ centrais-de-conteudo/publicacoes/boletins/epidemiologicos/ covid-19/2023/boletim_covid_153_julho_11set23.pdf/view
6. Sociedade Brasileira de Pediatria. Nota de Alerta: Notificação obrigatória no Ministério da Saúde dos casos de síndrome inflamatória multissistêmica pediátrica (MIS-C) potencialmente associada à COVID-19. Rio de Janeiro: SBP; 2020. Disponível em: https://www.sbp.com. br/imprensa/detalhe/nid/ notificacao-obrigatoria-noministerio-da-saude-dos-casos de-sindrome-inflamatoriamultissistemica-pediatrica-MIS-C potencialmenteassociada-a-covid-19/
7. Royal College of Paediatrics and Child Health. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. England: RCPCH; 2020. Disponível em: https://www. rcpch.ac.uk/resources/paediatric-multisystem inflammatorysyndrome-temporally-associated-covid-19-pims guidance
8. MARCONDES, E. et al. Pediatria Básica. 9.ed. São Paulo: Sarvier, 2002. https://www.uptodate.com/contents/approach-to-the patient-with-neutrophilia. Acesso em 24 de outubro de 2022.
10. https://microscopic-haematology.com/paediatric-reference ranges/. Acesso em 24 de outubro de 2022.
11. C-reactive protein, high sensitivity, serum. Mayo Clinic Laboratories. https://www.mayocliniclabs.com/test-catalog/ Clinical+and+Interpretive/82047. Acesso em 24 de outubro de 2022.
12. JAMA. 2020;324(3):259-269. doi:10.1001/jama.2020.10369 Publicado online em 8 de junho de 2020.
13. https://cidades.ibge.gov.br/brasil/sc/pesquisa/10070/64506. Acesso em 13 de novembro de 2022.
14. PRATA-BARBOSA, Arnaldo et al. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study, 2020.
15. Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. E Clinical Medicine. 2020; 26:100527. doi:10.1016/j.eclinm.2020.100527
16. Davies P, Evans C, Kanthimathinathan HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020;4(9):669-677. doi:10.1016/S2352-4642(20)30215-7
17. Godfred-Cato S, Bryant B, Leung J, et al. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1074 1080. Publicado em 14 de agosto de 2020. doi:10.15585/mmwr. mm6932e2
18. Valverde I, Singh Y, Sanchez-de-Toledo J, et al. Acute Cardiovascular Manifestations in 286 Children with Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in Europe. Circulation. 2021;143(1):21-32. doi:10.1161/ CIRCULATIONAHA.120.050065 8 Goulart/Carvalho DOI: http://dx.doi.org/10.31365/issn.2595-1769.v24i1p01-08
19. Matsubara D, Kauffman HL, Wang Y, et al. Echocardiographic Findings in Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 in the United States. J Am Coll Cardiol. 2020;76(17):1947-1961. doi:10.1016/j.jacc.2020.08.056
20. Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and Outcomes of US Children and Adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C) Compared with Severe Acute COVID-19. JAMA. 2021;325(11):1074-1087. doi:10.1001/jama.2021.2091
21. Morparia K, Park MJ, Kalyanaraman M, McQueen D, Bergel M, Phatak T. Abdominal Imaging Findings in Critically Ill Children with Multisystem Inflammatory Syndrome Associated With COVID-19. Pediatr Infect Dis J. 2021;40(2):e82-e83. doi:10.1097/INF.0000000000002967
22. Capone CA, Misra N, Ganigara M, et al. Six-Month Follow-up of Patients with Multi-System Inflammatory Syndrome in Children. Pediatrics. 2021;148(4):e2021050973. doi:10.1542/peds.2021-050973
23. Bowen A, Miller AD, Zambrano LD, et al. Demographic and Clinical Factors Associated with Death Among Persons <21 Years Old With
Multisystem Inflammatory Syndrome in Children-United States, February 2020-March 2021. Open Forum Infect Dis. 2021;8(8):ofab388.
Publicado em 19 de junho de 2021. doi:10.1093/ofid/ofab388
24. https://covid.cdc.gov/covid-data-tracker/#mis-national surveillance. Acesso em 9 de novembro de 2022.
25. Belhadjer Z, Méot M, Bajolle F, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context
of global SARS-CoV 2 pandemic. Circulation AHA. 2020;142:429-436. Publicado em 17 de maio de 2020. https://doi.org/10.1161/
CIRCULATIONAHA.120.048360
26. Ferretti L, Wymant C, Kendall M, et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing.
Science. 2020;368(6491):eabb6936. doi:10.1126/science.abb6936
27. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A
Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017;135(17):e927-e999. doi:10.1161/CIR.0000000000000484
28. Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and Outcomes of US Children and Adolescents with Multisystem
Inflammatory Syndrome in Children (MIS-C) Compared with Severe Acute COVID-19. JAMA. 2021;325(11):1074-1087. doi:10.1001/jama.2021.2091
29. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med.
2020;383(4):334-346. doi:10.1056/NEJMoa2021680
30. Yousaf AR, Cortese MM, Taylor AW, et al. Reported cases of multisystem inflammatory syndrome in children aged 12-20 years in the USA who received a COVID-19 vaccine, December, 2020, through August, 2021: a surveillance investigation. Lancet Child Adolesc Health. 2022;6(5):303-312. doi:10.1016/S2352-4642(22)00028-1