Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

• Published in: Epidemiology and infection Vol. 148; p. e196
• Main Authors: Mamishi, Setareh, Movahedi, Zahra, Mohammadi, Mohsen, Ziaee, Vahid, Khodabandeh, Mahmoud, Abdolsalehi, Mohammad Reza, Navaeian, Amene, Heydari, Hosein, Mahmoudi, Shima, Pourakbari, Babak
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-01-2020
• Subjects: Abdomen; Albumins; Antibodies; C-reactive protein; Calcium-binding protein; Children; Children & youth; Comorbidity; Conjunctivitis; Coronaviruses; COVID-19; Demographics; Dimers; Disease control; Edema; Erythrocyte sedimentation rate; Erythrocytes; Ferritin; Fever; Fibrinogen; Hospitals; Hyponatremia; Ileitis; Infections; Inflammation; Kawasaki disease; Medical laboratories; Mucocutaneous lymph node syndrome; Multisystem inflammatory syndrome in children; Nausea; Original Paper; Pain; Pandemics; Patients; Renal failure; Sepsis; Septic shock; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Toxic diseases; Toxic shock syndrome; Troponin; Ultrasonic imaging; Viral diseases; Vomiting; Iran; Japan; COVID-19; Multisystem Inflammatory Syndrome; Children
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S095026882000196X

During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has a similar clinical presentation to Kawasaki disease, toxic shock syndrome and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the three paediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom and Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between 7 March and 23 June 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) with median duration of symptoms prior to presentation of 5 (interquartile range (IQR) 3, 7) days. Fifty-three percent of children showed lymphopaenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (>500 ng/ml) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dl, D-dimer was 3909 (IQR 848, 4528) ng/ml and troponin was 0.6 (IQR 0.1, 26) ng/ml, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatraemia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis and pericardial effusions were found in 18%, 11%, 4% and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalised children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin and albumin; and multi-organ involvement.