Background: Multisystem Inflammatory Syndrome in Children (MISC) is a hyper-inflammatory state with similarities to Kawasaki Disease, 4 to 6 weeks after Covid-19 infection 1 . Literature describes a 11:1 Relative Risk for Asian children versus Caucasians 2 . Since the start of the pandemic, 17,699 children under 12 years were infected with Covid-19 3 .
Objectives: To describe presentation and short term outcomes, for a cohort of children with MIS-C at the sole Children’s Hospital in Singapore.
Methods: Demographic and clinical/lab data were collected from children diagnosed with MIS-C accrording to the WHO criteria 4 at KK Woman’s and Children’s Hospital, Singapore. Nonparametric descriptive statistics were used to describe and analyse data.
Results: Eleven patients were diagnosed with MIS-C between October 2021 and Jan 2022. Seven (64%) were male and 4 (36%) were Chinese, with median age at presentation was 8.08 years (IQR 4.54 - 9.79). All patients had positive COVID-19 serology at the time of diagnosis. Median duration of fever prior to diagnosis was 5 days (IQR 4 - 5); Nine (82%) had gastrointestinal symptoms and median number of Kawasaki Disease (KD) features were 2 (IQR 2 - 3.5); common manifestations were conjunctivitis (90%), red lips (55%) and rash (36%). Of note, 8 (70%) patients had KD type peeling on follow-up. No BCGitis was found during acute phase. Seven (64%) were admitted to higher dependency care.
No | Age (yr ) | GI symptoms | KD features | Hemoglobin (g/DL ) | Absolute Lymphocyte (10x9/L ) | Platelet (10x9/L ) | CRP (mg/L ) | D-Dimer (mg/L FEU ) | Ferritin (ug/L ) | Enoxaparin started | Peeling | Abnormal echo |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 10 | YES | 2 | 12.2 | 0.23 | 67 | 173.2 | 32 | 3179.1 | YES | YES | YES |
2 | 11 | NO | 2 | 14.8 | 1 | 166 | 94.9 | 2.51 | 350 | NO | YES | YES |
3 | 4.25 | YES | 2 | 10.4 | 1.02 | 241 | 134.6 | 6.05 | 277.2 | YES | NO | YES |
4 | 7.67 | YES | 5 | 11 | 0.41 | 102 | 250.6 | 9.32 | 3607.6 | YES | YES | NO |
5 | 8.58 | YES | 4 | 11.4 | 0.56 | 93 | 105.6 | 1.31 | 846.6 | NO | YES | NO |
6 | 4.58 | YES | 2 | 10.3 | 3.09 | 198 | 137.4 | 1.87 | 291 | NO | NO | NO |
7 | 9.58 | YES | 3 | 12.2 | 1.31 | 119 | 184 | 2.51 | 244.3 | NO | YES | NO |
8 | 4.5 | YES | 4 | 11.9 | 0.45 | 102 | 181.8 | 11.12 | 1798.4 | YES | NO | YES |
9 | 11 | YES | 1 | 10.1 | 1.23 | 59 | 74.2 | 4.53 | 1445.8 | YES | YES | NO |
10 | 3.42 | NO | 2 | 9.1 | 1.09 | 138 | 153.9 | 8.66 | 609.4 | YES | YES | NO |
11 | 8.08 | YES | 2 | 11.4 | 1.25 | 101 | 66.8 | 1.31 | 521.8 | NO | YES | YES |
Conclusion: 1.Asian prevalence of MIS-C is not as high as that reported from the West. Similarities in presentation as to age and gender were noted.
2.Most of our MIS-c patients developed periungual peeling at follow up, similarly to Kawasaki Disease.
3.Different from our typical KD population, no BCG site inflammation was found.
REFERENCES:
[1]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.
[2]Middelburg JG, Crijnen TEM, D’Antiga L, et al. Association of Ethnicity with Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2 Infection Frontiers in Pediatrics Oct 2021 Vol 9.
[3]Ang Qing, Number of children admitted for covid-19 at KKH doubles since December 2021. New Straits Times, 27 Jan 2022.
[4]World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief. 2020
Disclosure of Interests: None declared