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Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran.
Epidemiol Infect. 2020 08 28; 148:e196.EI

Abstract

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.

Authors+Show Affiliations

Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.Department of Pediatric Infectious Disease, Faculty of Medicine, Qom University of Medical Sciences and Health Services, Qom, Iran.Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.Department of Pediatric Infectious Disease, Faculty of Medicine, Qom University of Medical Sciences and Health Services, Qom, Iran.Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32854812

Citation

Mamishi, Setareh, et al. "Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection in 45 Children: a First Report From Iran." Epidemiology and Infection, vol. 148, 2020, pp. e196.
Mamishi S, Movahedi Z, Mohammadi M, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiol Infect. 2020;148:e196.
Mamishi, S., Movahedi, Z., Mohammadi, M., Ziaee, V., Khodabandeh, M., Abdolsalehi, M. R., Navaeian, A., Heydari, H., Mahmoudi, S., & Pourakbari, B. (2020). Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiology and Infection, 148, e196. https://doi.org/10.1017/S095026882000196X
Mamishi S, et al. Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection in 45 Children: a First Report From Iran. Epidemiol Infect. 2020 08 28;148:e196. PubMed PMID: 32854812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. AU - Mamishi,Setareh, AU - Movahedi,Zahra, AU - Mohammadi,Mohsen, AU - Ziaee,Vahid, AU - Khodabandeh,Mahmoud, AU - Abdolsalehi,Mohammad Reza, AU - Navaeian,Amene, AU - Heydari,Hosein, AU - Mahmoudi,Shima, AU - Pourakbari,Babak, Y1 - 2020/08/28/ PY - 2020/8/29/pubmed PY - 2020/9/25/medline PY - 2020/8/29/entrez KW - COVID-19 KW - Children KW - Multisystem Inflammatory Syndrome SP - e196 EP - e196 JF - Epidemiology and infection JO - Epidemiol Infect VL - 148 N2 - 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. SN - 1469-4409 UR - https://www.unboundmedicine.com/medline/citation/32854812/Multisystem_inflammatory_syndrome_associated_with_SARS_CoV_2_infection_in_45_children:_a_first_report_from_Iran_ DB - PRIME DP - Unbound Medicine ER -