COVID-19 Related Pediatric Multisystem Inflammatory Disease (MIS-C): Management and Outcome

Abstract

The false impression that children have been less harmed than adults during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic was invalidated as pediatric cases resembling Kawasaki disease and toxic shock syndrome started to be reported from the United Kingdom in April 2020. We propose that this disease, called coronavirus disease 2019 (COVID-19) related pediatric multisystem inflammatory disease (MIS-C), should be managed in hospital even if the diagnosis is uncertain. In children who have not life-threatening disease, a comprehensive laboratory evaluation should be performed to determine whether the criteria for MIS-C are met and treatment decision should be made after this evaluation. Immunomodulatory treatment should be initiated without waiting for a definitive diagnosis in critically-ill children if the disease is suspected. Children with MIS-C should be followed up in an institution with subspecialists of pediatric infectious diseases, pediatric rheumatology, pediatric cardiology, pediatric intensive care, and pediatric gastroenterology, if possible. We suggest that healthcare workers entering rooms of patients with suspected COVID-19 should be cautious against airborne transmission, although this route is controversial for SARS-CoV-2. Management primarily consists of intravenous immunoglobulin, steroids, biologicals, antithrombotic drugs, and antimicrobial agents. Although duration of therapy is debatable, the prerequisites of discharge are restoration of cardiac function and no fever in the last 24 hours. MIS-C has a favorable prognosis, the case fatality rate being only 1-2%.

Keywords

• COVID-19
• SARS-CoV-2
• child
• pediatric multisystem inflammatory disease
• COVID-19 related

COVID-19 İlişkili Pediatrik Multisistem İnflamatuar Hastalık (MIS-C) - Tedavi ve Sonuçlar

Abstract

Nisan 2020'de İngiltere’den Kavasaki hastalığı ve toksik şok sendromu benzeri bir klinik tablo ile sağlık kurumuna getirilen çocuk hastaların bildirilmeye başlamasıyla birlikte şiddetli akut solunum sendromu koronavirüsü 2 (SARS-CoV-2) pandemisi sırasında çocukların yetişkinlerden daha az zarar gördüğü inanışı ortadan kalkmıştır. 2019 koronavirüs hastalığı (COVID-19) ile ilişkili pediatrik multisistem inflamatuar hastalık (MIS-C) olarak adlandırılan bu klinik antitenin, tanısı şüphe düzeyinde bile olsa, hastanede tedavi edilmesini önermekteyiz. Yaşamsal tehlikesi bulunmayan çocuklarda MIS-C ölçütlerinin karşılanıp karşılanmadığının saptanması için kapsamlı bir laboratuvar değerlendirmesi yapılmalı, tedavi kararı bu değerlendirmeden sonra verilmelidir. Klinik durumu kritik olan çocuklara ise, hastalıktan şüphelenildiği takdirde, kesin tanı koyulması beklenmeden immünomodülatör tedavi başlanmalıdır. MIS-C’li çocuklar mümkünse çocuk enfeksiyon hastalıkları, çocuk romatolojisi, çocuk kardiyolojisi, çocuk yoğun bakım ve çocuk gastroenterolojisi yan dal uzmanlarının bulunduğu bir kurumda izlenmelidir. Henüz tartışmalı da olsa, SARS-CoV-2’nin hava yoluyla bulaşması söz konusu olduğundan, COVID-19 şüpheli hastaların odalarına giren sağlık çalışanlarının hava yolu bulaşına karşı da tedbirli olmalarını öneriyoruz. Tedavi başlıca intravenöz immünoglobülin, steroid, biyolojik ajan, antitrombotik tedavi ve antimikrobiyal tedaviden oluşmaktadır. Tedavi süresi kesinlik kazanmamakla birlikte taburculuk için kardiyak işlevlerin normale dönmesi ve son 24 saatte ateş saptanmaması önkoşuldur. MIS-C’nin prognozu çoğunlukla iyi olup, vaka fatalite hızı %1-2’dir.

Keywords

• COVID-19 ilişkili pediatrik multisistem inflamatuar hastalık
• COVID-19
• SARS-CoV-2
• çocuk
• MIS-C

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