A confusing final diagnosis in the differential diagnosis of SARS-CoV-2 associated Multisystem Inflammatory Syndrome in Children: Salmonellosis

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe clinical condition associated with the SARS-CoV-2 infection characterized by an increased inflammatory response. MIS-C shares common features with other pediatric inflammatory and infectious conditions including bacterial infections. Salmonella infections should be kept in mind as a causative agent of bacterial gastroenteritis in the differential diagnosis of patients with suspected MIS-C to avoid misdiagnosis. In this report, a case series of pediatric patients with a final diagnosis of salmonellosis were presented, although a primarily diagnosis of MIS-C at admission was considered due to symptoms and findings together with strong laboratory or epidemiological evidence for SARS-CoV-2 infection.

Keywords

• SARS-CoV-2
• Multisystem Inflammatory Syndrome in Children
• Salmonellosis
• Misdiagnosis

Çocuklarda SARS-Cov-2 ile İlişkili Multisistem İnflamatuar Sendrom Ayırıcı Tanısında Kafa Karıştıran Bir Son Tanı: Salmonelloz

Abstract

Çocuklarda Multisistem İnflamatuar Sendrom (MIS-C), artmış inflamatuar yanıtla karakterize, SARS-CoV-2 enfeksiyonu ile ilişkili ciddi bir klinik durumdur. MIS-C, bakteriyel enfeksiyonlar dahil olmak üzere diğer pediatrik inflamatuar ve enfeksiyöz durumlarla ortak özellikler taşır. Yanlış tanıdan kaçınmak için MIS-C şüphesi olan hastalarda ayırıcı tanıda bakteriyel gastroenterit etkeni olarak Salmonella enfeksiyonları akılda tutulmalıdır. Bu raporda, SARS-CoV-2 enfeksiyonu için güçlü laboratuvar veya epidemiyolojik kanıtlarla birlikte semptomları ve bulguları nedeniyle başvuru sırasında öncelikle MIS-C tanısı düşünülmesine rağmen, kesin salmonelloz teşhisi konan pediatrik hastalardan oluşan bir vaka serisi sunulmuştur.

Keywords

• SARS-CoV-2
• Çocuklarda Multisistem İnflamatuar Sendrom
• Salmonelloz
• Yanlış Teşhis

References

1. 1. Radia T, Williams N, Agrawal P,  Harman K, Weale J, Cook J,  et al.  Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev 2020:S1526-0542(20)30117-2.
2. 2. Lee PY, Day-Lewis M, Henderson LA, Friedman KG, Lo J, Roberts JE, et al.  Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflammatory syndrome in children. J Clin Inves. 2020:141113.
3. 3. Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, et al. CACTUS Study Team, Landegren N, Palma P, Brodin P. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell 2020:S0092-8674(20)31157-0.
4. 4. Aronoff SC, Hall A, Del Vecchio MT. The Natural History of SARS-Cov-2 Related Multisystem Inflammatory Syndrome in Children (MIS-C): A Systematic Review. J Pediatric Infect Dis Soc 2020:piaa112.
5. 5. Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. New York State and CDC Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020;383:347–58.
6. 6. Pereira F, Hsu D. Diarrhea. In: Shaw KN, Bachur RG (eds). Textbook of Pediatric Emergency Medicine. 7th ed. Wolters Kluwer: Philadelphia, PA; 2016:35.
7. 7. CDC. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Accessed 8 July 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html.
8. 8. WHO. Multisystem inflammatory syndrome in children and adolescents with COVID-19.  Accessed 8 July 2021. Available from: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children and-adolescents-with-covid-19.

9. 9. Tack DM, Ray L, Griffin PM, Cieslak PR, Dunn J, Rissman T, et al. Preliminary Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016-2019. MMWR Morb Mortal Wkly Rep 2020 May 1;69(17):509-514.
10. 10. Bhutta ZA. Typhoid fever: current concepts. Infect Dis Clin Pract 2006;14:266-272.
11. 11. Rife E, Gedalia A. Kawasaki Disease: an Update. Current Rheumatology Reports 2020;22:75.
12. 12. Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int 2021;41(1):19-32.
13. 13. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;324(3):259–269.
14. 14. Hoard JC, Medus C, Schleiss MR. A 3-Year-Old With Fever and Abdominal Pain: Availability Bias in the Time of COVID-19. Clin Pediatr (Phila) 2021;60(1):83-86.
15. 15. Alamarat Z, Pérez N, Wootton S, Kamdar A, Smith K, Heresi GP, et al. Murine Typhus Outbreak Presenting as Multisystem Inflammatory Syndrome in Children During SARS-CoV-2 Pandemic. Pediatr Infect Dis J 2020;39(12):e447-e449.
16. 16. Dworsky ZD, Roberts JE, Son MBF, Tremoulet AH, Newburger JW, Burns JC. Mistaken MIS-C: A Case Series of Bacterial Enteritis Mimicking MIS-C. Pediatr Infect Dis J 2021;40(4):e159-e161.
17. 17. Repper DC, Arrieta AC, Cook JE, Renella P. A Case of Lemierre Syndrome in the Era of COVID-19: All That Glitters Is Not Gold. Pediatr Infect Dis J 2020;39(12):e445-e447.
18. 18. Brenner FW, Villar RG, Angulo FJ, Tauxe R, Swaminathan B. Salmonella nomenclature. J Clin Microbiol 2000;38:2465-2467.
19. 19. Agbaje M, Begum RH, Oyekunle MA, Ojo OE, Adenubi OT. Evolution of Salmonella nomenclature: a critical note. Folia Microbiol (Praha) 2011;56:497-503.
20. 20. Nelson JD, Kusmiesz H, Jackson LH, Woodman E. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo. Pediatrics 1980;65:1125-1130.
21. 21. Pettersson T, Klemola E, Wager O. Treatment of acute cases of Salmonella infection and Salmonella carriers with ampicillin and neomycin. Acta Med Scand 1964;175:185-190.
22. 22. Batmaz G, Villain E, Bonnet D, L Iserin, A Fraisse, J Kachaner. Therapy and prognosis of infectious complete atrioventricular block in children. Arch Mal Coeur Vaiss 2000;93(5):553-7.
23. 23. Kir D, Mohan C, Sancassani R. Heart Brake. An Unusual Cardiac Manifestation of COVID-19. JACC Case Rep 2020; 2:1252.
24. 24. Dionne A, Mah DY, Son MBF, Lee PY, Henderson L, Baker AL, et al. Atrioventricular Block in Children With Multisystem Inflammatory Syndrome. Pediatrics 2020;146(5):e2020009704.
25. 25. Huang DB, DuPont HL. Problem pathogens: extra-intestinal complications of Salmonella enterica serotype Typhi infection. Lancet Infect Dis 2005;5:341–348.
26. 26. Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 2015;5:20407.