Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study

• Published in: Jornal de pediatria Vol. 97; no. 3; pp. 354 - 361
• Main Authors: Lima-Setta, Fernanda, Magalhães-Barbosa, Maria Clara de, Rodrigues-Santos, Gustavo, Figueiredo, Elaine Augusta das Neves, Jacques, Melissa de Lorena, Zeitel, Raquel de Seixas, Sapolnik, Roberto, Borges, Cibelle Teixeira da Siva, Lanziotti, Vanessa Soares, Castro, Roberta Esteves Vieira de, Bellinat, Ana Paula Novaes, Silva, Thiago Peres da, Oliveira, Felipe Rezende Caino de, Reis, Bárbara Carvalho Santos dos, Castro, Natália Almeida de Arnaldo Silva Rodriguez, Macedo, João Henrique Garcia Cobas, Scarlato, Ana Carolina Cabral Pinheiro, Riveiro, Paula Marins, Mota, Isabele Coelho Fonseca da, Lorenzo, Vivian Botelho, Lucena, Natalia Martins Lima de, Azevedo, Zina Maria Almeida de, Cunha, Antonio José L.A., Prata-Barbosa, Arnaldo
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01.05.2021; Elsevier; Sociedade Brasileira de Pediatria
• Subjects: Brazil - epidemiology; Child; Children; Coronavirus; COVID-19; Humans; Male; MIS-C; Multisystem inflammatory syndrome in children; Original; Pandemics; PEDIATRICS; Prospective Studies; SARS-CoV-2; Systemic Inflammatory Response Syndrome; Brazil; COVID-19; SARS-CoV-2; MIS-C; Multisystem inflammatory syndrome in children; Coronavirus; Children
• ISSN: 0021-7557; 1678-4782; 1678-4782
• DOI: 10.1016/j.jped.2020.10.008

To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C. Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively. Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4−10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. d-Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5–6.5). The median length of PICU stay was six days (IQR 5–11), and one death occurred (1.8%). Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.