Multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection: a scoping review of the literature

  1. Mohamed Sabbour
  2. Seif Tarek El-Swaify
  3. Nourhan Farrag
  4. Menna Kamel
  5. Sara H. Ali
  6. Abdelrahman Amir
  7. Mazen A. Refaat
  8. Menatalla A. Dyab
  9. Ashraf Nabhan

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Abstract

Background

With the rise of the COVID-19 pandemic, a new severe life-threatening inflammatory syndrome has been reported in some pediatric populations. Global attention was shifted towards the syndrome termed multisystem inflammatory syndrome in children (MIS-C), with new case reports flooding in.

Objectives

The aim of this scoping review is to summarize the existing reports on MIS-C and focus on the demographics, diagnosis, clinical presentation, laboratory investigations, imaging studies, treatment, and patient outcomes.

Methods

We conducted a systemic search using LitCovid and MEDLINE electronic databases. We screened citations, titles and abstracts, then reviewed potentially relevant articles in full. After data extraction, we reported our final data under subheadings of demographics, diagnosis, clinical presentation, laboratory investigations, imaging studies, treatment, and patient outcomes.

Results

Our search strategy yielded 42 original studies reporting 674 pediatric patients fitting the case definition of MIS-C. The studies included 21 case reports, 16 case series and 5 cohort studies. The most common reported symptom of MIS-C was fever (98%). Gastrointestinal symptoms were common (N=557, 83%). Interleukin-6 (IL-6) levels were measured in 125 patients and was elevated in 94 % (N=117). Echocardiography detected coronary artery lesions in 100 patients. Prophylactic and/or therapeutic heparin was required in 34% (N=227) of patients. The most commonly administered treatment modality targeting MIS-C was intravenous immunoglobulin (IVIG) (N=490). Corticosteroids (N=347) and aspirin (N=112) were also integral parts of the treatment regimens. Biologic therapy was integrated into the treatment regimen for 116 patients. Intensive care unit (ICU) admission was alarming (N=478, 71%). 9 fatalities were recorded due to MIS-C

Conclusions

We believe MIS-C bears pathophysiological resemblance to the well-known Kawasaki disease but with some key differences highlighted. Understanding those differences will aid our management plan for such patients.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.03.20167361: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Stage 2: Identifying relevant studies: We conducted a systematic search on LitCovid and MEDLINE electronic databases; the search was last updated on July 8, 2020.
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study had several limitations. The first and foremost is that we did not assess the quality of reports. We understand that during a pandemic, the intention to share data rapidly might have an impact on the quality of published primary reports. Some of the primary sources might overlap. We have traced the cases through careful data collection and contacting the authors to minimize the possibility of double counting. Another limitation is that the included studies used variable methods of reporting. We contacted several study authors to obtain primary data and reduce inter-study variability. Several studies had incomplete data for their patients. We understand this may introduce bias in the reporting of certain variables such as mortality. Finally, most studies did not report the exact confirmatory method for diagnosing MIS-C, whether RT-PCR or serology, on an individual basis. We also selected patients according to the CDC case definition only. In conclusion, we believe MIS-C bears pathophysiological resemblance to the well-known Kawasaki disease. In fact, respiratory viruses, including coronaviridae, have also been implicated in the etio-pathogenesis of KD [69-71]. This review summarizes the major points of difference between both entities. The predominant hyperinflammatory features, the delayed onset after SARS-CoV-2 infection, and the similarity to KD support the hypothesis that MIS-C is a syndrome of immune-mediated injury [72]. This proinflammatory effect of SARS-CoV-...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.08.03.20167361v1 on medRxiv