Table 2.
This table summarizes the clinical characteristics of children with multisystem inflammatory syndrome reported in a few additional clinical studies.
| Study | Date of publication | Study type | Country | Number of patients | Age/Age range | Highlights/Findings |
|---|---|---|---|---|---|---|
| Cardiac Dysfunction and Shock in Pediatric Patients With COVID-19 (62) | 15 July 2020 | Case Series | USA | 3 | 6–13 years | • A picture of multisystem inflammatory syndrome was seen in the three patients • Ventricular dysfunction and cardiac shock were among the encountered complications • The three patients were admitted to PICU and discharged few days after admission |
| Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study (63) | 3 June 2020 | Prospective observational study | France | 21 | 3.7–16.6 years | • A picture of multisystem inflammatory syndrome was seen in all patients • Myocarditis was noted in 76% of the patients • SARS-CoV-2 infection was detected in 19 patients • Gastrointestinal symptoms were reported by all patients • IVIG was given to all patients, and corticosteroids to 10 of them |
| COVID-19–Associated Pediatric Multisystem Inflammatory Syndrome (64) | 22 May 2020 | Letter to editor | USA | 1 | 6 years | • A 6-year-old female patient presented with symptoms of fever, sore throat and decreased oral intake. She was initially diagnosed as group A streptococcus pharyngitis • Her condition was complicated by respiratory distress, cardiac failure, and electrolytic abnormalities (i.e., Hyponatremia, hyperkalemia, and azotemia) • In short, she had findings suggestive of Kawasaki-like disease and myocarditis, and was admitted to PICU • After a week of illness, COVID-19 PCR was found to be positive |
| Multisystem Inflammatory Syndrome in Children in New York State (65) | 23 July 2020 | Retrospective observational study | USA | 191 | 0–20 years | • Of the 191 patients, 95 had confirmed MIS-C • Fever was noted in all patients • CRP was elevated in all patients. D-dimer and troponin were found elevated in 91 and 71% of the patients • Vasopressors were given to 62% of the patients • 80% of the patients were transferred to ICU • 2 deaths were reported |
| Multisystem Inflammatory Syndrome in U.S. Children and Adolescents (66) | 23 July 2020 | Observational study | USA | 186 | 0–20 years | • A picture of multisystem inflammatory syndrome was seen in all patients • Gastrointestinal symptoms followed by cardiovascular symptoms were reported in most patients • 80% of the patients were admitted to ICUMechanical ventilation and vasopressors were provided to 20 and 48% of the patients, respectively• Inflammatory markers were elevated in almost all patients • 4 deaths were reported |
| Outbreak of Kawasaki disease in children during COVID-19 pandemic: a prospective observational study in Paris, France (67) | 14 May 2020 | Prospective observational study | France | 17 | 3.7–16.6 years | • A picture of Kawasaki disease was seen in all patients • Gastrointestinal symptoms were initially reported by all patients • Inflammatory markers were elevated in all patients • 11 patients were admitted to ICU • 12 patients had myocarditis • No deaths were reported |
| Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19: A New York City Experience (68) | 25 June 2020 | Retrospective observational study | USA | 15 | 3–20 years | • A picture of MIS-C was seen in 15% of patients • Not all patients had positive PCR tests, but all had positive serology suggesting post-infection inflammatory response rather than direct viral injury • Initially, lymphopenia (in 13 patients), thrombocytopenia (6), hypoalbuminemia (8), and elevated fibrinogen (14) were noted • Inflammatory markers were elevated: CRP and D-dimer (100% of patients), ferritin (87%), and ESR (93%) • Interleukin-6 and interleukin-8 were elevated in all patients • 13 patients had gastrointestinal symptoms while only 5 patients reported respiratory symptoms • 13 patients showed features of severe cardiac involvement • 9 patients required vasopressors or inotropes, and 1 patient required intra-aortic balloon pump • 20% required intubation, 33% non-invasive ventilation • 1 death in a child who required extra-corporeal membrane oxygenation for 9 days |
| Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic (69) | 17 May 2020 | Retrospective observational study | France and Switzerland | 35 | 2–16 years | • 31/35 had positive PCR tests • 28% had comorbidities • Gastrointestinal symptoms were reported in 80% • 33% had left ventricular ejection fraction below 30%, 72% below 50%, 80% had cardiogenic shock, 3% ventricular arrhythmia, 17% coronary artery dilation • 100% required ICU admission • 80% needed inotropic agents and 28% needed ECMO • Elevated BNP, troponin, CRP, and D-dimer was documented • IL-6 elevated in 13 patients • Left ventricular function returned to normal in 25 patients in 7 days • No deaths were reported |
| Systemic Inflammation With Cardiac Involvement in Pediatric Patients With Evidence of COVID-19 in a Community Hospital in the Bronx, New York (70) | 20 July 2020 | Case Series | USA | 4 | 3–20 years | • All patients had initial negative PCR tests but positive serology • 3 patients had gastrointestinal symptoms, all had fever, and none had respiratory symptoms • Elevated CRP, ferritin, troponin and pro-BNP noted in all patients, D-dimer in 3 patients and fibrinogen in 2 patients • 3 patients had mild and 1 severe depression of left ventricular function • 1 patient required intubation • 1 patient developed vasogenic shock required ECMO and died due intracranial hemorrhage associated with herniation |
| COVID-19 and Kawasaki Disease: Novel Virus and Novel Case (71) | 7 April 2020 | Case report | USA | 1 | 6 months | • A 6-month-old baby girl presented with a picture of Kawasaki disease • COVID-19 PCR was found to be positive • Inflammatory markers (i.e., CRP and ESR) were elevated • No cardiac abnormalities were noted • Patient was treated with IVIG and aspirin |
| SARS-CoV-2-related pediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020 (72) | 4 June 2020 | Case series | France | 156 | 5–11 years | • Cases were classified into: confirmed/proven SARS-Cov-2 related pediatric inflammatory multisystem syndrome (CoV-PIMS) (79 patients), probable CoV-PIMS (16), possible CoV-PIMS (13), and non—CoV-PIMS (48) • Myocarditis and Kawasaki-like disease were noted in 70 and 61% of the CoV-PIMS, respectively • Macrophage activation syndrome and seritis documented in 25 and 24% of the CoV-PIMS, respectively • 67% of the CoV-PIMS required ICU admission, of these 43% required intubation and mechanical ventilation, and 73% needed vasopressors or inotropes • 1 death was reported |