COVID-19 in children: multisystem inflammatory syndrome

Abstract

Unlike adults, children are less likely to get infected SARS-CoV-2, their disease has a mild form and fatal cases are rather rare. However, a new disease associated with SARS-CoV-2, the multisystem inflammatory syndrome (MIS-C), has been described in children. Most children with MIS-C in the world are blacks or asians. Purpose - to analyze of peculiarities of MIS-C in children of Lviv Region. Materials and methods. We have analyzed medical records of 16 children who were treated in Communal Non-Commercial Establishment of Lviv Regional Council «Lviv Regional Children Clinical Hospital «OKHMATDYT» in the period from September 2020 to January 2021 with the diagnosis of MIS-C, associated with SARS-CoV-2. Results. MIS-C was diagnosed in 16 children (average age was 8,2±0,065 years, girls:boys = 1:0,6). None of our patients was the «primary source of SARS-CoV-2» in the household but contracted coronavirus disease after a contact with the sick relatives. The disease occurred in 4 (25%) children against the background of acute coronavirus disease, in 4 (25%) more children during the first month and 8 (50%) children more than a month after acute SARS-CoV-2 infection. All children has febrile fever and general weakness. Besides, in most of the patients clinical progression of MIS-C was characterized by typical skin rashes and conjunctivitis (13 children - 81,5%), facial swelling and edema of distal parts of extremities (11 children - 68,75%). Muscle pain was present in 9 (56%) children, hyperesthesia - in 4 (25%) children, gastrointestinal symptoms - in 8 (50%) our patients. Myocarditis was diagnosed in 4 (25%) children, linear dilatation of coronary arteries (2 children - 12,5%) and small aneurysms (1 child - 6,25%) - in 3 (18,75%) our patients. All these changes returned to normal 1 month after discharge from the hospital. Conclusions. The syndrome of multisystem inflammatory response before the 48th day after acute coronavirus disease and is characterized by typical clinical course. Treatment with human immunoglobulin at the dose of 1-2 g/kg, glucocorticosteroids at the dose of 1-2 mg/kg, aspirin 3-5 mg/kg against the background of antibacterial therapy is effective for the prevention of changes in the coronary arteries and for the recovery of all patients. The research was conducted in accordance with the principles of bioethics set out in the WMA Declaration of Helsinki and Universal Declaration on Bioethics and was approved by the Commission on Ethics of Scientific Research, Experimental Developments and Scientific Works of Danylo Halytsky Lviv National Medical University. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: COVID-19, pediatric inflammatory multisystem syndrome, pediatric multisystem inflammatory disease, COVID-19 related, MIS-C associated with COVID-19, PIMS-TS.