Rosa Pino (Spain)
Hospital Universitari Sant Joan de Déu (Barcelona) Pediatric Hospitalist, Paediatric UnitPresenter of 1 Presentation
MIS-C IN CHILDREN WITH COMPLETE AND INCOMPLETE KAWASAKI DISEASE CRITERIA IN SPAIN: CLINICAL AND MICROBIOLOGICAL OUTCOMES. (ID 981)
Abstract
Background
Since April 2020, clusters of children with multisystem inflammatory syndrome (MIS-C) linked to SARS-CoV-2 infection have been described in Europe. The syndrome shares features with Kawasaki Disease (KD), toxic shock syndrome and macrophage activation syndrome. We aimed to describe and compare the epidemiologic, clinical and diagnostic findings, the therapeutic approach and the outcomes on MIS-C patients in our cohort.
Methods
Case series of children (0-18 years old) with MIS-C associated with SARS-CoV-2 enrolled from the 1st March to the 31th of December 2020 in the Epidemiological Study of COVID-19 in Children (EPICO-AEP), a multicentre (49 hospitals) prospective registry cohort of children with SARS-CoV-2 infection in Spain. We describe different groups inside MIS-C spectrum: Kawasaki Disease (KD) or incomplete KD (IKD) were defined according the 2017 American Heart Association definition. For MIS-C definition, WHO's was used.
Results
85 hospitalized children were diagnosed with MIS-C by WHO criterial. 97% had microbiological or serological evidence of SARS-CoV-2 infection: 36/85 (42.3%%) positive RT-PCR, 23/68 (33.2%%) positive IgM and 60/68 (88%) positive IgG. 16/85 children (18.8%) fulfilled complete KD definition and 41/85 (48.2%%) IKD, while 28/85 (32.9%) did not meet either. Clinical and microbiological aspects of these groups are summarized in table 1.
Conclusions
MIS-C clinical and biomarker profile overlaps with KD and difficult its diagnosis and classification. MIS-C cases not fulfilling KD criteria differ in several characteristics as compared with KD SARS-CoV-2 related: patients are older, present more often with respiratory, gastrointestinal and neurological symptoms, and develop a more severe disease in terms of cardiovascular involvement (myocarditis and higher pro-BNP). Higher rates of leukopenia, lymphopenia and thrombocytopenia, as well as increased inflammation have been reported but were not statistically significant. Why a small fraction of SARS-CoV-2–infected children develop MIS-C remains unclear.