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COVID-19 AND MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN IN PAKISTAN: A COMPARATIVE ANALYSIS
Abstract
Background
SARS-CoV-2 affects children as coronavirus infectious disease (COVID-19) or multisystem inflammatory syndrome (MIS-C). COVID-19 results in mild to moderate symptoms in children; MIS-C can present with features of Kawasaki disease and cardiovascular compromise.
Aims
Pediatric COVID-19 and MIS-C have overlapping features, despite different pathophysiologies. We present a comparison between the clinico-pathological features, clinical course and outcomes of pediatric COVID-19 and MIS-C, to aid in early diagnosis and appropriate management.
Methods
We reviewed the medical records of children ≤16 years with the diagnosis of COVID-19 versus MIS-C presenting to two centers in the Islamabad-Rawalpindi metropolitan area, the fourth-largest of Pakistan, between March-December 2020. Demographics, clinical presentation, investigations, management and outcomes were compared. Descriptive analysis was performed; statistical association was determined between independent variables by calculating adjusted odds ratio using logistic regression. P<0·05 was considered statistically significant.
Results
Of 60 children included, 37 children had COVID-19 and 23 children had MIS-C. More children with COVID-19 had underlying illnesses while children with MIS-C were previously healthy. All children with MIS-C were symptomatic; 65% of children had symptomatic COVID-19. Features of Kawasaki disease were only seen in MIS-C. More children with MIS-C had cardiovascular involvement [signs of shock: COVID-19 n=5 (13·5%), MIS-C n=9 (39·1%), OR 5.30, 95% CI (0·95, 29·77), p=0.04; abnormal echocardiogram: COVID-19 n=0, MIS-C n=4 (17·4%), OR 8.36, 95%CI (1·43, 33·47), p=0·002; thus, being sicker, their hospitalization rates were higher. Outcomes were similar for both.
Conclusions
Compared to COVID-19, MIS-C occurs in healthy children but with more severe presentation, frequent cardiovascular involvement, worse laboratory findings, and higher hospitalization rates.