COVID-19 Related Multi System Inflammatory Syndrome in Children: Scenario from a Tertiary Care Hospital in Bangladesh

Abstract

Background: An association of multisystem inflammatory syndrome in children (MIS-C) with SARS-CoV-2 infection is now a well-established serious phenomenon and been increasingly reported from different countries. Objectives: The present study documents the presentation, management and immediate outcome of MIS-C patients from Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Study design: This was a retrospective study. Methods: This retrospective study was conducted in the department of pediatrics, BSMMU, Dhaka, Bangladesh. It included all the eligible MIS-C patients diagnosed during the study period (August 2020 to February 2022). Sixty cases fulfilled the diagnostic criteria and they had been included in the study. Data were collected using a predesigned and pre-tested questionnare from hospital records and also by interviewing the patients/parents over telephone when required. Results: Mean age of the children was 6.8year with F: M ratio of 1.2:1. All the sixty cases presented with fever associated with gastro-intestinal complications in 68% followed by other symptoms. Fifty two cases (87%) had known contacts. Laboratory evidence ofSARS-CoV-2 infection was present in 55% cases having positive serology or RT-PCR. Twelve patients (20%) had pre-existing co- morbidities. Majority of patients (48%) presented with Kawasaki Disease (KD) like illness. Mean neutrophil count, ESR, CRP, ferritin, LDH and D-dimer were higher and mean platelet and lymphocyte count were lower in this series. Interleukin-6 (IL-6) level was raised in all theseventeen (28%) patients, who were tested. Sixteen patients (27%) had chest X-ray abnormalities and ten of them had HRCT involvement. Fifteen (25%) patients had abnormalities in abdominal ultrasonogram. Coronary artery dilatation and ventricular dysfunction was present in seventeen (28%) and thirteen (22%) of MIS-C cases. IVIG and intravenous steroid was used in forty one (68%) and thirty nine (65%) children. Aspirin was given to twenty eight (47%) cases. Inotropic support was needed in 17% cases. Antibiotics were prescribed to all the patients. Fifty seven percent and 37% children were discharged without and with complications respectively. Mechanical ventilation was required in 6.6 % children who had pre-existing co-morbidities and all of them expired. Conclusion: Forty eight percent of MIS-C cases presented with KD like illness. Mortality was 6.6% and all the cases had preexisting comorbidities. MIS-C is a pediatric emergency and is of a great concern especially in children with pre-existing co-morbidities. Early diagnosis and referral to tertiary center for optimum management is essential. Bangladesh Medical Res Counc Bull 2023; 49(1): 22-31