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儿童多系统炎症综合征(MIS-C):SARS-CoV-2 大流行期间智利圣地亚哥病例的临床和流行病学特征报告。

Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic.

机构信息

Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Antonio Varas 360, Providencia, Santiago, Chile.

Department of Pediatrics, Hospital Exequiel González Cortés, Faculty of Medicine, Universidad de Chile, José Miguel Carrera 3100, Piso 3, San Miguel, Santiago, Chile.

出版信息

Int J Infect Dis. 2020 Nov;100:75-81. doi: 10.1016/j.ijid.2020.08.062. Epub 2020 Aug 28.

Abstract

OBJECTIVE

To describe the clinical and epidemiological characteristics of hospitalized children with multisystem inflammatory syndrome in children (MIS-C) in Santiago, Chile.

METHODS

This was an observational study of children with MIS-C (May 1 to June 24, 2020), in three pediatric hospitals in Santiago. Demographic characteristics and epidemiological data, medical history, laboratory tests, cardiology evaluations, treatment, and clinical outcomes were analyzed.

RESULTS

Twenty-seven patients were admitted (median age 6, range 0-14 years). Sixteen of the 27 (59%) required intensive care unit admission; there were no deaths. Seventy-four percent had no comorbidities, and the median number of days of symptoms before admission was 4 (range 2-9 days). Gastrointestinal symptoms were the most frequent, and inflammatory markers were increased at admission. A recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was detected in 82% of cases. The severe group showed significantly lower hemoglobin and albumin levels, decreased platelet counts, and higher d-dimer during disease evolution. Echocardiography showed abnormalities (myocardial, pericardial, or coronary) in 12 patients (46%) during their hospital stay. Anti-inflammatory treatment (immunoglobulin and/or corticosteroids) was prescribed in 24 patients. MIS-C appeared in clusters weeks after the peak of SARS-CoV-2 cases, especially in the most vulnerable areas of Santiago.

CONCLUSIONS

This study describes the first series (n = 27) of children with MIS-C in a Latin American country, showing favorable clinical outcomes. Education and alerts are required for clinical teams to establish an early diagnosis and prompt treatment.

摘要

目的

描述智利圣地亚哥住院儿童川崎病(MIS-C)的临床和流行病学特征。

方法

这是一项对圣地亚哥三家儿科医院 2020 年 5 月 1 日至 6 月 24 日期间住院的 MIS-C 患儿进行的观察性研究。分析了人口统计学特征和流行病学资料、既往病史、实验室检查、心脏病学评估、治疗和临床结局。

结果

共收治 27 例患儿(中位年龄 6 岁,范围 0-14 岁)。16 例(59%)需要入住重症监护病房,无死亡病例。74%的患儿无合并症,入院前症状持续中位数时间为 4 天(范围 2-9 天)。胃肠道症状最常见,入院时炎症标志物升高。82%的病例近期检测到严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)感染。重症组在疾病进展过程中血红蛋白和白蛋白水平显著降低,血小板计数降低,D-二聚体升高。12 例患儿(46%)在住院期间行超声心动图检查,显示存在心肌、心包或冠状动脉异常。24 例患儿接受了抗炎治疗(免疫球蛋白和/或皮质激素)。MIS-C 在 SARS-CoV-2 病例高峰数周后出现聚集性发病,尤其是在圣地亚哥最脆弱的地区。

结论

本研究描述了拉丁美洲国家首例(n=27)MIS-C 患儿系列病例,结果显示临床结局良好。需要对临床团队进行教育和警示,以早期诊断和及时治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d27/7452906/fa5d4ffc1fe7/gr1_lrg.jpg

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