van Heerden Jennifer, Nel Jeremy, Moodley Pramodhini, Govender Preesha, Hooijer Jonathan, Ickinger Claudia, Lahri Sa'ad, Louw Elizabeth, Rabie Helena, Reddy Denasha, Tsitsi Jacob, Venter Michelle, Parker Arifa
Helen Joseph Hospital, Johannesburg, South Africa.
Division of Infectious Diseases, Department of Medicine, Helen Joseph Hospital and University of Witwatersrand, Johannesburg, South Africa.
Int J Infect Dis. 2021 Oct;111:227-232. doi: 10.1016/j.ijid.2021.08.042. Epub 2021 Aug 21.
The aim of this study was to add to the descriptive data pertaining to the epidemiology, presentation, and clinical course of multisystem inflammatory syndrome (MIS) temporally associated with coronavirus disease 2019 in adults and adolescents from low- and middle-income countries.
Patients presenting to the adult wards (14 years and older) of three academic hospitals in South Africa, who were diagnosed with MIS between August 1, 2020 and May 31, 2021, were reviewed retrospectively. The presentation, laboratory and radiographic findings, and clinical course are described.
Eleven cases of MIS were reported, four in adolescents (14-19 years) and seven in adults (≥19 years). Fever was universal. Gastrointestinal symptoms (90.9%), cardiorespiratory abnormalities (90.9%), and mucocutaneous findings (72.7%) were prominent. Echocardiography in 10/11 patients (90.9%) showed a median left ventricular ejection fraction of 26.3% (interquartile range 21.9-33.6%). All patients required high care admission and 72.7% required inotropic support. Glucocorticoids were initiated in all cases and 72.7% received intravenous immunoglobulin.
This constitutes the largest multicentre review of adults and adolescents with MIS in Africa. MIS may be overlooked in resource-limited settings, and heightened suspicion is needed in patients with multi-organ dysfunction, especially where repeated investigations for other aetiologies are negative.
本研究旨在补充有关中低收入国家成人和青少年中与2019冠状病毒病在时间上相关的多系统炎症综合征（MIS）的流行病学、临床表现和临床病程的描述性数据。
对2020年8月1日至2021年5月31日期间在南非三家学术医院成人病房（14岁及以上）被诊断为MIS的患者进行回顾性研究。描述了其临床表现、实验室和影像学检查结果以及临床病程。
共报告11例MIS病例，其中青少年（14 - 19岁）4例，成人（≥19岁）7例。发热普遍存在。胃肠道症状（90.9%）、心肺异常（90.9%）和皮肤黏膜表现（72.7%）较为突出。11例患者中的10例（90.9%）超声心动图显示左心室射血分数中位数为26.3%（四分位间距21.9 - 33.6%）。所有患者均需重症监护病房收治，72.7%的患者需要使用血管活性药物支持。所有病例均开始使用糖皮质激素，72.7%的患者接受了静脉注射免疫球蛋白治疗。
这是非洲对成人和青少年MIS进行的最大规模多中心研究。在资源有限的环境中，MIS可能被忽视，对于多器官功能障碍的患者，尤其是在针对其他病因的反复检查均为阴性的情况下，需要提高警惕。
