Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, Division of Immunology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa.
BMC Pediatr. 2022 May 2;22(1):241. doi: 10.1186/s12887-022-03308-z.
Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide.
A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed.
Sixty eight children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). Ninety seven healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p = 0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. Ninety four percent received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. Forty percent required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR = 1.523, CI 1.074, 2.16, p = 0.018). The median hospital stay duration was 7 days with no deaths.
The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment.
多系统炎症综合征是儿童感染 SARS-CoV-2 的严重表现。感染后 MIS-C 的发病率尚不清楚。尽管 MIS-C 在全世界的黑儿童中更为常见，但在非洲，描述 MIS-C 的队列非常少。
本研究从 2020 年 5 月至 2021 年 5 月，在南非开普敦的两家主要儿科医院招募了患有 MIS-C 的儿童和健康儿童队列。收集了临床和人口统计学数据，并检测了血清中的 SARS-CoV-2 抗体。使用健康组中血清阳性率的估计来计算 MIS-C 的发病率。进行了汇总数据、非参数比较和逻辑回归分析。
共招募了 68 例 MIS-C 患儿，中位年龄为 7 岁（3.6，9.9）。招募了 97 例健康儿童，血清阳性率为 30%。在此期间，该市 MIS-C 的估计发病率为 22/100000 暴露。黑人儿童在 MIS-C 组中占比过高（62% vs 37%，p=0.002）。MIS-C 中最常见的临床特征是发热（100%）、心动过速（98.5%）、皮疹（85.3%）、结膜炎（77.9%）、腹痛（60.3%）和低血压（60.3%）。MIS-C 患者的血红蛋白、钠、中性粒细胞计数、白细胞计数、CRP、铁蛋白、心脏（pro-BNP、trop-T）和凝血标志物（D-二聚体和纤维蛋白原）均明显异常。心脏、肺、中枢神经系统和肾脏受累分别占 71%、29.4%、27.9%和 27.9%。94%接受静脉注射免疫球蛋白，64.7%接受甲基强的松龙，61.7%两者均接受。40%需要入住 ICU，38.2%需要正性肌力支持，38.2%需要氧疗，11.8%需要有创通气，6%需要腹膜透析。年龄较大是需要正性肌力支持的独立预测因素（OR=1.523，95%CI 1.074-2.16，p=0.018）。中位住院时间为 7 天，无死亡病例。
南部非洲缺乏报告并不反映 MIS-C 病例的缺乏。只要大流行持续下去，MIS-C 就会给该地区的儿童带来重大负担。MIS-C disproportionately 影响黑人儿童。该地区 MIS-C 的临床表现和结果突出表明需要加强监测、报告和数据，以提供诊断和治疗信息。
