Migowa Angela Nyangore, Samia Pauline, Shah Jasmit, Del Rossi Sean, Kenei Chemutai, Malande Oliver Ombeva, Ayaya Joy, Jeruto Daisy, Oyiengo Laura, Lewandowski Laura
Aga Khan University Medical College East Africa.
University of Nairobi College of Health Sciences: University of Nairobi Faculty of Health Sciences.
Res Sq. 2022 Aug 17:rs.3.rs-1951206. doi: 10.21203/rs.3.rs-1951206/v1.
Background Since the onset of the recent COVID-19 pandemic, there have been growing concerns regarding multisystem inflammatory syndrome in children (MIS-C). This study aims to describe the clinico-epidemiological profile and challenges in management of MIS-C in low-middle income countries by highlighting the Kenyan experience. Methods A retrospective study at the Aga Khan University Hospital Nairobi, Avenue Hospital Kisumu and Kapsabet County Referral Hospital was undertaken to identify cases of MIS-C. A detailed chart review using the World Health Organization (WHO) data collection tool was adapted to incorporate information on socio-demographic details and treatment regimens. Findings: Twenty children with MIS-C were identified across the three facilities. Seventy percent of the children were male (14 of 20). COVID-19 PCR testing was done for five children and only one was positive. The commonest clinical symptoms were fever (90%), tachycardia (80%), prolonged capillary refill (80%), oral mucosal changes (65%) and peripheral cutaneous inflammation (50%). Four children required admission into the critical care unit for ventilation support and inotropic support. Cardiac evaluation was available for six patients four of whom had myocardial dysfunction, three had valvulitis and one had pericarditis. Immunoglobulin therapy was availed to two children and systemic steroids provided for three children. There were no documented mortalities. Interpretation: We describe the first case series of MIS-C in East and Central Africa. Majority of suspected cases of MIS-C did not have access to timely COVID-19 PCR testing and other appropriate evaluations which highlights the iniquity in access to diagnostics and treatment.
背景 自近期新冠疫情爆发以来，人们对儿童多系统炎症综合征（MIS-C）的担忧日益增加。本研究旨在通过突出肯尼亚的经验，描述中低收入国家MIS-C的临床流行病学特征及管理挑战。方法 在肯尼亚内罗毕的阿迦汗大学医院、基苏木大道医院和卡普萨贝特县转诊医院进行了一项回顾性研究，以确定MIS-C病例。采用世界卫生组织（WHO）数据收集工具进行详细的病历审查，并纳入社会人口统计学细节和治疗方案等信息。结果：在这三家医疗机构共确诊20例MIS-C患儿。70%的患儿为男性（20例中的14例）。对5名儿童进行了新冠病毒PCR检测，仅1例呈阳性。最常见的临床症状为发热（90%）、心动过速（80%）、毛细血管再充盈时间延长（80%）、口腔黏膜改变（65%）和外周皮肤炎症（50%）。4名儿童需要入住重症监护病房接受通气支持和强心药物支持。对6例患者进行了心脏评估，其中4例有心肌功能障碍，3例有瓣膜炎，1例有心肌炎。2名儿童接受了免疫球蛋白治疗，3名儿童使用了全身性类固醇。无死亡记录。解读：我们描述了东非和中非首例MIS-C病例系列。大多数疑似MIS-C病例无法及时进行新冠病毒PCR检测及其他适当评估，这凸显了在诊断和治疗可及性方面的不公平。
