Berry Crista-Lee Shahine, Melbourne-Chambers Roxanne Helene, Harrison Abigail Natalie, Anzinger Joshua James, Gordon-Johnson Kelly-Ann Maxorinthia, Deyde Varough Mohamed, Christie Celia Dana Claire
Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica.
Department of Child and Adolescent Health (Neurology), University Hospital of the West Indies, Kingston, Jamaica.
Front Pediatr. 2022 Sep 7;10:904788. doi: 10.3389/fped.2022.904788. eCollection 2022.
COVID-19 in children was initially mild until the emergence of Multisystem Inflammatory Syndrome in Children (MIS-C). We describe pediatric COVID-19 in a developing country within the Caribbean.
Jamaican children who were hospitalized with SARS-CoV-2 infection, in one Caribbean regional academic referral center from April 2020 through June 2021 were included. Prospective surveillance and pediatric infectious disease consultations were performed using the CDC's MIS-C case definition. Data were extracted from patients' hospital charts using WHO's reporting form, entered into the RedCap database, and SPSS 28 was used for analysis. MIS-C and non-MIS-C patients were compared using independent sample -tests for continuous variables and Fisher's exact test for categorical variables, values < 0.05 were statistically significant.
Seventy-nine children with COVID-19 with/without MIS-C presented to UHWI. Thirty-eight (48%) were mild ambulatory cases. Hospitalizations occurred in 41 (52%) children, with median age of 10 years. SARS-CoV-2 RT-PCR positivity was present in 26 (63%), Immunoglobulin M, or Immunoglobulin G (IgM/IgG) positivity in 8 (20%), with community exposures in 7 (17%). Eighteen (44%) MIS-C positive patients were significantly more likely than 23 MIS-C negative patients (56%) to present with fever (94% vs. 30%; < 0.001), fatigue/lethargy (41% vs. 4%; = 0.006), lymphadenopathy (33% vs. 0%; = 0.003), elevated neutrophils (100% vs. 87%; = 0.024), and ESR (78% vs. 9%; = 0.002). Involvement of > two organ systems occurred more frequently in MIS-C positive cases (100% vs. 34%; < 0.001), including gastrointestinal (72% vs. 17%; < 0.001); vomiting/nausea (39% vs. 9%; < 0.028); hematological/coagulopathic (67% vs. 4%; < 0.001); dermatologic involvement (56% vs. 0%; < 0.001); and mucositis (28% vs. 0%; = 0.001). MIS-C patients had Kawasaki syndrome (44%), cardiac involvement (17%), and pleural effusions (17%). MIS-C patients had >4 abnormal inflammatory biomarkers including D-dimers, C-reactive protein, ESR, ferritin, troponins, lactate dehydrogenase, neutrophils, platelets, lymphocytes, and albumen (72%). MIS-C patients were treated with intravenous immune gamma globulin (78%), aspirin (68%), steroids (50%), and non-invasive ventilation (11%). None required inotropes/vasopressors. MIS-C negative patients received standard care. All recovered except one child who was receiving renal replacement therapy and developed myocardial complications.
In this first report of COVID-19 from the Caribbean, children and adolescents with and without MIS-C were not very severe. Critical care interventions were minimal and outcomes were excellent.
在儿童多系统炎症综合征（MIS-C）出现之前，儿童新冠病毒病（COVID-19）最初症状较轻。我们描述了加勒比地区一个发展中国家的儿童COVID-19情况。
纳入2020年4月至2021年6月在加勒比地区一个学术转诊中心因感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）而住院的牙买加儿童。采用美国疾病控制与预防中心（CDC）的MIS-C病例定义进行前瞻性监测和儿科传染病会诊。使用世界卫生组织（WHO）的报告表从患者的医院病历中提取数据，录入RedCap数据库，并使用SPSS 28进行分析。对MIS-C和非MIS-C患者进行比较，连续变量采用独立样本t检验，分类变量采用Fisher精确检验，P值<0.05具有统计学意义。
79例患有或未患有MIS-C的COVID-19儿童到西印度大学医院就诊。38例（48%）为轻症门诊病例。41例（52%）儿童住院，中位年龄为10岁。26例（63%）SARS-CoV-2逆转录聚合酶链反应（RT-PCR）呈阳性，8例（20%）免疫球蛋白M或免疫球蛋白G（IgM/IgG）呈阳性，7例（17%）有社区暴露史。18例（44%）MIS-C阳性患者出现发热（94%对30%；P<0.001）、疲劳/嗜睡（41%对4%；P = 0.006）、淋巴结病（33%对0%；P = 0.003）、中性粒细胞升高（100%对87%；P = 0.024）和红细胞沉降率（ESR）升高（78%对9%；P = 0.002）的可能性显著高于23例MIS-C阴性患者（56%）。MIS-C阳性病例中累及两个以上器官系统的情况更常见（100%对34%；P<0.001），包括胃肠道（72%对17%；P<0.001）；呕吐/恶心（39%对9%；P<0.028）；血液学/凝血异常（67%对4%；P<0.001）；皮肤受累（56%对0%；P<0.001）；以及粘膜炎（28%对0%；P = 0.001）。MIS-C患者有川崎综合征（44%）、心脏受累（17%）和胸腔积液（17%）。MIS-C患者有超过4种异常炎症生物标志物，包括D-二聚体、C反应蛋白、ESR、铁蛋白、肌钙蛋白、乳酸脱氢酶、中性粒细胞、血小板、淋巴细胞和白蛋白（72%）。MIS-C患者接受静脉注射免疫球蛋白（78%）、阿司匹林（68%）、类固醇（50%）和无创通气（11%）治疗。无人需要使用血管活性药物。MIS-C阴性患者接受标准治疗。除一名接受肾脏替代治疗并出现心肌并发症的儿童外，所有患者均康复出院。
在这份来自加勒比地区的COVID-19的首份报告中，患有和未患有MIS-C的儿童和青少年病情都不太严重。重症监护干预措施很少，预后良好。
