Avcu Gulhadiye, Arslan Asli, Arslan Sema Y, Sahbudak Bal Zumrut, Turan Caner, Ersayoglu Irem, Cebeci Kubra, Kurugol Zafer, Ozkinay Ferda
Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Ege University, Izmir, Turkey.
Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Ege University, Izmir, Turkey.
J Paediatr Child Health. 2023 Apr;59(4):667-672. doi: 10.1111/jpc.16371. Epub 2023 Feb 13.
As the COVID-19 pandemic continues, multisystem inflammatory syndrome in children (MIS-C) maintains its importance in the differential diagnosis of common febrile diseases. MIS-C should be promptly diagnosed because corticosteroid and/or intravenous immunoglobulin treatment can prevent severe clinical outcomes. In this study, we aimed to evaluate clinical presentation, diagnostic parameters and management of MIS-C and compare its clinical features to those of common febrile disease.
This study was conducted at a tertiary-level university hospital between December 2020 and October 2022. One hundred and six children who were initially considered to have MIS-C disease were included in the study. During the follow-up period in the hospital, when the clinical and laboratory findings were re-evaluated, 38 out of 106 children were diagnosed differently. The clinical and laboratory findings of 68 children followed up with the diagnosis of MIS-C and 38 children who were initially misdiagnosed as MIS-C but with different final diagnoses were retrospectively compared.
We identified 68 patients with MIS-C and 38 patients misdiagnosed as MIS-C during the study period. Infectious causes (71%), predominantly bacterial origin, were the most frequently confused conditions with MIS-C. Patients with MIS-C were older and had a more severe clinical course with high rates of respiratory distress, shock, and paediatric intensive care unit admission. While rash and conjunctivitis were more common among patients with MIS-C, cough, abdominal pain and diarrhoea were observed more frequently in patients misdiagnosed as MIS-C. Lower absolute lymphocyte counts, platelet counts and higher C-reactive protein and fibrinogen levels, pathological findings on echocardiography were the distinctive laboratory parameters for MIS-C. Multivariate analysis showed that older age, presence of conjunctivitis, high level of serum CRP and lower platelets were the most discriminative predictors for the diagnosis of MIS-C.
There are still no specific findings to diagnose MIS-C, which therefore can be confused with different clinical conditions. Further data are needed to assist the clinician in the differential diagnosis of MIS-C and the diagnostic criteria should be updated over time.
随着新冠疫情的持续，儿童多系统炎症综合征（MIS-C）在常见发热性疾病的鉴别诊断中仍具有重要意义。由于皮质类固醇和/或静脉注射免疫球蛋白治疗可预防严重的临床后果，因此应及时诊断MIS-C。在本研究中，我们旨在评估MIS-C的临床表现、诊断参数和管理，并将其临床特征与常见发热性疾病的特征进行比较。
本研究于2020年12月至2022年10月在一家三级大学医院进行。106名最初被认为患有MIS-C疾病的儿童被纳入研究。在医院的随访期间，当重新评估临床和实验室检查结果时，106名儿童中有38名被诊断为其他疾病。回顾性比较了68例确诊为MIS-C的儿童和38例最初被误诊为MIS-C但最终诊断不同的儿童的临床和实验室检查结果。
在研究期间，我们确定了68例MIS-C患者和38例被误诊为MIS-C的患者。感染性病因（71%），主要为细菌感染，是与MIS-C最常混淆的疾病。MIS-C患者年龄较大，临床病程更严重，呼吸窘迫、休克和入住儿科重症监护病房的发生率较高。虽然皮疹和结膜炎在MIS-C患者中更常见，但咳嗽、腹痛和腹泻在被误诊为MIS-C的患者中更频繁出现。较低的绝对淋巴细胞计数、血小板计数以及较高的C反应蛋白和纤维蛋白原水平，超声心动图的病理结果是MIS-C独特的实验室参数。多变量分析表明，年龄较大、存在结膜炎、血清CRP水平高和血小板水平低是诊断MIS-C最具鉴别性的预测因素。
目前仍没有诊断MIS-C的特异性表现，因此可能会与不同的临床情况相混淆。需要更多数据来帮助临床医生进行MIS-C的鉴别诊断，并且诊断标准应随着时间的推移而更新。
