Albanji Mohammed H, Baghafar Ahmed A, Alghanmi Yasser A, Shaaban Mohammed M, Alkashlan Ebrahim A, Sende Haifa H, Alzahrani Mofareh S, Filfilan Nuha N
Pediatric Neurology, Royal Commission Medical Center, Yanbu, SAU.
Pediatrics, Royal Commission Medical Center, Yanbu, SAU.
Cureus. 2023 Oct 12;15(10):e46918. doi: 10.7759/cureus.46918. eCollection 2023 Oct.
Multisystem inflammatory syndrome in children (MIS-C) is a relatively new syndrome associated with coronavirus disease 2019 (COVID-19) that is characterized by a severe clinical course compared to pediatric COVID-19. This review aimed to compile the available evidence on the clinical presentation and management of MIS-C in children with COVID-19. During this systematic review, a comprehensive search was performed in the following databases: PubMed, Embase, Medline, Google Scholar, Cochrane, and Scopus, using predetermined search terms, such as Medical Subject Headings (MeSH) and keywords to find relevant studies on the MIS-C. Relevant data were extracted, and the quality of the studies was evaluated using suitable methods. The collected findings were synthesized and discussed in the study. The World Health Organization's (WHO) definition of MIS-C was the most favored due to its precision and inclusiveness. MIS-C primarily affected children aged 6-12 years, with male predominance. MIS-C involves a range of systems, including gastrointestinal, cardiovascular, hematologic, mucocutaneous, and respiratory. Radiographic findings revealed cardiovascular abnormalities, solid visceral organ involvement, and bowel abnormalities, reflecting a systemic inflammatory process. Laboratory investigations unveiled elevated inflammatory markers, neutrophil activation, release of extracellular traps in vessels, elevated procalcitonin, hyponatremia, hypoalbuminemia, low hemoglobin, and thrombocytopenia. The inflammatory markers and autoantibody profiles are essential in differentiating MIS-C from COVID-19. The preferred treatment primarily involves immunomodulatory therapies like intravenous immunoglobulin (IVIG), glucocorticoids, and interleukin-6 or 1RA inhibitors or a combination of those. In severe cases, extracorporeal membrane oxygenation (ECMO) and mechanical ventilation are necessary, leading to reduced mortality and quick recovery. This review found that the average hospital stay was seven days, and most discharged children fully recovered within seven days. MIS-C is a life-threatening post-COVID-19 condition and involves multiple systems due to systemic inflammation, with elevated inflammation markers. Recognition of multisystem involvement is crucial, and prompt identification and multidisciplinary treatment are vital for optimal outcomes.
儿童多系统炎症综合征（MIS-C）是一种与2019冠状病毒病（COVID-19）相关的相对较新的综合征，与儿童COVID-19相比，其临床病程较为严重。本综述旨在汇总关于COVID-19患儿MIS-C临床表现及管理的现有证据。在本次系统综述中，使用预先确定的检索词（如医学主题词（MeSH）和关键词）在以下数据库中进行了全面检索：PubMed、Embase、Medline、谷歌学术、Cochrane和Scopus，以查找关于MIS-C的相关研究。提取了相关数据，并使用合适的方法评估了研究质量。在研究中对收集到的结果进行了综合和讨论。世界卫生组织（WHO）对MIS-C的定义因其精确性和包容性而最受青睐。MIS-C主要影响6至12岁的儿童，男性居多。MIS-C涉及一系列系统，包括胃肠道、心血管、血液、皮肤黏膜和呼吸系统。影像学检查结果显示心血管异常、实体内脏器官受累和肠道异常，反映了全身炎症过程。实验室检查发现炎症标志物升高、中性粒细胞活化、血管中细胞外陷阱释放、降钙素原升高、低钠血症、低白蛋白血症、低血红蛋白和血小板减少。炎症标志物和自身抗体谱对于区分MIS-C与COVID-19至关重要。首选治疗主要包括免疫调节疗法，如静脉注射免疫球蛋白（IVIG）、糖皮质激素、白细胞介素-6或1RA抑制剂或这些药物的联合使用。在严重病例中，体外膜肺氧合（ECMO）和机械通气是必要的，可降低死亡率并促进快速康复。本综述发现，平均住院时间为7天，大多数出院儿童在7天内完全康复。MIS-C是一种危及生命的COVID-19后病症，由于全身炎症而累及多个系统，炎症标志物升高。认识到多系统受累至关重要，及时识别和多学科治疗对于获得最佳结果至关重要。
