Gençeli Mustafa, Üstüntaş Talha, Metin Akcan Özge, Saylik Sinan, Ercan Fatih, Pekcan Sevgi, Gençeli Sipil, Yaşar Durmuş Sevgi, Argun Mustafa
Department of Pediatric Infectious Diseases, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkiye.
Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkiye.
Turk J Med Sci. 2024 Oct 6;54(6):1237-1243. doi: 10.55730/1300-0144.5905. eCollection 2024.
BACKGROUND/AIM: Differentiating multisystem inflammatory syndrome in children (MIS-C) from adenovirus infection (AI) can be challenging due to similar clinical and laboratory findings. This study aimed to identify distinguishing characteristics and develop a scoring system to facilitate accurate diagnosis.
A comprehensive review of medical records was undertaken for 108 MIS-C patients and 259 patients with confirmed AI. A comparison of laboratory data and clinical findings was conducted across the patient groups using appropriate statistical tests.
The MIS-C patients were significantly older than the AI patients (p < 0.001). Diarrhea, rash, abdominal pain, vomiting, nonexudative conjunctivitis, lymphadenopathy tachycardia, bradycardia, hypotension, hypoxia seizures, agitation, headache, and altered consciousness symptoms were more frequently associated with MIS-C (p < 0.001), while cough and runny nose were significantly more common in AI (p < 0.001). Lymphopenia and thrombocytopenia were more prevalent in the MIS-C patients (p < 0.001). AI and MIS-C were scored by giving one point each to the parameters that created the difference. For AI, being ≤60 months of age, the presence of cough, runny nose and absence of diarrhea, rash, abdominal pain, vomiting, nonexudative conjunctivitis, lymphadenopathy, tachycardia, bradycardia, hypotension, hypoxia seizures, agitation, headache, and altered consciousness, lymphopenia, thrombocytopenia, and C-reactive protein value <124.5 mg/L were determined as each parameter plus one point. A total score above 14 could predict AI with a high degree of accuracy, with sensitivity at around 97.5% and specificity at 92.6%.
The proposed inpatient scoring system, when used in conjunction with polymerase chain reaction testing, may improve the early differentiation of AI and MIS-C. This approach could help reduce unnecessary testing and optimize resource allocation. Further research with larger samples should investigate this novel scoring system to establish its reliability and generalizability.
背景/目的：由于儿童多系统炎症综合征（MIS-C）和腺病毒感染（AI）在临床和实验室检查结果上存在相似之处，因此鉴别二者具有挑战性。本研究旨在确定其鉴别特征并开发一种评分系统，以促进准确诊断。
对108例MIS-C患者和259例确诊为AI的患者的病历进行了全面回顾。使用适当的统计检验对患者组间的实验室数据和临床表现进行了比较。
MIS-C患者的年龄显著大于AI患者（p<0.001）。腹泻、皮疹、腹痛、呕吐、非渗出性结膜炎、淋巴结病、心动过速、心动过缓、低血压、缺氧、惊厥、烦躁、头痛和意识改变等症状与MIS-C的相关性更高（p<0.001），而咳嗽和流鼻涕在AI中更为常见（p<0.001）。淋巴细胞减少和血小板减少在MIS-C患者中更为普遍（p<0.001）。根据造成差异的参数，对AI和MIS-C进行评分，每个参数得1分。对于AI，年龄≤60个月、存在咳嗽、流鼻涕且无腹泻、皮疹、腹痛、呕吐、非渗出性结膜炎、淋巴结病、心动过速、心动过缓、低血压、缺氧、惊厥、烦躁、头痛和意识改变、淋巴细胞减少、血小板减少以及C反应蛋白值<124.5mg/L，每个参数计1分。总分高于14分可高度准确地预测AI,敏感性约为97.5%，特异性为92.6%。
所提出的住院患者评分系统与聚合酶链反应检测结合使用时，可能会改善AI和MIS-C的早期鉴别。这种方法有助于减少不必要的检测并优化资源分配。应使用更大样本进行进一步研究，以调查这种新型评分系统，确定其可靠性和通用性。
