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To the Editor: Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening complication of COVID-19 that may occur during or after recovery from acute infection [1]. Very limited clinical data are available on MIS-C from India till date [2, 3]. This prospective observational study was conducted in a tertiary care pediatric hospital of South India to describe the clinical presentation of children with MIS-C. Seventy-four children below 12 y of age who satisfied the World Health Organization’s diagnostic criteria for MIS-C were included in the study [4]. Clinical parameters were recorded during hospital course. Forty-two children (56.8%) were under 5 y and 32 children (43.2%) belonged to 6–12 y age group. The male:female ratio was 1:1.9. COVID RT-PCR was negative in all patients. Positive COVID antibodies and history of contact with COVID positive case were seen in 93% and 73% of cases, respectively. Dull activity (67.6%), poor feeding (59.5%), vomiting (41.9%), abdominal pain (31.1%), loose stools (23.0%), cough (16.2%), and cold (16.2%) are common symptoms of MIS-C, and the common signs were rash (51.4%), conjunctival congestion (41.9%), hypotension (35.1%), tachycardia (33.8%), hypoxemia (16.3%), and tachypnea (13.5%). Among systems, gastrointestinal system was the commonly affected (62%) followed by hepatic (54%), cardiovascular (35%), and renal (26%) systems. Common laboratory abnormalities seen in the study population includes elevated C-reactive protein (CRP) (82%), elevated erythrocyte sedimentation rate (ESR) (75%), leukocytosis (47%), high N/L ratio (22%), thrombocytopenia (39%), elevated serum ferritin (44%), elevated D-dimer (77%), and elevated LDH (33%). To the best of our knowledge, our study is reporting the largest case series of MIS-C published yet from India, with a total of 74 cases. However, large-scale descriptive studies from other parts of India are needed to confirm these preliminary findings.
References
Shankaralingappa A, Thirunavukkarasu AB. Pathogenesis of COVID-19 and multi-system inflammatory syndrome in children. Int J Contemp Pediatr. 2021;8:777–81.
Jain S, Sen S, Lakshmivenkateshiah S, Bobhate P, Venkatesh S, Udani S et al. Multisystem inflammatory syndrome in children with COVID-19 in Mumbai, India. Indian Pediatr. 2020;57:1015–9.
Sugunan S, Bindusha S, Geetha S, Niyas HR, Kumar AS. Clinical profile and short-term outcome of children with SARS-CoV-2 related multisystem inflammatory syndrome (MIS-C) treated with pulse methylprednisolone. Indian Pediatr. 2021;58:718–22.
World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. 2020. Available at: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Accessed on 3 Aug 2021.
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Sai, B.V.K., Kumar, H., Arun Babu, T. et al. Clinical Spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 Infection. Indian J Pediatr 89, 418 (2022). https://doi.org/10.1007/s12098-021-04054-3
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DOI: https://doi.org/10.1007/s12098-021-04054-3