Infectious Disease

Heart and inflammation problems resolve quickly with MIS-C, study results

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Heart and inflammation problems in pediatric patients who were hospitalized with multisystem inflammatory syndrome in children mostly resolved within a few months, according to a study published in the journal Pediatrics.

Kanwal M. Farooqi, MD, an assistant professor of pediatrics at Columbia University’s Vagelos College of Physicians and Surgeons, and colleagues admitted 45 patients under the age of 21 to be admitted to New York-Presbyterian Hospital with Multisystem Inflammatory Syndrome in Children (MIS-C) in 2020 were admitted, a rare but serious syndrome related to SARS-CoV-2 infection.

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The mean age of the patients in the study was 9 years. At admission, 80% (n = 36) had at least mild and 44% (n = 20) moderate to severe echocardiographic abnormalities, including coronary abnormalities, the researchers reported.

“It was both challenging and scary because we didn’t know how these patients would fare over the long term, particularly with regard to cardiac and immunological abnormalities, which were the top issues at the time,” Farooqi said in a new press release.

According to the communication, doctors treated the children with steroids, IV immunoglobulin and immunomodulators, as well as blood pressure medication, and a third received respiratory support, although no extracorporeal membrane oxygenation was required.

“These children were quite sick, but in our hospital, where we routinely used steroids and other treatments for MIS-C, most of the patients responded quickly and were discharged in about 5 days,” Farooqi said in the press release.

The researchers found that most markers of inflammation normalized within 1 to 4 weeks, but 32% (n = 11) of the patients showed persistent lymphocytosis with elevated double negative T cells in 96% of the patients studied (n = 23 of 24).

All children were followed up 1 to 4 weeks, 1 to 4 months, and 4 to 9 months after discharge. The median follow-up was 5.8 months.

In weeks 1 to 4, 18% (n = 7 of 39) had mild echocardiographic findings and all had normal coronary values. After 1 to 4 months, the proportion of double-negative T cells remained increased in 92% of the patients. Between the ages of 4 and 9 months, only one child had persistent mild dysfunction.

“It is a relief that this study shows that most of the severe cardiac and immunological manifestations we saw in children with MIS-C disappeared quickly,” Farooqi said.

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