Infectious Disease

MIC-C cases in second wave more severe, study results

November 27, 2021

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According to a study published in the Pediatric Infectious Disease Journal, patients with multisystem inflammatory syndrome in children suffered more severe illness during a second wave of cases compared to the first.

The CDC defines Multisystem Inflammatory Syndrome in Children (MIS-C) as a condition in any patient 21 years of age or younger who has a fever, laboratory evidence of inflammation, signs of a clinically severe disease that requires hospitalization, with two or more more involved organs that have no alternative plausible diagnosis and that have tested positive for a current or recent SARS-CoV-2 infection or are reporting exposure to a suspected or confirmed case of COVID-19. A similar syndrome can also occur in adults.

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Source: Adobe Stock.

Ashraf S. Harahsheh, MD, FACC, FAAP, a cardiologist at Children’s National Hospital in Washington, and colleagues cared for two pediatric cohorts of patients with MIS-C following a surge in COVID-19 cases in the United States

The first cohort consisted of 43 patients hospitalized between March and October 2020, while the second consisted of 63 patients hospitalized between November and April 2021.

“Since the pandemic began, we’ve now seen three different waves of MIS-C, with each wave following national peaks in cases.” Roberta DeBiasi, MD, Chief of Pediatric Infectious Diseases at Children’s National and co-author of the study, said in a press release.

“Children in the second wave cohort may have been intermittently and / or repeatedly exposed to the virus circulating in their communities,” DeBiasi said. “This in turn could have acted as a repeated trigger for your immune system, leading to a stronger inflammatory response.”

Of a total of 106 patients from both waves, 46% were female, 54% were black, 39% were Hispanic, and the mean age was 8.4 years (range: 4.7-13.4). No underlying diseases were found in 80 patients (75%).

Compared to patients hospitalized during the first wave, the patients hospitalized during the second wave comprised a higher proportion of older children (21% vs. 5%) and were more likely to have difficulty breathing (18% vs. 3%) ) but tested positive for SARS-CoV-2 less often (16% vs. 49%).

Participants who were hospitalized during the second wave also required vasopressors more often (73% vs. 51%) and used only a high-flow nasal cannula less often (10% vs. 26%).

“Despite the increased clinical severity and laboratory anomalies in the [second] In the cohort, no significant differences were found when comparing the cohorts of wave 2 and wave 1, ”the authors write.

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David Cennimo, MD

David Cennimo

It is interesting to evaluate how a new clinical entity may evolve over time in the pandemic. These authors examined two periods of MIS-C surges that closely followed the significant waves of COVID-19 in their community.

I was a little surprised to see differences in the patients presenting with MIS-C at each point in time. Those from wave 2 in particular were older (> 15 years) and appeared sicker in many ways. They were more likely to complain of dyspnea, required ionotropic support, required bilevel-positive airway pressure or other more intensive ventilation support, and had higher troponin and natriuretic peptide levels in the brain.

Despite the evidence of a higher degree of severity, there were no significant long-term differences, such as B. coronary aneurysms or length of stay. Aside from age, the groups were similar in terms of gender and race / ethnicity so this would not explain the differences.

I was tempted to refer to differences in the SARS-CoV-2 variants in circulation, but these data come from the time before the rise in delta variants.

I would also consider increased recognition as we learned more about MIS-C (the second wave was less likely to be SARS-CoV-2 PCR positive), but the authors suggest that a standard protocol was used.

One possible explanation was that repeated exposure to SARS-CoV-2 in the community over time may have sensitized patients in wave 2 to a more robust response.

This could be an area for further study. However, we have not seen rampant recurrence of MIS-C in previously affected children. A case report has also recently been published for this purpose.

In addition, there is no contraindication for vaccination according to MIS-C. If immune stimulation from repeated infection was a problem, this could also be seen with vaccination, which has not previously been the case.

I think MIS-C will be a fascinating area of ​​research in the years to come.

References:

Buddingh EP, et al. Pediatr Infect Dis J. 2021; doi: 10. 1097 / INF.0000000000003280.

David Cennimo, MD

Clinician and Assistant Professor of Infectious Diseases in Adults

Rutgers New Jersey Medical School

Disclosure: Cennimo does not disclose any relevant financial information.

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