Distinguishing Multisystem Inflammatory Syndrome in Children From COVID-19, Kawasaki Disease and Toxic Shock Syndrome

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Godfred-Cato, Shana ; Abrams, Joseph Y. ; Balachandran, Neha ; Jaggi, Preeti ; Jones, Kaitlin ; Rostad, Christina A. ; Lu, Austin T. ; Fan, Lucie ; Jabbar, Aysha ; Anderson, Evan J. ; Kao, Carol M. ; Hunstad, David A. ; Rosenberg, Robert B. ; Zafferani, Marc J. ; Ede, Kaleo C. ; Ballan, Wassim ; Laham, Federico R. ; Beltran, Yajira ; Bryant, Bobbi ; Meng, Lu ; Hammett, Teresa A. ; Oster, Matthew E. ; Morris, Sapna Bamrah ; Belay, Ermias D.
• Description:
  Background:
  
  Distinguishing multisystem inflammatory syndrome in children (MIS-C) from coronavirus disease 2019 (COVID-19), Kawasaki disease (KD), and toxic shock syndrome (TSS) can be challenging. Because clinical management of these conditions can vary, timely and accurate diagnosis is essential.
  
  Methods:
  
  Data were collected from patients <21 years of age hospitalized with MIS-C, COVID-19, KD, and TSS in 4 major health care institutions. Patient demographics and clinical and laboratory data were compared among the 4 conditions, and a diagnostic scoring tool was developed to assist in clinical diagnosis.
  
  Results:
  
  A total of 233 patients with MIS-C, 102 with COVID-19, 101 with KD, and 76 with TSS were included in the analysis. Patients with MIS-C had the highest prevalence of decreased cardiac function (38.6%), myocarditis (34.3%), pericardial effusion (38.2%), mitral regurgitation (31.8%) and pleural effusion (34.8%) compared with patients with the other conditions. Patients with MIS-C had increased peak levels of C-reactive protein and decreased platelets and lymphocyte nadir counts compared with patients with COVID-19 and KD and elevated levels of troponin, brain natriuretic peptide and pro-brain natriuretic peptide compared with COVID-19. Diagnostic scores utilizing clinical findings effectively distinguished MIS-C from COVID-19, KD, and TSS, with internal validation showing area under the curve ranging from 0.87 to 0.97.
  
  Conclusions:
  
  Compared with COVID-19, KD, and TSS, patients with MIS-C had significantly higher prevalence of cardiac complications, elevated markers of inflammation and cardiac damage, thrombocytopenia, and lymphopenia. Diagnostic scores can be a useful tool for distinguishing MIS-C from COVID-19, KD, and TSS.
  
  
• Subjects:
  Adolescent Age Factors Article Child Child, Preschool COVID-19 Diagnosis, Differential Female Humans Kawasaki Disease Male MIS-C Mucocutaneous Lymph Node Syndrome Sex Factors Shock, Septic Systemic Inflammatory Response Syndrome TSS

  More +
• Source:
  Pediatr Infect Dis J. 41(4):315-323
• Pubmed ID:
  35093995
• Pubmed Central ID:
  PMC8919949
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; HHSN272201300018C/AI/NIAID NIH HHSUnited States/ ; HHSN272201300018I/AI/NIAID NIH HHSUnited States/
• Volume:
  41
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8c2f02c2566a24a89fe78d7a2e4db9a1e3583d30a4904b78a7de4dcaa1fb6326
• Download URL:
  https://stacks.cdc.gov/view/cdc/116357/cdc_116357_DS1.pdf
• File Type:
  [PDF - 1.22 MB ]