Association of Multisystem Inflammatory Syndrome Temporally Associated with COVID-19 (MIS-C) with Coinfections: A Retrospective Cross Sectional Analytical Study from Northern India
Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52068.16332
Afreen Khan, Aparna Chakravarty, Rizwan Naqishbandi, Rekha Harish, Faizan Kamili
1. Assistant Professor, Department of Paediatrics, HIMSR and HAHC, New Delhi, Delhi, India.
2. Associate Professor, Department of Paediatrics, HIMSR and HAHC, New Delhi, Delhi, India.
3. Senior Resident, Department of Paediatrics, HIMSR and HAHC, New Delhi, Delhi, India.
4. Professor, Department of Paediatrics, HIMSR and HAHC, New Delhi, Delhi, India.
5. Senior Resident, Department of Paediatrics, HIMSR and HAHC, New Delhi, Delhi, India.
Correspondence
Afreen Khan,
Assistant Professor, Department of Paediatrics, Handard Institute of Medical
Science and Research, New Delhi, Delhi, India.
E-mail: afreenkhan1204@yahoo.com
Introduction: Multisystem Inflammatory Response Syndrome in Children (MIS-C) temporally associated with Coronavirus Disease 2019 (COVID-19) is characterised by fever, raised inflammatory markers, multisystem involvement with evidence of COVID-19 infection (positive RT-PCR or serology). It occurs concurrently or after 4-6 weeks of acute COVID infection. It has wide range of clinical presentation ranging from mild asymptomatic infection to severe life-threatening illness. Clinical presentation of MIS-C has considerable overlapping features with other tropical infections. During peak wave of COVID-19, when large proportion of population has been affected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), contracting other infections during and within four weeks of active COVID-19 is inevitable. Despite of this concern, only few researchers have studied co-infection and they explained a complex interaction between COVID-19 and other infections like tuberculosis and dengue. They demonstrated how one infection augments the severity of other. To the best of our knowledge no paediatric population-based study explained the interaction of acute COVID-19 and MIS-C with other infections so far.
Aim: To determine the association of MIS-C with co-infections in SARS-CoV-2 positive children of one month to less than 18 years of age.
Materials and Methods: A retrospective cross-sectional analysis of the medical records of paediatric patients with SARS-CoV-2 infection, treated from September 2020 to February 2021, was performed. All the patients who fulfilled World Health Organisation (WHO) criteria of MIS-C were included. Detailed demographic, clinical, laboratory parameters and associated co-infections were recorded.The severe and non severe MIS-C groups were compared. Sample ‘t’ test, Wilcoxon test and Chi-squared test were used for statistical analysis.
Results: A total of 44 children fulfilled the diagnostic criteria of MIS-C and were included in the study. Out of 44, 20 children (45.4%) had severe disease and 24 had non severe disease. The mean age of children with severe MIS-C was 7.38±5.39 years, as compared to 4.37±4.61 years in the non severe group (p-value=0.044). Males were predominantly affected in both the groups (Male: Female=1.22:1 in severe MIS-C and 2.4:1 in non severe MIS-C). The gastrointestinal system was most commonly affected in both groups. Associated coinfection was noted more in severe MIS-C group (11 vs 1 patient in severe vs non severe group, p-value <0.001). Tuberculosis was found to be associated in three patients, followed by complicated enteric fever, and severe dengue in two patients each. The odds ratio for developing severe MIS-C in the presence of co-infections was 10.5 (CI=2.33-47.27) while in its absence it was 0.10 (0.02-0.43).
Conclusion: The findings of this study support that concurrent infections in COVID-19 can exacerbate the severity of COVID-19 illness and may lead to severe MIS-C.
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