Thursday, July 2, 2020



Dr K Aggarwal
President CMAAO

963: Multisystem Inflammatory Syndrome in Children in New York State


BACKGROUND: A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019.
METHODS: Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.
RESULTS: As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age.
All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days.
CONCLUSIONS: The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.
Case definition: On May 13, 2020, the NYSDOH established an interim case definition of MIS-C. Confirmed cases were defined by the presence of both clinical and laboratory criteria. Laboratory evidence consisted of elevated levels of two or more inflammatory markers and virologic evidence (any positive molecular test for SARS-CoV-2) or serologic evidence within 10 days after admission (reactivity for IgG or IgM antibodies against SARS-CoV-2). For this evaluation, patients without supportive virologic laboratory evidence of SARS-CoV-2 were categorized as having a suspected case if they met clinical criteria and had exposure to a person with Covid-19 in the 6 weeks before hospitalization.

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