141 CMAAO
CORONA FACTS and MYTH BUSTER: Colchicine
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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