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Research Snapshot Theater: Epidemiology - Outcomes, Adult and Pediatric II

(279) Clinical Characteristics and Outcome of Multisystem Inflammatory Syndrome in Children in Nepal

Monday, January 22, 2024
10:15 AM – 11:15 AM MT
Location: Connections Central - RST 13

    First Author(s)

  • Puja Amatya (she/her/hers)

    Associate Professor, Department of Pediatics, PAHS, Nepal
    Patan Academy of Health Sciences
    Lalitpur, Bagmati, Nepal

    • Co-Author(s)

  • RR

    Rateena Rajbhandari, MD

    Rateena Rajbhandari, MD, Assistant professor Pediatrics
    Patan Academy of Health Sciences
    Lalitpur, Nepal

  • ST

    Sucharita Tuladhar, MD

    Sucharita Tuladhar, MD Pediatric Hematooncologist, Assistant Professor of Pediatrics
    Patan Academy of Health Sciences
    Kathmandu, Nepal

  • SB

    Sanjeev Bijukchhe, n/a

    Puja Amatya, MD, Fellowship in Pediatric Critical Care, Pediatric Intensivist, Associate Professor
    Patan Academy of Health Sciences
    Kathmandu, Nepal

  • GS

    Ganesh Shah, MD

    Ganesh Shah, MD Professor and Head of Department of Pediatrics
    Patan Acdemy of Health Sciences
    Kathmandu, Nepal

  • SS

    Shrijana Shrestha, MD

    Shrijana Shrestha, MD
    Patan Hospital
    Kathmandu, Nepal

  • SB

    Sangita Basnet, MD, FAAP, FCCM

    Professor
    Southern Illinois University School of Medicine
    Springfield, Illinois, United States

Introduction: Multisystem Inflammatory Syndrome in Children (MIS‐C) manifests several weeks after SARS‐CoV‐2 infection and is characterized by fever, inflammation and multi-organ dysfunction. Presentation may overlap with Kawasaki Disease like features. The US Centers for Disease Control and Prevention first introduced the case definition on May 14, 2020. Nepal reported its first death of a child with MIS-C on December 22, 2020, and the first case of MIS-C was diagnosed and managed at Patan hospital on July 2021. There is paucity of data regarding clinical spectrum and outcome of MIS-C in Nepal. This study was done to determine the clinical characteristics, management, and outcome of children with MIS-C in our settings.

Methods: This is a retrospective study done from January 2020 to March 2022 at Patan hospital, a tertiary care facility in the capital city Kathmandu. All children aged 1 month to 14 years of age fulfilling case definition of MIS-C by WHO were eligible. Data is presented in percentages and proportions.

Results: Fifty patients were admitted with the diagnosis of MIS-C. Only 36 had complete data and were included in the review. Mean age was 5.4 years (range 4 months-14 years), 20 (56%) were male. Most common symptoms were fever in 36 (100%) patients, gastrointestinal 23 (64%), rash 13 (36%) and respiratory 8 (23%). Other symptoms included Kawasaki disease like features in 8 (23%) patients, toxic shock syndrome 5 (14%), meningoencephalitis 3 (8%), subconjunctival hemorrhage 1 (3%), and pulmonary edema 1(3%). Left ventricular dysfunction with mild pericardial effusion was noted in 10 (28%) and 3 (8%) patients had dilated coronary arteries. One child required invasive mechanical ventilation and 2 were on noninvasive ventilation. Eight (23%) patients required inotropic support. Both IVIG and steroid was administered in 10 (27%) patients, while 10 (27%) and 6 (17%) received just steroid and IVIG respectively. Thirty-one (86%) patients received aspirin. There was no mortality.

Conclusions: The symptoms of MIS-C in Nepal were similar to those outlined in the literature. The overall outcome of MIS-C patients was good, including those with severe symptoms.