Differentiating MIS-C from Dengue and Other Tropical Infections: A Challenging Conundrum

Multisystem inflammatory syndrome in children (MIS-C) is a severe manifestation of COVID-19 in children, and diagnostic guidelines were quickly established to identify this condition. However, in India, differentiating MIS-C from other tropical infections like dengue, malaria, chikungunya, and rickettsial infections is challenging, as they present similar clinical and laboratory features. A study comparing hospitalized dengue patients with MIS-C patients found distinct differences, such as a higher prevalence of rash, mucocutaneous changes, and gallop rhythm in MIS-C, while dengue patients exhibited higher rates of petechiae, hepatomegaly, headache, and myalgia.

Laboratory features also differed, with MIS-C patients showing elevated CRP and IL-6 levels, while dengue patients had higher Hb, AST/ALT levels, and lower platelet counts. Although dengue serology is the most specific test, the study highlighted the limited usefulness of SARS-CoV-2 antibody positivity in diagnosing MIS-C due to high rates of natural infection. Furthermore, other tropical infections like chikungunya, enteric fever, and rickettsial infections pose additional diagnostic challenges. Developing locally adapted diagnostic algorithms, as advocated by the Indian Academy of Paediatrics, is crucial to accurately differentiate MIS-C from these tropical mimics.

Singhal T. The Conundrum of Differentiating MIS-C from Dengue and Other Tropical Infections. Indian J Pediatr. 2023; 90:639–640. https://doi.org/10.1007/s12098-023-04630-9