Multisystem Inflammatory Syndrome (MIS-C) and Dengue among Pediatric In-Patients

Multisystem inflammatory syndrome (MIS-C) in children is a febrile condition that shows symptoms like other locally prevalent illnesses. The goal of the study was to understand their initial presentation.

This retrospective study involved comparisons between the clinical and laboratory profiles of children admitted with MIS-C and dengue. Here, children aged 12 years and below, who were admitted with either MIS-C (defined by the WHO) or laboratory-confirmed dengue from August 2020 to January 2021 in a hospital in North India, were analyzed.

Overall, 84 children (40 with MIS-C and 44 with dengue) were included. The mean age (83.5 months with a standard deviation of 39 vs. 91.6 months with a standard deviation of 35) was similar between the two groups. Specific symptoms like rash, conjunctival injection, oral mucocutaneous changes, and gallop rhythm were more frequently observed in children with MIS-C. On the other hand, petechiae, myalgia, headache, and hepatomegaly were more common in those with dengue. Children with MIS-C had markedly higher levels of C-reactive protein (124 vs. 3.2 mg/L) and interleukin (IL)-6 (95.3 vs. 20.7 ng/mL), whereas those with dengue showed higher hemoglobin levels (12 vs. 10.2 g/dL), lower mean platelet count (26 vs. 140 × 109/L), and greater aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases elevations. Further, hospital stay was longer for children with MIS-C; however, the stays in the pediatric intensive care unit (PICU) and mortality rates were comparable between the two groups.

From the findings, it was concluded that among pediatric in-patients with acute febrile illness, the presence of mucocutaneous features and significantly elevated C-reactive protein could help distinguish MIS-C from dengue. Conversely, the presence of petechiae, hepatomegaly, and hemoconcentration may suggest a diagnosis of dengue.

Source: Randhawa MS, Angurana SK, Nallasamy K, et al. Indian Journal of Pediatrics. 2022 May 5:1-6.