Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: a meta-analysis and insights into pathogenesis

• Published in: International journal of infectious diseases 2021-01, Vol.102, p.319-326
• Main Authors: Zou, Hua, Lu, Juan, Liu, Jingjing, Wong, Josiah Hiu-yuen, Cheng, Si, Li, Qiuhong, Shen, Yan, Li, Chunli, Jia, Xiaojiong
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; COVID-19; COVID-19 - diagnosis; COVID-19 - drug therapy; COVID-19 - virology; Critical Care; Female; Humans; Immunoglobulin G - administration & dosage; Length of Stay; Male; Pediatric Multi-system Inflammatory Syndrome; Respiration, Artificial; SARS-CoV-2; SARS-CoV-2 - physiology; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - drug therapy; Systemic Inflammatory Response Syndrome - virology
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.11.145

•Our study documented three common types of PMIS clinical presentation: persistent fever and gastrointestinal symptoms, shocked with heart dysfunction and Kawasaki disease-like syndrome.•PMIS patients proved with a marked inflammatory state are possibly associated with SARS-CoV-2 infection.•we put forward several potential hypotheses in this discussion in hope of shedding light for future research. There was an outbreak of pediatric multisystem inflammation syndrome (PMIS) was observed in multiple countries recently, and this syndrome was suspected to be associated with SARS-CoV-2 infection. At present, there is still no standardized diagnostic criteria and treatment regimen for PMIS, while the etiology and pathogenesis still remain unclear. We performed a systematic review on PubMed and Embase from the time of inception to June 24th 2020 in order to find relevant cases. There are seven studies included, and 80% of patients suffered persistent fever and 90% appeared gastrointestinal symptoms. IgG antibody against SARS-CoV-2 was positive on 81% of patients, while 37% of the patients were nucleic acid positive. C-reactive protein, IL-6 and PCT were elevated and intravenous immunoglobulin was a routine treatment for PMIS. There were more than half of patients required inotropic supports and mechanical ventilation were applied to 33% of patients. The median length of hospital stay was 10.66 days and 74% had admitted to accept intensive care. Our study documented three common types of PMIS clinical presentation: persistent fever and gastrointestinal symptoms, shocked with heart dysfunction and Kawasaki disease-like syndrome. PMIS patients proved with a marked inflammatory state were possibly associated with SARS-CoV-2 infection.