Abstract：
BACKGROUND: In multisystem inflammatory syndrome (MIS-C), children typically present high-grade fever, gastrointestinal symptoms, Kawasaki-like symptoms, and even a toxic shock-like syndrome days to weeks after recovering from SARS-CoV-2 infection. It is important to raise awareness of this condition in order to have early diagnosis and immediate treatment of patients. We have, herein, reported 44 cases of MIS-C with various risk factors and symptoms. Furthermore, we have emphasized the efficacy of experience in treating children with MIS-C with high-dose corticosteroids as an alternative to immunoglobulin in low-income countries.
METHODS: We conducted a targeted survey of MIS-C from early May 2020 to October 2022 on 44 children and adolescents with characteristics of multisystem inflammatory syndrome admitted to the pediatric department of the university hospital center in Oujda, Morocco, to which patients diagnosed with MIS-C were referred. The case definition included six criteria: serious illness leading to hospitalization, age under 18 years, fever of at least 24 hours, laboratory evidence of inflammation, multi-organ involvement, biological inflammatory syndrome, and evidence of coronavirus infection based on polymerase chain reaction, antibody testing or exposure to people with COVID-19 in the past month. The criteria used to diagnose myocarditis were impaired left ventricular function, central mitral leak, and elevation of BNP or pro-BNP. Coronary involvement was assessed by the z-score and the criteria for its presence was a z-score equal to or greater than 2.5.
RESULTS: Our study included 44 children and adolescents with MIS-C in our hospital, with male predominance (79%) and a median age of six years. Cardiovascular involvement was present in 91%, mucocutaneous in 78%, gastrointestinal in 70%, hematologic in 84%, and respiratory in 2% of patients. Coronary abnormalities (z-score ≥ 2.5) were documented in 21 cases (48%). Glucocorticoids were frequently used in comparison to immunoglobulin, which were uncommonly available and expensive.
CONCLUSIONS: The therapeutic protocol that was adopted was high doses of short-term prednisone (Cortancyl) at 4mg/kg/day for 4 days. Favorable outcome was noted in all patients over a 2-year period.
METHODS: We conducted a targeted survey of MIS-C from early May 2020 to October 2022 on 44 children and adolescents with characteristics of multisystem inflammatory syndrome admitted to the pediatric department of the university hospital center in Oujda, Morocco, to which patients diagnosed with MIS-C were referred. The case definition included six criteria: serious illness leading to hospitalization, age under 18 years, fever of at least 24 hours, laboratory evidence of inflammation, multi-organ involvement, biological inflammatory syndrome, and evidence of coronavirus infection based on polymerase chain reaction, antibody testing or exposure to people with COVID-19 in the past month. The criteria used to diagnose myocarditis were impaired left ventricular function, central mitral leak, and elevation of BNP or pro-BNP. Coronary involvement was assessed by the z-score and the criteria for its presence was a z-score equal to or greater than 2.5.
RESULTS: Our study included 44 children and adolescents with MIS-C in our hospital, with male predominance (79%) and a median age of six years. Cardiovascular involvement was present in 91%, mucocutaneous in 78%, gastrointestinal in 70%, hematologic in 84%, and respiratory in 2% of patients. Coronary abnormalities (z-score ≥ 2.5) were documented in 21 cases (48%). Glucocorticoids were frequently used in comparison to immunoglobulin, which were uncommonly available and expensive.
CONCLUSIONS: The therapeutic protocol that was adopted was high doses of short-term prednisone (Cortancyl) at 4mg/kg/day for 4 days. Favorable outcome was noted in all patients over a 2-year period.
摘要：
背景：在多系统炎症综合征（MIS-C）中，儿童通常表现为高烧，胃肠道症状,类似川崎的症状,甚至在SARS-CoV-2感染恢复后的几天到几周内出现中毒性休克样综合征。重要的是要提高对这种情况的认识，以便对患者进行早期诊断和立即治疗。我们有,在这里，报告44例有各种危险因素和症状的MIS-C。此外，我们强调了在低收入国家使用大剂量糖皮质激素替代免疫球蛋白治疗MIS-C患儿的疗效.
方法：我们于2020年5月初至2022年10月对乌吉达大学医院中心儿科收治的44名具有多系统炎症综合征特征的儿童和青少年进行了MIS-C的针对性调查。摩洛哥,被诊断为MIS-C的患者被转诊。病例定义包括六个标准：严重疾病导致住院，18岁以下,发烧至少24小时，炎症的实验室证据，多器官参与，生物炎症综合征，以及基于聚合酶链反应的冠状病毒感染的证据，过去一个月抗体检测或暴露于COVID-19患者。用于诊断心肌炎的标准是左心室功能受损，中央二尖瓣渗漏,和BNP或pro-BNP的升高。通过z评分评估冠状动脉受累，其存在的标准是z评分等于或大于2.5。
结果：我们的研究包括我们医院的44名患有MIS-C的儿童和青少年，男性占主导地位（79％），中位年龄为6岁。91%的患者有心血管受累，皮肤粘膜占78%，70%的胃肠道，血液在84%，2％的患者呼吸。21例（48％）记录了冠状动脉异常（z评分≥2.5）。与免疫球蛋白相比，糖皮质激素经常使用，这是不常见的和昂贵的。
结论：采用的治疗方案是4mg/kg/天的短期泼尼松（Cortancyl）高剂量，持续4天。在2年内，所有患者均获得了良好的结果。
方法：我们于2020年5月初至2022年10月对乌吉达大学医院中心儿科收治的44名具有多系统炎症综合征特征的儿童和青少年进行了MIS-C的针对性调查。摩洛哥,被诊断为MIS-C的患者被转诊。病例定义包括六个标准：严重疾病导致住院，18岁以下,发烧至少24小时，炎症的实验室证据，多器官参与，生物炎症综合征，以及基于聚合酶链反应的冠状病毒感染的证据，过去一个月抗体检测或暴露于COVID-19患者。用于诊断心肌炎的标准是左心室功能受损，中央二尖瓣渗漏,和BNP或pro-BNP的升高。通过z评分评估冠状动脉受累，其存在的标准是z评分等于或大于2.5。
结果：我们的研究包括我们医院的44名患有MIS-C的儿童和青少年，男性占主导地位（79％），中位年龄为6岁。91%的患者有心血管受累，皮肤粘膜占78%，70%的胃肠道，血液在84%，2％的患者呼吸。21例（48％）记录了冠状动脉异常（z评分≥2.5）。与免疫球蛋白相比，糖皮质激素经常使用，这是不常见的和昂贵的。
结论：采用的治疗方案是4mg/kg/天的短期泼尼松（Cortancyl）高剂量，持续4天。在2年内，所有患者均获得了良好的结果。
