Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.
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Author
Feldstein, Leora RRose, Erica B
Horwitz, Steven M
Collins, Jennifer P
Newhams, Margaret M
Son, Mary Beth F
Newburger, Jane W
Kleinman, Lawrence C
Heidemann, Sabrina M
Martin, Amarilis A
Singh, Aalok R
Li, Simon
Tarquinio, Keiko M
Jaggi, Preeti
Oster, Matthew E
Zackai, Sheemon P
Gillen, Jennifer
Ratner, Adam J
Walsh, Rowan F
Fitzgerald, Julie C
Keenaghan, Michael A
Alharash, Hussam
Doymaz, Sule
Clouser, Katharine N
Giuliano, John S
Gupta, Anjali
Parker, Robert M
Maddux, Aline B
Havalad, Vinod
Ramsingh, Stacy
Bukulmez, Hulya
Bradford, Tamara T
Smith, Lincoln S
Tenforde, Mark W
Carroll, Christopher L
Riggs, Becky J
Gertz, Shira J
Daube, Ariel
Lansell, Amanda
Coronado Munoz, Alvaro
Hobbs, Charlotte V
Marohn, Kimberly L
Halasa, Natasha B
Patel, Manish M
Randolph, Adrienne G
Journal title
The New England journal of medicineDate Published
2020-06-29Publication Volume
383Publication Issue
4Publication Begin page
334Publication End page
346
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Show full item recordAbstract
Background: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. Methods: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. Results: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). Conclusions: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.).Citation
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, Singh AR, Li S, Tarquinio KM, Jaggi P, Oster ME, Zackai SP, Gillen J, Ratner AJ, Walsh RF, Fitzgerald JC, Keenaghan MA, Alharash H, Doymaz S, Clouser KN, Giuliano JS Jr, Gupta A, Parker RM, Maddux AB, Havalad V, Ramsingh S, Bukulmez H, Bradford TT, Smith LS, Tenforde MW, Carroll CL, Riggs BJ, Gertz SJ, Daube A, Lansell A, Coronado Munoz A, Hobbs CV, Marohn KL, Halasa NB, Patel MM, Randolph AG; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020 Jul 23;383(4):334-346. doi: 10.1056/NEJMoa2021680. Epub 2020 Jun 29. PMID: 32598831; PMCID: PMC7346765.DOI
10.1056/NEJMoa2021680ae974a485f413a2113503eed53cd6c53
10.1056/NEJMoa2021680
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- Creative Commons
Except where otherwise noted, this item's license is described as Copyright © 2020 Massachusetts Medical Society.
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