Distinguishing Multisystem Inflammatory Syndrome in Children From COVID-19, Kawasaki Disease and Toxic Shock Syndrome

• Type of Material: Article
• Authors: Shana Godfred-Cato, CDC COVID-19 Response Team; Joseph Y Abrams, CDC COVID 19 Response Team; Neha Balachandran, CDC COVID 19 Response Team; Preeti Jaggi, Emory University; Kaitlin Jones, Childrens Healthcare Atlanta; Christina Rostad, Emory University; Austin T Lu, Emory University; Lucie Fan, Emory University; Aysha Jabbar, Childrens Healthcare Atlanta; Evan Anderson, Emory University; Carol Kao, Emory University; David A Hunstad, Washington University School of Medicine; Robert B Rosenberg, hoenix Children’s Hospital; Marc J Zafferani, hoenix Children’s Hospital; Kaleo C Ede, University of Arizona; Wassim Ballan, University of Arizona; Federico R Laham, Orlando Health Arnold Palmer Hospital for Children; Yajira Beltran, Orlando Health Arnold Palmer Hospital for Children; Bobbi Bryant, CDC COVID 19 Response Team; Lu Meng, CDC COVID 19 Response Team; Teresa A Hammett, CDC COVID 19 Response Team; Matthew Oster, Emory University; Sapna B Morris, CDC COVID 19 Response Team; Ermias D Belay, CDC COVID 19 Response Team
• Language: English
• Date: 2022-04-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/INF.0000000000003449
• Title of Journal or Parent Work: PEDIATRIC INFECTIOUS DISEASE JOURNAL
• Volume: 41
• Issue: 4
• Start Page: 315
• End Page: 323
• Grant/Funding Information: NIH R61 RADx-rad funding for predicting Viral-Associated Inflammatory Disease Severity in Children With Laboratory Diagnostics and Artificial Intelligence (PreVAIL)–Emory site PI; overall PI is Charles Chiu, MD, PhD, at UCSF; Genentech, Inc, funding as a coinvestigator; Emory PI is Ann Chahroudi, MD, PhD, VTEU, HHSN272201300018I role: as a coinvestigator; Emory PI is Nadine Rouphael, MD, MS, BioFire, Janssen, MedImmune, Micron, Moderna, PaxVax, Pfizer investigatory in clinical trials with support to Emory University. This study was supported by the CDC. The CDC provided funds for the principal investigators and abstractors and laboratory sample collection and testing. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.; F.R.L. received funding as the principal investigator for Orlando Health for this project from the CDC. F.R.L. received an honoraria from Tyme, Inc, as a Medical Advisory Board member. R.B.R. received funding as the principal investigator for Phoenix Children’s Hospital for this project from the CDC. C.A.R. received funding as the principal investigator for Emory Healthcare for this project from the CDC; she has also received start-up funding and pilot funding for specimen collection for the Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University. Co-inventor of a pending patent (US20180333477A1) for respiratory syncytial virus vaccine technology, licensed to Meissa Vaccines, Inc, with royalties paid to Emory University.
• Keywords: Life Sciences & Biomedicine; MIS-C; Immunology; Science & Technology; Kawasaki disease; TSS; Infectious Diseases; Pediatrics; MODELS; COVID-19
• Research Categories: Health Sciences, Public Health

Abstract

Background: Distinguishing multisystem inflammatory syndrome in children MIS-C from coronavirus disease 2019 COVID-19, Kawasaki disease KD, and toxic shock syndrome TSS can be challenging. Because clinical management of these conditions can vary, timely and accurate diagnosis is essential. Methods: Data were collected from patients <21 years of age hospitalized with MIS-C, COVID-19, KD, and TSS in 4 major health care institutions. Patient demographics and clinical and laboratory data were compared among the 4 conditions, and a diagnostic scoring tool was developed to assist in clinical diagnosis. Results: A total of 233 patients with MIS-C, 102 with COVID-19, 101 with KD, and 76 with TSS were included in the analysis. Patients with MIS-C had the highest prevalence of decreased cardiac function 38.6%, myocarditis 34.3%, pericardial effusion 38.2%, mitral regurgitation 31.8% and pleural effusion 34.8% compared with patients with the other conditions. Patients with MIS-C had increased peak levels of C-reactive protein and decreased platelets and lymphocyte nadir counts compared with patients with COVID-19 and KD and elevated levels of troponin, brain natriuretic peptide and pro-brain natriuretic peptide compared with COVID-19. Diagnostic scores utilizing clinical findings effectively distinguished MIS-C from COVID-19, KD, and TSS, with internal validation showing area under the curve ranging from 0.87 to 0.97. Conclusions: Compared with COVID-19, KD, and TSS, patients with MIS-C had significantly higher prevalence of cardiac complications, elevated markers of inflammation and cardiac damage, thrombocytopenia, and lymphopenia. Diagnostic scores can be a useful tool for distinguishing MIS-C from COVID-19, KD, and TSS.