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Lishman J, Abraham DR, Fourie B, Yunis NA, Redfern A, van der Zalm MM, Rabie H. Short-term outcomes of South African children with multisystem inflammatory syndrome in children: a prospective cohort study. Arch Dis Child 2023; 108:792-798. [PMID: 37236771 DOI: 10.1136/archdischild-2022-325287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Despite the life-threatening presentation of multisystem inflammatory syndrome in children (MIS-C), the overall prognosis is favourable in centres with access to appropriate supportive care. In this study, we investigate the short-term outcomes in children with MIS-C in Cape Town, South Africa. METHODS This prospective observational cohort study included children <13 years who fulfilled the WHO case definition of MIS-C and were admitted to Tygerberg Hospital in Cape Town, South Africa between 1 June 2020 and 31 October 2021. Clinical features were recorded at baseline and at follow-up at the 6-week cardiology and 3-month rheumatology-immunology clinics, respectively. FINDINGS Fifty-three children with a median age of 7.4 years (IQR 4.2-9.9) were included. There was a slight male predominance (30/53; 56.6%) and the majority was of mixed ancestry (28/53; 52.83%) or black African ancestry (24/53; 45.3%). Fourteen children (14/53; 26.4%) had comorbid disease. The median length of hospital stay was 8 days (IQR 6-10). All children had an echocardiogram performed at baseline of which 39 were abnormal (39/53; 73.6%). All children were discharged alive. The median days from discharge to cardiology follow-up was 39 days (IQR 33.5-41.5) and for rheumatology-immunology clinic was 70.5 days (IQR 59.5-85.0). Eleven children (11/41; 26.8%) had a persistently abnormal echocardiogram at cardiology follow-up. Systemic inflammation and organ dysfunction resolved in most. INTERPRETATION Although the short-term outcomes of MIS-C in our cohort were generally good, the cardiac morbidity needs further characterisation and follow-up.
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Affiliation(s)
- Juanita Lishman
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Deepthi Raju Abraham
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Barend Fourie
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Nurea Abdulbari Yunis
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Andrew Redfern
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Marieke M van der Zalm
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
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Abstract
PURPOSE OF REVIEW Three years into the coronavirus disease 2019 (COVID-19) pandemic, data on pediatric COVID-19 from African settings is limited. Understanding the impact of the pandemic in this setting with a high burden of communicable and noncommunicable diseases is critical to implementing effective interventions in public health programs. RECENT FINDINGS More severe COVID-19 has been reported in African settings, with especially infants and children with underlying comorbidities at highest risk for more severe disease. Data on the role of tuberculosis and HIV remain sparse. Compared to better resourced settings more children with multisystem inflammatory disease (MISC) are younger than 5 years and there is higher morbidity in all settings and increased mortality in some settings. Several reports suggest decreasing prevalence and severity of MIS-C disease with subsequent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variant waves. Whether this decrease continues remains to be determined. Thus far, data on long-COVID in African settings is lacking and urgently needed considering the severity of the disease seen in the African population. SUMMARY Considering the differences seen in the severity of disease and short-term outcomes, there is an urgent need to establish long-term outcomes in children with COVID-19 and MIS-C in African children, including lung health assessment.
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Affiliation(s)
- Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Daniele Dona’
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Helena Rabie
- Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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