KD vs MISC

Abstract

Children with MIS-C have overlapping clinical features with other hyperinflammatory syndromes, both due to exaggerated immune response. A Subtype of MISC has features similar to Kawasaki Disease (KD) with more severe systemic involvement requiring different treatment protocol as compared to KD.

Full text

Dr. Ravleen Kaur, Dr. Seema Sharma, Dr. Milap Sharma
Department of pediatrics, Dr. Rajendra Prasad Medical college,
Kangra at Tanda, Himachal Pradesh.
ravleenkaur5@gmail.com
Children with MIS-C have overlapping clinical features with
other hyperinflammatory syndromes, both due to
exaggerated immune response. A Subtype of MISC has
features similar to Kawasaki Disease (KD) with more severe
systemic involvement requiring different treatment protocol
as compared to KD.
•All patients admitted in the age group of 1 month to 18
years of age fulfilling the criteria for KD as per AHA,2017
guidelines and KD-Phenotype MIS-C as per WHO criteria
were included in the study.
•rofile of all patients admitted in our centre were assessed.
•13 children with KD and 6 children with KD phenotype
MIS-C were studied in period of 2 years from
september,2020 to october,2020.
•A comparitive analysis was done between the 2 groups.
There were 13 patients from KD group and 6 patients from KD-
Phenotype MIS-C group admitted during study period.
•KD Phenotype MISC patients had more PICU admissions, MODS and
requirement of ionotropic support despite presenting with similar
features to KD patients.
•Both had good outcome with early diagnosis and treatment.
•The likely etiology is cytokine storm for both diseases , thus leading
to more similarities than difference between the two diseases.
•KD Phenotype MISC seems to be the severe type of KD disease.
Study of the profile of KD and KD Phenotype MIS-C patients.
Patients from both groups were compared on the basis of
clinical, investigational , treatment and outcome profile.
Kawasaki Disease vs KD Phenotype Multisystem Inflammatory
Syndrome- in Children (MIS-C): Two sides of the same coin?
Introduction
Objective
Methods
Result and Observations
0%
20%
40%
60%
80%
100%
Mucocutaneous Changes
Rash
GI symptoms
Excessive Irritability
100%
53.80% 38.40% 38.40%
50%
33.30%
50%
0%
Clinical Profile
KD KD Phenotype MIS-C
KD (n=13) KD Phenotype MIS-C (n=6)
Profile
Frequency (%) Frequency (%)
Fever
12(92.3) 6(100%)
Rash
7(53.8%) 2(33.3%)
Mucocutaneous changes
13(100%) 3(50%)
GI symptoms
5(38.4%) 3(50%)
Hepatospleenomegaly
4(30.7%) 2(33.3%)
Shock
1(7.6%) 2(33.3%)
MODS
Nil 3(50%)
Conclusion
KD (n=13)
KD Phenotype MIS
-
C
(n=6)
Profile
Frequency
(Percentage)
Frequency
(Percentage)
IVIG only
13(100%) 2(33.3%)
Methylprednisolone +
IVIG
Nil 4(66.6%)
PICU Admission
5(38.4%) 2(33.3%)
Nil
0(0%) Nil
Male
50%
Female
50%
KD PHENOTYPE MIS-C
Male
62%
Femal
e
38%
KAWASAKI DISEASE
KD (n=13) KD Phenotype
MIS-C (n=6)
Investigations
Frequency
(Percentage
)
Frequency
(Percentage)
Anemia
13(100%) 5(83.3%)
Neutrophil:
Lymphocyte Ratio
2(15.3%) 2(33.3%)
Leucopenia
Nil 2(33.3%)
Platelet
Count
↑↑
13(100%) 1(16.6%)
↓↓
Nil 4(66.6%)
CRP
12(92.3%) 6(100%)
SARS CoV
-2 IgG
antibody
4(38.4%) 2(33.3%)
S. Ferritin
13(100%) 4(66.6%)
Pro
-BNP 11(84.6%) 2(33.3%)
ECHO
2(15.3%) Nil
Investigation profile
Treatment and outcome profile