Pediatria pre prax 1/2023

4 wawes of PIMS-TS – course, complications, sequelae

Introduction: In timely relation to the beginning of the COVID-19 pandemic, first cases of the multisystemic inflammatory syndrome PIMS-TS/MIS-C were noted in Europe and the USA in April 2020 and with a short delay also in Slovakia, where 4 waves of the disease were recorded from June 2020 to August 2022. Aims: To analyse the cohort of children treated for PIMS-TS at the National Institute for Children’s Diseases (NÚDCH) in Bratislava, to assess the occurrence of short-term complications and long-term sequelae and to compare the waves of PIMS-TS. Results: From June 2020 to August 2022, altogether 36 children, predominantly males (n=24, 66 %) aged 2,5 to 17 years (median 7 years) with PIMS-TS were treated as inpatients at NÚDCH, with PIMS-TS developing 18–60 days (median 29 days) from COVID-19. The leading clinical symptoms were fever lasting 1–14 days (median 5 days) in all children, exanthema (n=29), abdominal pain (n=24) with diarrhoea (n=17) and vomiting (n=20), non-suppurative conjunctivitis (n=27) and headache (n=17). Nine children presented with positive meningeal signs. Nearly all (n=33) children had tachycardia, in 19 (53 %) arterial hypotension developed, 10 (28 %) required intensive care. The dominant laboratory findings were increased inflammatory parameters (CRP, IL-6, PCT, ferritin, fibrinogen), lymphopenia, thrombocytopenia, hypoalbuminemia, hyponatremia, increased cardiac markers (NTproBNP, troponine). Transient myocardial dysfunction was observed in 3 (8%), dilation of ventricles in 8 (22 %) and dilation of coronary arteries in 5 (14 %) patients. Six children (16,7 %) required inotropic support and 4 non-invasive lung ventilation. A more pronounced increase of inflammatory markers CRP (224,0 vs. 169,5 mg/l), PCT (7,7 vs. 2,6 ug/l) and lymphopenia (0,7 vs. 1,1x109/ml) conferred significantly increased risk for the need of intensive care vs. standard care, respectively (p<0,05). Among our patients no statistically significant differences in the clinical presentation, laboratory parameters and clinical course could be observed between 4 waves of PIMS-TS. The incidence of PIMS-TS significantly decreased with the onset of the omicron wave of COVID-19. Conclusions: All children recovered without known permanent cardiac or other sequelae. 7 children experienced a repeated COVID-19 infection without recurrence of PIMS-TS, 2 children were vaccinated with the SARS-CoV-2 mRNA vaccine without recurrence of PIMS-TS or any other complications.

Keywords: PIMS-TS, MIS-C, COVID-19, Slovakia, course, sequelae