Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study)
Dilek Yilmaz Ciftdogan
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
Search for more papers by this authorCorresponding Author
Yildiz Ekemen Keles
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
Correspondence: Dr. Yildiz Ekemen Keles, Health Sciences University, Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Izmir, Turkey, Gaziler street number: 468, 35020 Yenisehir Konak/İzmir, Turkey. Fax number: +90 232 469 69 69; email: [email protected]
Search for more papers by this authorAdem Karbuz
Department of Pediatric Infectious Diseases, Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
Search for more papers by this authorBenhur Sirvan Cetin
Department of Pediatric Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
Search for more papers by this authorSefika Elmas Bozdemir
Department of Pediatric Infectious Diseases, Bursa Dortcelik Children's Hospital, Bursa, Turkey
Search for more papers by this authorEda Kepenekli Kadayifci
Department of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
Search for more papers by this authorOzge Metin Akcan
Department of Pediatric Infectious Diseases, Faculty of Medicine, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
Search for more papers by this authorArife Ozer
Division of Pediatric Infectious Diseases, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
Search for more papers by this authorTugba Erat
Division of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
Search for more papers by this authorMurat Sutcu
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istinye University Hospital, Istanbul, Turkey
Search for more papers by this authorAyse Buyukcam
Division of Pediatric Infectious Diseases, Gaziantep CG Obstetrics and Children's Hospital, Gaziantep, Turkey
Search for more papers by this authorNursen Belet
Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylul University Hospital, İzmir, Turkey
Search for more papers by this authorEmine Hafize Erdeniz
Department of Pediatric Infectious Diseases, Ondokuz Mayis University Hospital, Samsun, Turkey
Search for more papers by this authorNazan Dalgic Karabulut
Division of Pediatric Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
Search for more papers by this authorSelda Hancerli Torun
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorSelim Oncel
Department of Pediatric Infectious Diseases, Faculty of Medicine, Kocaeli University Hospital, Kocaeli, Turkey
Search for more papers by this authorZerrin Orbak
Department of Pediatrics, Faculty of Dentistry and Medicine, Atatürk University, Erzurum, Turkey
Search for more papers by this authorOzden Turel
Department of Pediatric Infectious Diseases, Faculty of Medicine, Bezmialem Vakif University Hospital, Istanbul, Turkey
Search for more papers by this authorZeynep Gokce Gayretli Aydin
Department of Pediatric Infectious Diseases, Faculty of Medicine, Karadeniz Teknik University Hospital, Trabzon, Turkey
Search for more papers by this authorOmer Kilic
Department of Pediatric Infectious Diseases, Faculty of Medicine, Osmangazi University Hospital, Eskisehir, Turkey
Search for more papers by this authorAysun Yahsi
Division of Pediatric Infectious Diseases, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
Search for more papers by this authorAhu Kara Aksay
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
Search for more papers by this authorZeynep Ergenc
Department of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
Search for more papers by this authorMey Talip Petmezci
Department of Intensive Care, Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
Search for more papers by this authorMehmet Burhan Oflaz
Department of Pediatric Cardiology, Faculty of Medicine, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
Search for more papers by this authorRemzi Sarikaya
Division of Cardiology, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
Search for more papers by this authorGülcin Otar Yener
Division of Pediatric Romatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
Search for more papers by this authorSeval Ozen
Department of Pediatric Infectious Diseases, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Search for more papers by this authorDoruk Gul
Department of Pediatrics, Faculty of Medicine, Istinye University Hospital, Istanbul, Turkey
Search for more papers by this authorGazi Arslan
Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University Hospital, İzmir, Turkey
Search for more papers by this authorSoner Sertan Kara
Department of Pediatric Infectious Diseases, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
Search for more papers by this authorDemet Demirkol
Department of Pediatric Intensive Care, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorPinar Yazici Ozkaya
Department of Pediatric Intensive Care, Faculty of Medicine, Ege University Hospital, Izmir, Turkey
Search for more papers by this authorYilmaz Yozgat
Department of Pediatric Cardiology, Faculty of Medicine, Bezmialem Vakif University Hospital, Istanbul, Turkey
Search for more papers by this authorCelal Varan
Department of Pediatric Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Search for more papers by this authorManolya Kara
Division of Pediatric Infectious Diseases, Necip Fazil City Hospital, Kahramanmaras, Turkey
Search for more papers by this authorGul Arga
Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University Hospital, Ankara, Turkey
Search for more papers by this authorNurhayat Yakut
Department of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
Search for more papers by this authorAhmet Osman Kilic
Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
Search for more papers by this authorOzlem Cakici
Department of Pediatric Infectious Diseases, Faculty of Medicine, Kocaeli University Hospital, Kocaeli, Turkey
Search for more papers by this authorMehmet Kucuk
Division of Pediatric Cardiolgy, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
Search for more papers by this authorOzge Kaba
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorHatice Karaoglu Asrak
Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylul University Hospital, İzmir, Turkey
Search for more papers by this authorBurcu Bursal Duramaz
Department of Pediatric Infectious Diseases, Faculty of Medicine, Bezmialem Vakif University Hospital, Istanbul, Turkey
Search for more papers by this authorTahir Dalkiran
Division of Pediatric Intensive Care, Necip Fazil City Hospital, Kahramanmaras, Turkey
Search for more papers by this authorAyse Berna Anil
Department of Pediatric Intensive Care, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
Search for more papers by this authorMehmet Turgut
Department of Pediatric Infectious Diseases, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Search for more papers by this authorBulent Karapinar
Department of Pediatric Intensive Care, Faculty of Medicine, Ege University Hospital, Izmir, Turkey
Search for more papers by this authorAyper Somer
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorFerhan Elmali
Department of Biostatistics, Izmir Katip Celebi University, Izmir, Turkey
Search for more papers by this authorEner Cagri Dinleyici
Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Search for more papers by this authorErgin Ciftci
Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University Hospital, Ankara, Turkey
Search for more papers by this authorAtes Kara
Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University Hospital, Ankara, Turkey
Search for more papers by this authorDilek Yilmaz Ciftdogan
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
Search for more papers by this authorCorresponding Author
Yildiz Ekemen Keles
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
Correspondence: Dr. Yildiz Ekemen Keles, Health Sciences University, Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Izmir, Turkey, Gaziler street number: 468, 35020 Yenisehir Konak/İzmir, Turkey. Fax number: +90 232 469 69 69; email: [email protected]
Search for more papers by this authorAdem Karbuz
Department of Pediatric Infectious Diseases, Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
Search for more papers by this authorBenhur Sirvan Cetin
Department of Pediatric Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
Search for more papers by this authorSefika Elmas Bozdemir
Department of Pediatric Infectious Diseases, Bursa Dortcelik Children's Hospital, Bursa, Turkey
Search for more papers by this authorEda Kepenekli Kadayifci
Department of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
Search for more papers by this authorOzge Metin Akcan
Department of Pediatric Infectious Diseases, Faculty of Medicine, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
Search for more papers by this authorArife Ozer
Division of Pediatric Infectious Diseases, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
Search for more papers by this authorTugba Erat
Division of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
Search for more papers by this authorMurat Sutcu
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istinye University Hospital, Istanbul, Turkey
Search for more papers by this authorAyse Buyukcam
Division of Pediatric Infectious Diseases, Gaziantep CG Obstetrics and Children's Hospital, Gaziantep, Turkey
Search for more papers by this authorNursen Belet
Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylul University Hospital, İzmir, Turkey
Search for more papers by this authorEmine Hafize Erdeniz
Department of Pediatric Infectious Diseases, Ondokuz Mayis University Hospital, Samsun, Turkey
Search for more papers by this authorNazan Dalgic Karabulut
Division of Pediatric Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
Search for more papers by this authorSelda Hancerli Torun
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorSelim Oncel
Department of Pediatric Infectious Diseases, Faculty of Medicine, Kocaeli University Hospital, Kocaeli, Turkey
Search for more papers by this authorZerrin Orbak
Department of Pediatrics, Faculty of Dentistry and Medicine, Atatürk University, Erzurum, Turkey
Search for more papers by this authorOzden Turel
Department of Pediatric Infectious Diseases, Faculty of Medicine, Bezmialem Vakif University Hospital, Istanbul, Turkey
Search for more papers by this authorZeynep Gokce Gayretli Aydin
Department of Pediatric Infectious Diseases, Faculty of Medicine, Karadeniz Teknik University Hospital, Trabzon, Turkey
Search for more papers by this authorOmer Kilic
Department of Pediatric Infectious Diseases, Faculty of Medicine, Osmangazi University Hospital, Eskisehir, Turkey
Search for more papers by this authorAysun Yahsi
Division of Pediatric Infectious Diseases, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
Search for more papers by this authorAhu Kara Aksay
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
Search for more papers by this authorZeynep Ergenc
Department of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
Search for more papers by this authorMey Talip Petmezci
Department of Intensive Care, Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
Search for more papers by this authorMehmet Burhan Oflaz
Department of Pediatric Cardiology, Faculty of Medicine, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
Search for more papers by this authorRemzi Sarikaya
Division of Cardiology, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
Search for more papers by this authorGülcin Otar Yener
Division of Pediatric Romatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
Search for more papers by this authorSeval Ozen
Department of Pediatric Infectious Diseases, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Search for more papers by this authorDoruk Gul
Department of Pediatrics, Faculty of Medicine, Istinye University Hospital, Istanbul, Turkey
Search for more papers by this authorGazi Arslan
Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University Hospital, İzmir, Turkey
Search for more papers by this authorSoner Sertan Kara
Department of Pediatric Infectious Diseases, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
Search for more papers by this authorDemet Demirkol
Department of Pediatric Intensive Care, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorPinar Yazici Ozkaya
Department of Pediatric Intensive Care, Faculty of Medicine, Ege University Hospital, Izmir, Turkey
Search for more papers by this authorYilmaz Yozgat
Department of Pediatric Cardiology, Faculty of Medicine, Bezmialem Vakif University Hospital, Istanbul, Turkey
Search for more papers by this authorCelal Varan
Department of Pediatric Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Search for more papers by this authorManolya Kara
Division of Pediatric Infectious Diseases, Necip Fazil City Hospital, Kahramanmaras, Turkey
Search for more papers by this authorGul Arga
Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University Hospital, Ankara, Turkey
Search for more papers by this authorNurhayat Yakut
Department of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
Search for more papers by this authorAhmet Osman Kilic
Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Meram Hospital, Konya, Turkey
Search for more papers by this authorOzlem Cakici
Department of Pediatric Infectious Diseases, Faculty of Medicine, Kocaeli University Hospital, Kocaeli, Turkey
Search for more papers by this authorMehmet Kucuk
Division of Pediatric Cardiolgy, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
Search for more papers by this authorOzge Kaba
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorHatice Karaoglu Asrak
Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylul University Hospital, İzmir, Turkey
Search for more papers by this authorBurcu Bursal Duramaz
Department of Pediatric Infectious Diseases, Faculty of Medicine, Bezmialem Vakif University Hospital, Istanbul, Turkey
Search for more papers by this authorTahir Dalkiran
Division of Pediatric Intensive Care, Necip Fazil City Hospital, Kahramanmaras, Turkey
Search for more papers by this authorAyse Berna Anil
Department of Pediatric Intensive Care, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
Search for more papers by this authorMehmet Turgut
Department of Pediatric Infectious Diseases, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Search for more papers by this authorBulent Karapinar
Department of Pediatric Intensive Care, Faculty of Medicine, Ege University Hospital, Izmir, Turkey
Search for more papers by this authorAyper Somer
Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University Hospital, Istanbul, Turkey
Search for more papers by this authorFerhan Elmali
Department of Biostatistics, Izmir Katip Celebi University, Izmir, Turkey
Search for more papers by this authorEner Cagri Dinleyici
Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Search for more papers by this authorErgin Ciftci
Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University Hospital, Ankara, Turkey
Search for more papers by this authorAtes Kara
Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University Hospital, Ankara, Turkey
Search for more papers by this authorConflict of interest: None declared.
Author's contribution: Yilmaz-Ciftdogan and Ekemen-Keles conceptualized and designed the study, collected data, drafted the initial manuscript and reviewed and revised the manuscript. Karbuz, Cetin, Elmas Bozdemir, Kepenekli Kadayifci, Ozer, Erat, Sutcu, Buyukcam, Belet, Oncel, Orbak, Turel, Gayretli Aydin, O Kilic, Yahsi, Kara Aksay, Ergenc, Petmezci, Oflaz, Sarikaya, Otar Yener, Ozen, Gul, Arslan, SS Kara, Demirkol, Yazici Ozkaya, Yozgat, Varan, M Kara, Arga, Yakut, AO Kilic, Cakici, Kucuk, Kaba, Karaoglu Asrak, Bursal Duramaz, Dalkiran, Berna Anil, Turgut, Karapinar, Somer, Elmali, Dinleyici and Ciftci designed the data collection instruments, collected data and reviewed and revised the manuscript. Kara Aksay, Cetin, Elmas Bozdemir, Kepenekli Kadayifci, Metin Akcan, Erdeniz, Dalgic Karabulut, Hancerli Torun and A Kara conceptualized and designed the study, drafted the initial manuscript, reviewed, coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Abstract
Aim
Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey.
Methods
The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.
Results
The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6–9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112–228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30–84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58–20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.
Conclusion
The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
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