Treatment of MIS-C in Children with Only Steroid - Our Experience in a Tertiary Health Care Center in Rural Bihar

Abstract

Introduction: During the COVID pandemic, initially the children were less affected or were asymptomatic. Later in 2021 many children and adolescents who suffered from COVID-19 infection either symptomatic or asymptomatic, got serious complication known as Paediatric Multisystem Inflammatory Syndrome (MIS) associated with severe acute respiratory syndrome coronavirus 2 (also known as MIS in children [MIS-C]). We admitted many such cases of MISC from surrounding community of Kishanganj located in Bihar. Clinical presentations were fever, shock with hyper‑inflammation, and multiorgan dysfunction, neurological, cardiological, and gastrointestinal dysfunction. This complication of COVID 19 infection was likely a post infection hyper‑inflammatory response as almost 90% of these children were tested positive for antibodies against CoV‑2 with significant rise in inflammatory markers and cytokine levels. Intravenous immunoglobulin (IVIG), aspirin, low molecular weight heparin, and steroids were the cornerstones of treatment protocol. We report here 41 cases of similar presentation, treatment, and outcome of children from Pediatrics Department of MGM Medical College, Kishanganj, Bihar. Materials and Methods: Forty-one cases suspected of MIS-C fulfilling the criteria set by the WHO were taken for this study at Mata Gujri Memorial Medical College and Hospital Kishanganj for a tenure of 10 months (June 2021–March 2022). After initial clinical assessment, blood investigation was sent for various biochemical (C-reactive protein, complete blood count, and neutrophil lymphocyte ratio) and microbiological (D-dimer, COVID IgG) assessment to come to a diagnosis of MIS-C. Treatment protocol includes steroid (methyl prednisolone, dexamethasone) and in two cases IVIG. Results: Among all the 41 patients treated with steroid, 38 cases (92.7%) patient were successfully recovered and discharged. We also noticed there were significant neurological (39%), gastrointestinal (14.6%), and respiratory (24.4%) manifestation. We found association of coinfection with other organism among 3 cases (7.3%) among these 41 patients. Conclusion: MIS-C is a hyperinflammatory syndrome associated with SARS‑CoV‑2 in children and adolescents with fevers, shock, and multiorgan dysfunction. Steroids, IVIG, and aspirin are the first line of management. Refractory cases may need repeat doses of IVIG, steroids or immune‑modulating drugs. However, in our study, we have demonstrated that most of the cases respond (92.7%) significantly to Methyl prednisolone alone.