ABSTRACT
Introduction: Since the beginning of SARS-Cov-2 pandemic, children represent a small proportion of patients with an acute disease and present with mild symptoms or are either asymptomatic. However pediatric patients might present with late, post infectious, manifestations of COVID 19, namely Pediatric Inflammatory Multisystemic Syndrome temporally associated with COVID 19 (PIMS-TS). Objectives: We aim to describe the characteristics of pediatric patients with PIMS-TS hospitalised in Sainte Justine Hospital and report their evolution according to their treatment and care. Methods: Patients were recruited prospectively since April 2020. Patient were included if they were less than 18 years old, had at least 2 days of fever, had multisystemic involvement (at least 2 systems) and had a temporal association with COVID 19. This temporal association was defined as: positive reverse transcription (RT)-PCR or antibodies to SARS-Cov2, history of contact with a confirmed or suspected SARS-Cov 2 infected individual or symptom appearance during the pandemic. Patient were excluded if they had an alternative diagnosis that explained the symptoms. Patient were sub categorized into two categories depending on their clinical presentation: 1- Complete or incomplete Kawasaki disease (KD), following the American Heart Association Criteria;or 2- Toxic shock syndrome (TSS). Data were collected during the hospitalization and the follow up. Results: Between April 30th, 2020 and April 30th, 2021, 72 patients were included, 13 (18.1%) with complete KD, 40 (55.6%) with incomplete KD and 19 (26.4%) with TSS. There was more male in the complete KD group (69.2%) and more female in the TSS group (52.6%) but there was no significative difference between the two groups (p = 0.35). Patient with TSS presentation were significatively older than those with KD presentation (10.3 years vs 4.9 years, p < 0.01). Caucasian patients are the most represented ethnic group in the cohort (26.4 %) but Afro-American patient are over-represented in the TSS group (6/19 patients, 31.6%;p= 0.2). Gastro-intestinal symptoms were seen in 50.9% (27/53) and 94.7% (18/19) patients with KD and TSS respectively (p < 0.001). Patients in the TSS group had higher mean value of PCR (239.1 mg/L vs 143.9 mg/L;p< 0.001) and more frequent lymphopenia (89.5% vs 34%;p< 0.001) than those in KD group. Only 40/72 (55.6%) patients in the cohort had either a positive RT-PCR and/or positive antibodies to SARS-Cov-2 and/or a contact with confirmed or suspected infected individual. These proportion increase to 18/19 (94.7%) in the TSS group (p < 0.001). Twenty-three patients (31.9%) required ICU hospitalization including 17 on 19 patients in the TSS group (89.5%;p < 0.001). Cardiac involvement was the most frequent complication either as coronary aneurysm, (15/72 - 20.8%) mainly in patient with KD presentation or as cardiac dysfunction (24/72 - 33.3%), mainly in patient with TSS presentation. Patient received intravenous immunoglobulins (69/72 - 95.8%), steroids (49/72 - 68.1%), sometimes both (48/72 - 66.7%). Five patients (6.9%) required biotherapy: 1 with Enbrel and 4 with Anakinra. Patient received a treatment 6.6 days after the beginning of the symptoms. After 3 months, 4 patients (0.5%) had persistent coronary dilatation and 2 (0.3%) had mitral insufficiency. Conclusion: This cohort study enables a better description of PIMS clinical and biological presentation, which can sometimes be confusing. It also highlights the importance of fast and adequate diagnosis and treatment to avoid the risk of acute and chronic complications, especially cardiac complications.