Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C)

ABSTRACT

OBJECTIVE: To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. METHODS: This comparative cross-sectional study was done at tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. RESULTS: During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. Of 34 cases, MIS-C with shock was seen in 15 cases (44%), MIS-C without shock, 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Conjunctival injection and swelling of hand and feet were more commonly seen in MIS-C. Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients, than dengue fever patients [100.2 (85.1) vs 16.9 (29.3) mg/dL (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Need for mechanical ventilation was significantly more in MIS-C cases. Mean hospital stay was longer in MIS- C patients days compared to dengue fever (8.6 vs 6.5 days;P=0.014). CONCLUSION: Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.