The PICU has 14 beds (650 admissions/year) and provided 2 beds for COVID-19 critically ill children. laboratory test results, echocardiographic findings, treatment, and outcomes. Results The median age was 8 years (IQR: 4C10years). All children were previously fit and well. Seven patients were boys. Known exposure to COVID-19 was reported in 4 cases. Fever and gastrointestinal symptoms were reported in all cases. Five patients NVP-BHG712 isomer had marked abdominal pain and were examined by the doctor for possible Rabbit polyclonal to Nucleophosmin appendicitis. Seven patients experienced diarrhea. On examination, we found rash (n=7), conjunctivitis (n=7), cheilitis (n=5), and meningism (n=3). We reported cardiac dysfunction in 7 cases and shock with hypotension in 3 cases. All patients received immunoglobulins, methylprednisolone, and a low dose of aspirin. No deaths occurred. Conclusion We reported here the first Tunisian cluster admissions of 8 critically ill children with MIS-C to spotlight the increase of a new severe emerging disease with evidence of prior COVID-19 contamination in older children. strong class=”kwd-title” Keywords: Multisystem inflammatory syndrome, Children, Critical care Introduction Multisystem inflammatory syndrome in children NVP-BHG712 isomer (MIS-C) is a new emerging severe disease that is temporally related to previous exposure to coronavirus contamination (COVID-19). It is characterized by fever, abdominal pain, gastrointestinal and cutaneous symptoms, and hemodynamic alterations. Since late April 2020, there has been an increasing quantity of worldwide reports of children with MIS-C.1,2,3,4,5 The world health organization (WHO) has developed a preliminary case definition for MIS-C in July 2020.6 It includes clinical presentation, elevated markers of inflammation, evidence of infection, or contact with patients who have COVID-19 after excluding other obvious microbial causes of inflammation. We describe the clinical features, laboratory findings, therapies, and outcomes for the first cluster of 8 children with MIS-C admitted in a Tunisian pediatric rigorous care unit (PICU). Informed consent has been obtained from patients and their parents. On November 29, 2020, we alerted the Tunisian National Observatory of New and Emerging Diseases (ONIAM) about an abnormal increase of very ill children with cardiac dysfunction requiring rigorous care admission. Patients and Methods Establishing The study was conducted in the PICU of Childrens hospital Bechir Hamza of Tunis. The PICU is usually a university-affiliated childrens hospital. The PICU has 14 beds (650 admissions/12 months) and provided 2 beds for COVID-19 critically ill children. From March to September 2020, no admissions occurred with a diagnosis of COVID-19. Study design We conducted a retrospective study between November 1 and November 30, 2020. We included all children aged less than 15 years who were admitted to our PICU and met MIS-C criteria according to the WHO definition case.6 We examined the medical documents of all patients to collect demographic and clinical data (comorbidities, symptoms, delay between symptom onset and PICU admission, organs involvement), severity scores (PRISM III), laboratory test results (markers of inflammation and cardiac enzymes), echocardiographic findings (left ventricular ejection fraction (LVEF)), treatment (medical treatment and need for mechanical ventilation or noninvasive ventilation), and outcomes (length of stay, mortality). A clinical diagnosis of shock was established in the presence of arterial hypotension, the need for vasoactive therapy to maintain normal blood pressure, or the presence of indicators of hypoperfusion despite adequate fluid resuscitation.7 Hypotension was defined by systolic or diastolic blood pressure values below the 5th percentile of the reference values for height or less than 90/50 for children aged 10 years or older.8 Acute cardiac dysfunction was defined as the appearance of reduced left ventricular ejection fraction (LVEF) less than 55%.9 Renal involvement was defined as an increase in serum creatinine levels of double the standard limits for the patients age according to pediatric pRIFLE.10 Liver involvement was defined as an increase in transaminase or bilirubin levels twice above baseline or average values for the patients age. All patients were tested for SARS-CoV-2 (nasopharyngeal reverse transcription-polymerase chain reaction (QIASTAT-RP-SARS-COV-2) and experienced serologic assessments (electrochemiluminescence immunoassay/Cobas e 411) Results In the study period, 35 patients aged less than 15 years were admitted to the PICU. Only three patients required rigorous care admission for respiratory distress and confirmed COVID-19 contamination. We reported eight children admitted with MIS-C. Seven patients were males. The median age was eight years (interquartile range IQR:4C10 years). All children were previously fit and well. No one had obesity. The first individual with confirmed MIS-C in our cohort was admitted on November 3, 2020. Known exposure to COVID-19 was reported in 4 cases. Demographic, clinical data, laboratory test findings, and echocardiographic findings were shown in table 1. Table 1 Clinical Features of 8 Children with Multisystem Inflammatory Syndrome in Children. thead th valign=”middle” align=”left” rowspan=”1″ colspan=”1″ /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Patient 1 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Patient 2 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ NVP-BHG712 isomer Patient 3 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Patient 4 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Patient 5 /th th.