82. Multisystem Inflammatory Syndrome in Children and non-sars-cov-2 Infections: A Retrospective Cross-sectional Study

Background: Multisystem inflammatory syndrome in children (MIS-C) has been described in areas with high Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) burden Clinical features included in the MIS-C case definition (e g fever, elevated inflammatory markers) overlap with features of other childhood infections The prevalence of non-SARS-CoV-2 infection in patients evaluated for MIS-C has not been described Methods: Retrospective cohort study of patients < 21 years of age admitted to a freestanding children's hospital in Boston, MA from May 14-June 6, 2020 who were evaluated for MIS-C We identified patients undergoing Rheumatology consultation and echocardiogram (per the hospital's protocol for evaluating children with suspicion for MIS-C) We tabulated patients evaluated for MIS-C found to have non-SARS-CoV-2 infection detected on standard microbiologic testing Results: 39 patients met inclusion criteria Median age was 5 years (IQR 2-12 years) Of evaluated patients, 19/39 (49%) were diagnosed with MIS-C according to the Massachusetts Department of Public Health case definition;10/39 (26%) required ICU admission Non-SARS-CoV-2 infections were identified in 7/39 (18%), of whom 5/7 (71%) had bacterial infections, 1/7 (14%) had viral infection, and 1/7 (14%) had viral and bacterial co-infections;no fungal or parasitic infections were identified Of patients diagnosed with MIS-C, 2/19 (11%) were found to have non-SARS-CoV-2 infection Additionally, 5/19 (26%) had a positive polymerase chain reaction test for SARS-CoV-2 at time of MIS-C diagnosis, of whom 4/5 (80%) received remdesivir Of patients evaluated for MIS-C, 17/39 (44%) received intravenous immune globulin, 14/39 (36%) aspirin, 4/39 (10%) anakinra, and 14/39 (36%) methylprednisolone Additionally, 21/39 (54%) received antibacterial and 5/39 (13%) antiviral therapy (Table) Conclusion: In this study, non-SARS-CoV-2 infections were diagnosed in 18% of children evaluated for MIS-C Clinicians should consider alternative or concomitant infectious diagnoses in patients undergoing MIS-C evaluation Research is needed to identify clinical and laboratory features that may distinguish patients with MIS-C from those with non-SARS-CoV-2 infection (Figure Presented)