The CDC and WHO have officially released advisories on multisystem inflammatory syndrome in children, which the medical community believes is related to COVID-19.
First seen and detected in the United Kingdom at the end of April, multisystem inflammatory syndrome (MIS-C) has since developed rapidly throughout New York State and City—the epicenter of U.S. COVID-19 infections. From April 16 through May 4, 15 patients aged 2 to 15 were hospitalized with symptoms then-unknown to be MIS-C. From May 4 to May 12, the New York State Department of Health identified 102 patients with symptoms indicative of MIS-C.
MIS-C is characterized by symptoms similar to those of Kawasaki disease and toxic shock syndrome. The young patients who initially presented with the syndrome in the UK had a persistent fever and a constellation of symptoms, including hypotension, multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic) involvement, and elevated inflammatory markers.
Doctors with Evelina London Children's Hospital in London published a study on May 7 in The Lancet reviewing 8 cases that came through the hospital’s Pediatric Intensive Care Unit, including one fatality. Six of the eight children either tested positive for SARS-CoV-2 through antibody testing or were confirmed to have been exposed through immediate family members.
Seven children were well enough to be discharged 4 to 6 days after admission to Evelina London Children's Hospital Pediatric Intensive Care Unit. A 14-year-old male died 6 days after he was admitted. Six of the children were of Afro-Caribbean descent, and five of the children were boys. All children except one were well above the 75th percentile for weight.
“We suggest that this clinical picture represents a new phenomenon affecting previously asymptomatic children with SARS-CoV-2 infection manifesting as a hyperinflammatory syndrome with multiorgan involvement similar to Kawasaki disease shock syndrome,” the doctors write in the paper. “The multifaceted nature of the disease course underlines the need for multispecialty input (intensive care, cardiology, infectious diseases, immunology, and rheumatology).”
For now, the CDC is defining case definition for MIS-C as follows:
- An individual aged 21 years and younger presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (more than 2) organ involvement; AND
- No alternative plausible diagnoses; AND
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms.
The public health agency is also asking medical professionals to consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.
Photo: X-ray showing aneurysmal enlargement of the coronary arteries, which is a common complication in Kawasaki disease.