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COVID-19 and MIS-C (Multisystem Inflammatory Syndrome in Children)

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COVID-19 and MIS-C (Multisystem Inflammatory Syndrome in Children)

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MIS-C is a potentially fatal condition that affects children infected with COVID-19. Please read the article to know its symptoms, risk factors, treatment, and prevention.

Medically reviewed by

Dr. Sudhakar Palanisamy

Published At October 23, 2020
Reviewed AtAugust 18, 2023

Introduction:

MIS-C, otherwise called multisystem inflammatory syndrome in children, is a potentially fatal and rare condition that affects children. It is being linked to the infection caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus, which is COVID-19. Even though most children infected with this new virus show relatively mild symptoms or are asymptomatic, some develop MIS-C. This condition can affect some or all organs and tissues in the body, such as the lungs, heart, kidneys, blood vessels, digestive tract, brain, eyes, and skin. The affected organs become severely inflamed. Most children recover from this syndrome with proper medical care. But in some children, the condition can result in fatal complications.

In children, symptoms similar to Kawasaki disease (KD) or toxic shock syndrome (TSS) was first reported in the United Kingdom. As similar symptoms were also reported in other parts of the world, the condition was named multisystem inflammatory syndrome in children (MIS-C). The other names include pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), pediatric multisystem inflammatory syndrome (PMIS), pediatric hyperinflammatory shock, and pediatric hyperinflammatory syndrome.

MIS-C is not a disease, but a collection of signs and symptoms, or in other terms, a syndrome, and a lot is unknown about it, such as the risk factors and cause. Depending on the organ or organs affected, the signs and symptoms of MIS-C vary. Only by evaluating more children with COVID-19 and MIS-C will we be able to identify the cause. The CDC (Centers for Disease Control and Prevention) and the NIH (National Institutes of Health) are working around the clock to find the risk factors and cause of MIS-C to diagnose and treat this syndrome effectively. Let us see what we know so far about this syndrome.

What Are Kawasaki Disease and Toxic Shock Syndrome?

Kawasaki Disease (KD) - Kawasaki disease is also a syndrome of unknown etiology that commonly affects children younger than 5 years. This condition results in inflammation of the blood vessels' walls throughout the body and can also affect the coronary arteries and heart.

MIS-C with Kawasaki disease is characterized by fever, conjunctival redness, cracked lips, strawberry tongue, rash, swollen and erythematous hands and feet and cervical lymphadenopathy.

Toxic Shock Syndrome(TSS) - TSS is a rare and potentially fatal complication of infection caused by the bacteria Staphylococcus aureus. This condition is caused when this bacteria enters the blood and produces toxins.

How Does SARS-CoV-2 Cause MIS-C?

It is not well understood how SARS-CoV-2 causes MIS-C. Scientists believe that this syndrome is caused by an abnormal response of the immune system to the Coronavirus. How this virus triggers the abnormal immune response is still not known. Most children exhibit symptoms of MIS-C test negative for SARS-CoV-2 through polymerase chain reaction (PCR) but have positive serology. This confirms that MIS-C results from an altered immune response after the infection's acute phase is over. It is still not clear why some children develop MIS-C following COVID-19, but others do not. However, it can also occur rarely in adults who were previously diagnosed with the Covid-19 virus and may not even know about it. It can occur weeks after the Covid-19 infection.

Risk Factors:

More Hispanic and African-American children have been affected by MIS-C in the US. However, it is still unknown why children of these ethnic groups get infected with MIS-C. Children of all ages can get affected, but MIS-C is commonly seen between 3 and 12 years old, with an average of eight years.

What Are the Reported Signs and Symptoms of MIS-C?

Based on the documented cases so far, children that present with MIS-C exhibit the following symptoms.

  • Fever that lasts for four to six days.

  • Stomach pain.

  • Fatigue.

  • Rashes

  • Cough.

  • Inability to wake up or stay awake.

  • Neck pain.

  • Sore throat.

  • Body pain.

  • Increased heart rate.

  • Shortness of breath.

  • Diarrhea and vomiting.

  • Skin rashes.

  • Pink eyes (conjunctivitis).

  • Headaches.

  • Confusion.

  • Bluish lips.

  • Swollen hands or feet.

  • Swollen tongue and lips.

  • Dizziness.

  • Swollen lymph nodes.

Fever is the most common symptom, and gastrointestinal symptoms can mimic appendicitis pain. Some children also exhibit neurologic symptoms, such as seizures, coma, and muscle weakness.

If your child has a severe stomach ache, breathing problems, confusion, bluish face or lips, and is unable to stay awake, seek immediate medical help.

What Are the Clinical and Laboratory Findings in Children With MIS-C?

On clinical examination, such children showed:

  1. Fissured lips.

  2. Strawberry tongue.

  3. Red and swollen extremities.

  4. Swollen cervical lymph nodes.

  5. Arrhythmia (irregular or fast heartbeat).

  6. Acute respiratory failure.

  7. Swollen liver.

  8. Swelling of the brain and surrounding membranes.

And laboratory findings include:

  1. Mild anemia.

  2. Lymphocytopenia (low lymphocytes).

  3. Neutrophilia (high neutrophils).

  4. Thrombocytopenia (low platelets).

  5. Raised cardiac markers, such as troponin.

  6. Elevated inflammatory markers, such as CRP (C-reactive protein), erythrocyte sedimentation rate (ESR), Ferritin, Interleukin-6 (IL-6), D-dimer.

  7. Hypoalbuminemia (low albumin in the blood).

  8. Raised lactate dehydrogenase.

  9. Hypertriglyceridemia (elevated blood triglycerides).

  10. Slightly elevated liver enzymes.

  11. There will be evidence of recent COVID-19 infection or likely contact with COVID-19 patients. So the RT-PCR antigen test or serology will be positive.

What Are the Possible Complications of MIS-C?

If the doctor suspects MIS-C, he or she will run various tests to see how well the heart, kidneys, and liver are functioning and if there is any inflammation. Polymerase chain reaction (PCR) and serology for SARS-CoV-2 are essential to detect an acute COVID-19 infection or detect antibodies that suggest past infection. A positive serology result indicates the child's immune system produced antibodies to fight the SARS-CoV-2 virus. Apart from this, the following tests might be needed:

  1. Complete blood count (CBC) with differential

  2. C-reactive protein (CRP) and erythrocyte sedimentation rate for inflammation.

  3. Liver function tests.

  4. Chest X-ray.

  5. Abdominal ultrasound.

  6. Heart ultrasound (echocardiogram).

  7. Serum electrolytes and kidney function tests.

  8. Urinalysis.

  9. Prothrombin time.

  10. Cardiac markers such as Troponin and Brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-pro-BNP).

Following tests might be needed to rule out other conditions that result in similar symptoms:

  1. Blood culture.

  2. Urine culture.

  3. Throat culture.

  4. Stool culture.

  5. Serology or PCR for Epstein-Barr virus, Cytomegalovirus, Enterovirus, and Adenovirus.

  6. Tests for typhoid and leptospirosis.

How Is MIS-C Treated?

Hospitalization, and sometimes treatment in the pediatric intensive unit, is needed for most children. As there is no cure, treatment is focused on reducing inflammation and symptoms. It is important to protect vital organs and prevent permanent damage. Depending on the affected organ and the severity of symptoms, the treatment options include:

  1. Intravenous fluids to prevent dehydration.

  2. Oxygen therapy to assist with breathing.

  3. If the blood pressure is too low, blood pressure stabilizing medications are administered. This helps the heart function properly and pump blood throughout the body.

  4. Ventilator support if the lungs are not functioning properly.

  5. Antibiotics to treat any secondary bacterial infection.

  6. Steroids to reduce inflammation. Taper steroids for two to three weeks with clinical and CRP monitoring.

  7. Immunoglobulin intravenously. These are antibodies that help the patient recover.

  8. Aspirin, Heparin, or other blood thinners to reduce the risk of blood clots.

  9. For children with cardiac involvement ECG has to be repeated 48 hourly and ECHO at 7 to 14 days and between 4 to 6 weeks, and after one year if initial ECHO was not normal. If the heart and lungs are severely affected, extracorporeal membrane oxygenation (ECMO) might be needed.

Even though MIS-C is not contagious, the child could still have an active COVID-19 infection or some secondary contagious infection. So, infection control measures should be employed at all times.

Prevention:

As MIS-C is linked to COVID-19, the best way to prevent this syndrome is by avoiding exposure to the SARS-CoV-2 virus. Teach your child how this virus spreads and what they can do to keep themselves safe. Make sure:

  1. Your child keeps his hands clean and washes them frequently with soap and water for at least 20 seconds. You can also teach them how to use alcohol-based hand sanitizers.

  2. You do not let people who are visibly sick come close to your child.

  3. Your child knows the importance of social distancing. Ask them to stay six feet or more away from other people when they go out.

  4. Your child wears a face mask in public (only if the child is older than two years, and he or she can take the mask off themselves).

  5. Your child does not touch his or her face without washing their hands first.

  6. Your child covers the mouth while sneezing to avoid spreading germs.

  7. Make your child get COVID vaccination. Pfizer-BioNTech and Moderna vaccines are used in the clinical trials of children aged six months, children above six months, and teenage people. These trials are made to come to a conclusion about COVID-19 vaccines for children. The Pfizer vaccine has been given permission for use in people 16 years of age and older and subsequently in children of 12 to 16 years of age and in the pediatric population of ages 5 through 11 years, with a change in the recommended dosage. Now the company is testing the vaccine’s efficacy in infants and children up to the age of five. Moderna vaccine has been approved as a COVID-19 vaccine for children above 18 years of age or older by the Centers for Disease Control and Prevention, United States (CDC), and six years or older by the European Medicines Agency. Covaxin was given approval for emergency use in children aged two years to 18 years years. The clinical trials in children are ongoing, and the vaccine’s efficacy and immune response generated were found to be similar to that of adults in the trials.

As a parent, you should clean and disinfect all the frequently touched surfaces, such as switches, remotes, chairs, tables, etc., at home every day with a good disinfectant. Wash your child's clothes using the warmest setting in the washing machine. Also, wash or wipe their toys regularly. In addition, it is essential to get vaccinated on your turn for further protection and to prevent the spread of COVID-19.

Frequently Asked Questions

1.

Is Multisystem Inflammatory Syndrome In Children (MIS-C) Occur by COVID-19?

Yes, MIS-C is believed to be caused by COVID-19. MIS-C is a rare but serious condition observed in children with COVID-19. While the exact cause of MIS-C is not yet fully unknown, it is thought to be related to an abnormal immune response triggered by the virus. Symptoms of MIS-C can include fever, rash, abdominal pain, vomiting, and diarrhea and can be severe enough to require hospitalization.

2.

What Is the Incidence of Multisystem Inflammatory Syndrome in Children?

Multisystem inflammatory syndrome in children (MIS-C) is considered a rare complication of COVID-19 in children, but the exact prevalence is not yet known. According to the Centers for Disease Control and Prevention (CDC) in the United States, as of January 2022, over 8,500 cases of MIS-C have been reported in the U.S., and there have been over 40 deaths. The condition appears more common in children and adolescents than in younger infants.

3.

Is there Any Correlation Between MIS-C And Positive Covid Test?

Children with the multisystem inflammatory syndrome in children (MIS-C) typically test positive for COVID-19 antibodies, indicating that they have been previously infected with the virus that causes COVID-19. However, some children with MIS-C may test negative for the virus, as the syndrome typically develops several weeks after the initial COVID-19 infection. It is essential to know that a positive COVID-19 test is not necessary to diagnose MIS-C, as the syndrome is primarily identified through its characteristic symptoms, including fever, rash, abdominal pain, vomiting, and diarrhea.

4.

How Much Time Is Require to Develop MIS-C in Post-Covid Children?

Multisystem inflammatory syndrome in children (MIS-C) typically develops several weeks after a child has had COVID-19. The Centers for Disease Control and Prevention (CDC) estimated that most cases of MIS-C occur in children ages 1 and 14, with the average age being around eight years old. The exact time frame for MIS-C development following a COVID-19 infection can vary, but it generally occurs between two to six weeks after the initial infection. It is essential for parents and caregivers to monitor children for symptoms of COVID-19 and to seek medical care if symptoms of MIS-C, such as fever, rash, abdominal pain, vomiting, and diarrhea, develop several weeks after the initial infection. Early recognition and treatment of MIS-C can be critical in preventing serious complications.

5.

Can Children With MIS-C Spread Infection?

Children with multisystem inflammatory syndrome are not thought to be contagious. MIS-C is a complication that can occur after a child has been infected with the virus that causes COVID-19, but it is not a direct result of the virus itself. While children with MIS-C may test positive for COVID-19 antibodies, indicating that they have been previously infected with the virus, they are not believed to be contagious to others with the syndrome.

6.

What is the Treatment of MIS-Cin Children?

Treating multisystem inflammatory syndrome in children (MIS-C) typically involves a combination of supportive care and medical interventions. This may include hospitalization in a pediatric intensive care unit (PICU) and treatment with IV fluids, anti-inflammatory medications, and immunomodulatory medications. Additional treatments may be necessary based on the child's symptoms and needs. Prompt recognition and treatment of MIS-C can prevent serious complications and improve outcomes.

7.

Is MIS-C in Children Occur Due to Omicron?

There is currently limited data on the association between the Omicron variant of the COVID-19 virus and the development of multisystem inflammatory syndrome in children (MIS-C). However, early reports suggest that the Omicron variant is associated with a lower risk of severe disease and hospitalization than earlier variants, such as Delta.

8.

What Increases the Risk of MIS-C?

MIS-C is a rare but serious complication that can occur in children infected with the virus that causes COVID-19. While anyone can develop MIS-C, some children may be at higher risk than others. Children between the ages of 1 and 14, with a higher prevalence in boys and some ethnic groups such as Black and Hispanic/Latinx children, may be at a higher risk for developing multisystem inflammatory syndrome in children (MIS-C) after being infected with the virus that causes COVID-19.

9.

Is Eight Week Required to Develop MIS-C after Covid?

Multisystem inflammatory syndrome in children (MIS-C) typically occurs two to six weeks after a child has been infected with the virus that causes COVID-19. However, there have been reports of children developing MIS-C several weeks or months after their initial COVID-19 infection. The exact timeline for MIS-C development can vary from case to case and may depend on factors such as the child's age, immune response, and overall health.

10.

Is MIS-C Curable?

Yes, multisystem inflammatory syndrome in children (MIS-C) can be treated, and early recognition and treatment are important for a good outcome. Treatment involves hospitalization in an intensive care unit (PICU) and a combination of medical interventions, such as:
- IV fluids and medications to help stabilize blood pressure and heart function.
- Anti-inflammatory medications, such as steroids, reduce inflammation in the body.
- Immunomodulatory medications, such as intravenous immunoglobulin (IVIG), help regulate the immune system.
- Other supportive treatments, such as oxygen therapy, if needed.

11.

How to Reduce Inflammation in Children?

Reducing inflammation in children typically involves using anti-inflammatory medications, nonsteroidal anti-inflammatory drugs (NSAIDs). These medications work by blocking the production of inflammatory molecules in the body, which can help to reduce inflammation and relieve symptoms. NSAIDs, including Ibuprofen and Naproxen, are commonly used to treat mild-to-moderate inflammation and pain in children. However, it is important to use these medications carefully and under the guidance of a healthcare provider, as they can have side effects.

12.

What Is the Reason for High CRP in Children?

A child may have a high C-reactive protein (CRP) level for various reasons, including infection, inflammation, injury, or autoimmune conditions. CRP is a protein produced in the liver in response to inflammation or tissue damage. When a child has an infection or inflammation, such as with COVID-19 or multisystem inflammatory syndrome in children (MIS-C), their immune system produces more CRP, which can cause the level of CRP in the blood to increase.

13.

Can MIS-C Occur During COVID-19?

No, MIS-C is a post-infectious complication that typically occurs several weeks after a child has been infected with the SARS-CoV-2 virus that causes COVID-19. MIS-C is not a primary symptom of acute COVID-19 infection and does not typically occur during the acute phase. MIS-C is caused by an abnormal immune response to the SARS-CoV-2 virus, which can cause inflammation and damage to multiple organ systems in the body.
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Dr. Sudhakar Palanisamy
Dr. Sudhakar Palanisamy

Pediatrics

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