Sandbox:Javaria

COVID-19 associated multi-system inflammatory syndrome in children

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: [..]
Synonyms and keywords: ; (MIS-C); (MIS-C) associated with COVID-19; (MIS-C) associated with SARS-CoV-2; Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19); Multisystem Inflammatory Syndrome in Children associated with COVID-19; Hyperinflammatory shock in children during COVID-19 pandemic.

Overview

COVID-19 associated Multi-system Inflammatory Syndrome in Children is a new disease entity affecting children less than 21 years of age. The diagnostic criteria include fever and inflammation with multiorgan involvement AND no alternative diagnoses AND COVID-19 positive or history of exposure.

Historical Perspective

It was not long after the elderly and immunocompromised were considered high-risk for COVID-19, that Multi-system Inflammatory Syndrome in Children drew the clinicians' attention. An increasing number of severe inflammatory syndrome cases in the pediatric population was highlighted by the physicians in the United Kingdom on April 26th, 2020. The children although previously healthy were COVID-19 positive or had a history of close contact with COVID-19 patients. Since then the cases of COVID-19 associated Multi-system Inflammatory Syndrome in Children are on the rise, as are COVID-19 cases in adolescents.

Causes

According to {CDC} no specific cause of COVID-19 associated multi-system inflammatory syndrome in children has been identified. However, the concomitant exposure or infection with COVID-19 has been observed.

Differentiating COVID-19 associated multi-system inflammatory syndrome in children from other diseases

COVID-19 associated multi-system inflammatory syndrome in children must be differentiated from other diseases that cause rash such as Kawasaki disease and toxic shock syndrome.

• Kawasaki disease A patient with fever for 5 or more days and at least 4 clinical signs (rash, bilateral conjunctival injection, more than 1.5 cm of cervical lymphadenopathy, oral mucosal changes and extremity changes) is known to have Kawasaki disease. Typically a patient is less than 5 years of age.

• Toxic Shock Syndrome

Epidemiology and Demographics

The nature of COVID-19 associated multi-system inflammatory syndrome in children makes the data requiring an update all the time. No causal relationship to any demographic factor has been established.

Age

The diagnostic criteria including children age less than 21 years helps highlight the age group that can be affected. The limited data of eight patients showed the affected children's age between 4- 14 years.

Mortality

• The limited data available shows low mortality due to COVID-19 associated multi-system inflammatory syndrome in children.

Geographic Distribution

• Most of the cases have been reported in North America and Europe but the evolving nature of itself COVID-19 and COVID-19 associated multi-system inflammatory syndrome in children requires more effort to keep the world updated.

WHO preliminary case definition

A preliminary case is a patient 0-19 years of age having a fever for more than three days and at least two of the following findings:

• 1. Rash or bilateral non-purulent conjunctivitis or mucocutaneous inflammation signs (oral, hands or feet).
  2. Hypotension or shock.
  3. Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP),
  4. Evidence of coagulopathy (by PT, PTT, elevated d-Dimers).
  5. Acute gastrointestinal problems (diarrhea, vomiting, or abdominal pain).

AND

• Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin.

AND

• No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.

AND

• Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram |Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies