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

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.

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

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