Multisystem Inflammatory Syndrome

Context:

Recently, the World Health Organization (WHO) has released fresh guidelines for treating children who developed Multisystem Inflammatory Syndrome (MIS-C) after being exposed to Covid-19 infection.

What is Multisystem Inflammatory Syndrome in Children (MIS-C)?

• It is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
  • It is also called pediatric multi-system inflammatory syndrome (PMIS or PIMS).
• Children with MIS-C may have a fever and various symptoms, including abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired.
• It typically emerges two to six weeks after a COVID infection, often one that produces only mild symptoms or none at all.
• The syndrome is rare, but can be very serious.
• The exact cause of MIS-C is not known yet, but it appears to be an excessive immune response related to COVID-19.

MIS-C with Neurological Complications:

• In a recent study, young people with the MIS-C syndrome have shown neurological issues which were life-threatening such as strokes or severe encephalopathy (any brain disease that alters brain function or structure).
  • Neurological symptoms include hallucinations, confusion, speech impairments, and problems with balance and coordination.
  • The new findings strengthen the theory that the syndrome is related to a surge of inflammation triggered by an immune response to the virus.

Causes of MIS-C:

• As the Syndrome is less researched, there are varied theories as to what causes MIS-C.
  • While some researchers believe that MIS-C is a delayed response to the coronavirus which in turn causes massive inflammation in the body and as a result damages organs.
  • Others believe that it can also be a result of the children’s immune response making antibodies against the virus.
  • There may be a genetic component as not every child develops MIS-C and the presenting symptoms are so varied.

Signs and Symptoms of Multisystem Inflammatory Syndrome in Children (MIS-C)

• The specific features of MIS-C may include:
  • Kawasaki-like symptoms: Rash, bloodshot eyes, swollen hands and feet, cracked lips, a swollen tongue that looks like a strawberry, and an enlarged lymph node in the neck.
  • Toxic shock-like symptoms: Severe flu-like symptoms with high fever, as well as a sunburn-like rash, low blood pressure, and a very high heart rate. 
  • Gastrointestinal symptoms: diarrhea, vomiting, abdominal pain, or a swollen abdomen.
  • Respiratory symptoms that have been reported with COVID-19, such as persistent cough and shortness of breath, may or may not be present.

Key Highlights

• The new findings strengthen the theory that the syndrome is related to a surge of inflammation triggered by an immune response to the virus.
• The new study evaluated children under 18 who were admitted to Great Ormond Street Hospital (GOSH) between April and September of last year with the syndrome.
• All 24 of the patients with neurological symptoms had headaches and 14 had encephalopathy.
  • Encephalopathy is a general term that can involve confusion, problems with memory or attention and other types of altered mental function.
• One child had seizures and three children had peripheral nerve abnormalities including weakness in facial or shoulder muscles.
• Six of the children had weakness or difficulty controlling muscles used in speech.
• Thirteen of the 24 with neurological symptoms needed to be placed on ventilators and 15 needed medications to improve their heart contractions.

WHO Guidelines for Treatment:

• It is suggested to use corticosteroids in addition to the standard of care for Kawasaki disease (conditional recommendation, very low certainty) in hospitalised children (0-18 years of age).
  • Commonly referred to as steroids, corticosteroids are a type of anti-inflammatory drug.
  • Corticosteroids along with supportive care resulted in a more effective treatment than either intravenous immunoglobulin plus supportive care or supportive care alone.
  • The treatment was also found to be effective in treating children with Kawasaki disease in association to Covid-19.
• Not to use corticosteroids in the treatment of patients with non-severe Covid-19 as the treatment brought no benefits, and could even prove harmful.

Kawasaki Disease

• It is an acute inflammatory disease of the blood vessels and usually occurs in children below the age of five.
• The inflammation in the coronary arteries that are responsible for supplying blood to the heart results in enlargement or in the formation of aneurysms (swelling of the wall of an artery), leading to heart attacks.
• Symptoms: Fever, rashes, redness of the cornea, red and cracked lips, a red tongue and lymph node enlargement of the neck.

Source: DTE

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