Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician's point of view

Abstract

Objective Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart. Sources The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original and review articles, systematic reviews, meta-analyses, case series, and recommendations from medical societies and health organizations published through July 3, 2020. The reference lists of the selected articles were manually searched to identify any additional articles. Summary of the findings COVID-19 infection is less severe in children than in adults, but can present as MIS-C, even in patients without comorbidities. There is evidence of an exacerbated inflammatory response with potential systemic injury, and it may present with aspects similar to those of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop weeks after COVID-19 infection, suggesting an immunomediated cause. The most frequent clinical manifestations include fever, gastrointestinal symptoms, rash, mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, lymphopenia, and coagulopathy are common laboratory findings. Supportive treatment and early immunomodulation can control the intense inflammatory response and reduce complications and mortality. Conclusions MIS-C associated with COVID-19 is serious, rare, and potentially fatal. The emergency department pediatrician must recognize and treat it early using immunomodulatory strategies to reduce systemic injury. Further studies are needed to identify the disease pathogenesis and establish the most appropriate treatment.

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

“…At least three recent studies have specifically addressed the cardiac manifestations of MIS-C, including the potential progression to cardiogenic shock and need for intensive care [72,76,77]. In addition to acute myocardial injury and myocarditis as identified in this review, these studies also suggest that other cardiac complications may include pericarditis, coronary artery aneurysm, valve dysfunction, pericardial effusion, arrhythmia, ventricular dilation, decreased ejection frac-tion, and tachycardia.…”

“…It is important to note that severe cardiovascular abnormalities may necessitate cardiopulmonary support, immunomodulatory and vasoactive agents, and anticoagulation which can reduce the inflammatory response and mortality. A recent study from a pediatric emergency physician stresses the importance of involving a multidisciplinary team including the emergency department, pediatricians and pediatric specialists, and intensivists where clinical instability is observed [76].…”

The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

“…1 New studies have con rmed the presence of hyper-in ammatory syndrome in patients with MIS-C. [2][3][4] In this study, we conducted a meta-analysis to identify the in ammatory markers of MIS-C for evidence-based monitoring of disease progression. We found that in ammatory markers, MIS-C, a consequence of an exacerbated immune system response or a maladaptive response, 33 is characterized by hyper-in ammation and cytokine storm, including massive release of in ammatory mediators and exaggerated activation of the immune system, which could be partly demonstrated by the laboratory in ammatory markers. 34 Our results showed no signi cant differences in WBC, PCT and ferritin between the MIS- Initial reports in the pandemic mainly indicated children to be 'immune from' or were only mildly or asymptomatic if affected by COVID-19.…”

Multisystem inflammatory syndrome in children: What is in it for a pediatric anesthesiologist?

“…The clinical condition has been variously described as multisystem inflammatory syndrome in children (MIS-C) and pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 (PIMS-TS) and is believed to occur due to an abnormal immune response of the host body to the coronavirus. 3,4 Most of the available literature regarding this condition is from leading international medicine and pediatrics journals. [1][2][3][4] To the best of our knowledge, there is no mention of MIS-C in anesthesia journals, particularly in those dealing with the practice of pediatric anesthesia.…”

“…3,4 Most of the available literature regarding this condition is from leading international medicine and pediatrics journals. [1][2][3][4] To the best of our knowledge, there is no mention of MIS-C in anesthesia journals, particularly in those dealing with the practice of pediatric anesthesia.…”