Approach to a child with Multisystem Inflammatory Syndrome associated with COVID19. Recommendations by the Polish Paediatric Society Expert Group. Update – February 2021

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical entity occurring in children and young adults, which is associated with the SARS-CoV-2 infection. The first cases of MIS-C were diagnosed in Poland in May 2020. Since October 2020, a significant increase in the incidence of this new disease has been observed in Poland, reflecting the increased incidence of COVID-19 in the paediatric population. MIS-C develops as a result of dysregulation of the immune system occurring 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on the following criteria: a set of clinical features (including fever and signs of multiple organ damage) and elevated inflammatory markers, with exclusion of other causes. The most common complications involve the cardiovascular system: acute myocardial damage with reduced left ventricular ejection fraction, shock, and coronary artery abnormalities and arrhythmias. Mortality in Western Europe and the United States is around 1-2%. Appropriate management, including vital function support and immunomodulatory treatment, allows for a quick recovery in the vast majority of patients. This document is an updated guideline for the diagnostic and therapeutic management of children with suspected MIS-C in Poland. The most important changes concern treatment, steroid therapy, and antiplatelet therapy in particular.

Air pollution might affect the clinical course of COVID-19 in pediatric patients

“…All patients were unvaccinated against COVID-19. All of these individuals were diagnosed and treated according to the Polish recommendations for the management of COVID-19 ( Flisiak et al, 2020a , Flisiak et al, 2021 , Flisiak et al, 2020 , Flisiak et al, 2020b , Marczyńska et al, 2020 , Okarska-Napierała et al, 2021 ).…”

Ocular Manifestations of Pediatric Inflammatory Multisystem Syndrome

“…• Age (0-18 years of age) [6]. By WHO definition, PIMS-TS is diagnosed in patients between 0-19 years with fever for at least 3 days, elevated inflammatory markers (CRP, PCT, ESR), excluded alternative microbial cause of infection, evidence of COVID-19 infection (RT-PCR, antigen test or serology positive) or exposure to COVID-19 and symptoms (at least 2 of the following): skin rash or bilateral conjunctivitis or stigmata of inflammation on mucosa or skin, hypotension or shock, myocardial dysfunction, valvulitis, pericarditis, or coronary abnormalities, coagulopathy, acute gastrointestinal problems [17].…”

“…The second line of therapy is intravenous glucocorticosteroids (GCs) such as methylprednisolone (10-30 mg/kg). The third-line therapy uses biological agents like an inhibitor of the IL-6 receptor (tocilizumab), an inhibitor of the IL-1 receptor (anakira) or an inhibitor of the TNF-α (infliximab) [6,24,25]. In reported cases of ocular symptoms in PIMS, the time from diagnosis to full recovery lasts from 1 to 4 weeks [6].…”

“…The third-line therapy uses biological agents like an inhibitor of the IL-6 receptor (tocilizumab), an inhibitor of the IL-1 receptor (anakira) or an inhibitor of the TNF-α (infliximab) [6,24,25]. In reported cases of ocular symptoms in PIMS, the time from diagnosis to full recovery lasts from 1 to 4 weeks [6]. Patients with conjunctivitis were provided with topical non-steroidal anti-inflammatory drugs (NSAIDs) (Ketorolac) and topical antibiotics to prevent secondary bacterial infection.…”

“…The first cases of PIMS occurred in April 2020 [4]. The condition is observed in children a few weeks after having SARS CoV-2 infection [5,6]. The other terms used to define PIMS are; multisystem inflammatory syndrome in children (MIS-C), pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), pediatric hyperinflammatory syndrome or Kawasaki-like disease [7].…”