Clinical features, diagnosis, and outcomes of multisystem inflammatory syndrome in children associated with coronavirus disease 2019

Abstract

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading worldwide since December 2019. Hundreds of cases of children and adolescents with Kawasaki disease (KD)–like hyperinflammatory illness have been reported in Europe and the United States during the peak of the COVID-19 pandemic with or without shock and cardiac dysfunction. These patients tested positive for the polymerase chain reaction or antibody test for SARS-CoV-2 or had a history of recent exposure to COVID-19. Clinicians managing such patients coined new terms for this new illness, such as COVID-19–associated hyperinflammatory response syndrome, pediatric inflammatory multisystem syndrome temporally associated with COVID-19, or COVID-19–associated multisystem inflammatory syndrome in children (MIS-C). The pathogenesis of MIS-C is unclear; however, it appears similar to that of cytokine storm syndrome. MIS-C shows clinical features similar to KD, but differences between them exist with respect to age, sex, and racial distributions and proportions of patients with shock or cardiac dysfunction. Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), interleukin-1 receptor antagonist (anakinra), or monoclonal antibody to tumor necrosis factor (infliximab) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy. The prognosis of MIS-C seemed favorable without sequelae in most patients despite a reported mortality rate of approximately 1.5%.

Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS): Prospective, national surveillance, United Kingdom and Ireland, 2020

“…Whether the observed ethnic disparities among children with PIMS-TS, as observed with COVID-19 cases too, are due to genetic or socio-economic risk factors – or both – remains to be established. [26] …”

Presentation and Outcome of Congenital Heart Disease During Covid-19 Pandemic: A Review

“…Multisystem inflammatory syndrome in children with COVID-19 disease, also named MIS-c is a confirmed serious potentially lethal clinical presentation of COVID-19 disease with various definitions ( 28 ). Centers for Disease Control (CDC) defines MIS-c in patients with COVID-19 disease and all four criteria: 1 .…”

Is multisystem inflammatory syndrome related with coronavirus disease 2019, Kawasaki disease, and angiotensin-converting enzyme 2 in children?

“…6) During the COVID-19 pandemic, children have been less affected than adults in South directly influences this change, it is important to pay careful attention because cases of MIS-C related to COVID-19 in children seem to be on the rise internationally. [3][4][5][6] As most MIS-C cases were presented in Europe and the US during the pandemic, rare reports are available of MIS-C in Korea, 8) implying that different genetic susceptibilities might play a role in the pathogenesis of MIS-C.…”

“…As most MIS-C cases were presented in Europe and the United States during the pandemic, rare reports are available of MIS-C in Korea [ 7 ], implying that different genetic susceptibilities might play a role in the pathogenesis of MIS-C.…”