Multi-system Inflammatory Syndrome: What You Need to Know

June 9, 2020

Multi-system Inflammatory Syndrome: What You Need to Know
While it was originally thought that children were spared from the effects of COVID-19, more recently there have been cases of an inflammatory syndrome affecting the pediatric population, and possibly tied to coronavirus. Like Kawasaki disease, this new syndrome has been identified as Multi-system Inflammatory Syndrome (MIS-C).

MIS-C is a serious disease and can include organ involvement, with potential long-term cardiac implications, said Siva Jonna, MD, pediatric intensivist at The Children’s Hospital at Saint Peter’s University Hospital. Like Kawasaki disease and toxic shock syndrome in that it affects systems in the body, the reason it’s being potentially linked to COVID-19 is two-fold – the appearance of the disease in confluence with the onset of COVID-19 in the general population and in most cases, those children affected have been exposed to a family member who previously had COVID-19.

MIS-C causes the body to have an inflammatory response to itself, often in connection to viral illness, said Dr. Jonna. While doctors may not yet be able to make a definitive connection to COVID-19, “what is important is that parents be able to identify symptoms because they can escalate quickly, leading to serious complications, including long-term cardiac conditions.”

The most common symptoms for parents to be aware of are:
  • Fever – moderate to high (101-102 degrees or higher) and lasting for longer than 2 to 3 days
  • Red eyes with no discharge
  • Red tongue
  • Abdominal pain
  • Cheilitis – chapped lips that may be cracked and bleeding
  • Lethargy and irritability
While these are the most common symptoms, others can include severe headache, difficulty breathing, joint pain, confusion or disorientation, swollen hands or feet, and diarrhea, said Dr. Jonna, noting that not all children have all symptoms, but the common denominator regardless, is fever.

By contrast, Kawasaki disease is usually confirmed when a child has four out of the five following symptoms:  red eyes with no discharge, strawberry tongue, swollen lymph nodes, and swelling of the extremities.

Confirmation of MIS-C is determined by a blood test which confirms the elevation of white blood cells as well as an increase in C-reactive protein levels. Treatment can include hospitalization. It is likely the physician will recommend aspirin on a long-term basis to prevent cardiac blockage. The Children’s Hospital at Saint Peter’s has assigned multidisciplinary teams to treat these pediatric patients. The teams consist of pediatricians, cardiologists, neurologists and infectious disease specialists. Other subspecialties are brought in on a case-by-case basis.

Long-term Concerns
While most children recover, the long-term impact of MIS-C is still unknown. As mentioned, there are serious concerns about the syndrome’s impact on the heart muscle post-treatment. Dr. Jonna explains that for these precautionary reasons, children that have been discharged from Saint Peter’s are recommended to be monitored for several years by a pediatric cardiologist.

What Should Parents Do
  • If your child presents with a moderate to high fever that does not respond to traditional treatment and lasts beyond 2 to 3 days, call your pediatrician. Be sure to let your child’s doctor know if you or anyone else your child has been exposed to has been diagnosed with COVID-19.
  • If you identify several concurrent symptoms from those listed above, call your pediatrician for further instructions.
  • As would be the case with any childhood illness, call your pediatrician if you have any doubts or concerns.
Emergency Room Visits During COVID
Should your child need emergency medical treatment, The Dorothy B. Hersh Pediatric Emergency Department at Saint Peter’s Children’s Hospital is ready to care for your child safely. Saint Peter’s continues to screen all patients for COVID-19 and any patient with suspected or confirmed COVID-19 is isolated to minimize the spread of coronavirus.

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