Multisystem Inflammatory Syndrome (MIS-C): What You Need to Know

University of Utah Health
25-May-2020 8:55 AM EDT, by University of Utah Health

Multisystem Inflammatory Syndrome in children (MIS-C) is a new type of health condition associated with COVID-19 that’s being diagnosed among a small number of children across the world. MIS-C is a condition that causes different parts of the body to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. It is unknown at this time what causes MIS-C, but children that have been diagnosed either had the virus that causes COVID-19 or had been around someone with COVID-19.

As health experts continue to learn about this new development, a panel of University of Utah Health and Primary Children’s Hospital experts answered questions about what is known about MIS-C so far.

How was MIS-C discovered?

Andrew Pavia, MD,: Reports about MIS-C first came from the United Kingdom and London in April of 2020 of what appeared to be children who had Kawasaki Disease following infection of COVID-19. At the same time, similar cases were being reported in New York City and Italy. In both the UK and the U.S., the cases appeared to peak about a month after the peak of infection of COVID-19.

What are MIS-C symptoms?

  • Fever
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Neck pain
  • Rash
  • Bloodshot eyes
  • Feeling extra tired

Pavia: The illness is characterized with children who come in with prolonged fever. They often have severe abdominal pain and rash, then go on to develop inflammation of many organs, hence the name Multisystem Inflammatory Syndrome. The most common symptoms are rash and fever. Less common symptoms include red eyes, swelling of the hands and feet, or swollen lymph nodes.

What is the cardiovascular element to MIS-C?

Dongngan Truong, MD: This seems to be one of the most striking features. One of the most common heart findings we are seeing is that the muscle of the heart or squeeze of the heart is being affected. In some of these reports out of Europe and the UK, somewhere up to 50% of patients had decreased squeeze of the heart.

What conditions of MIS-C relate to Rheumatology?

Erin Treemarcki, DO: We take care of children with high levels of inflammation – specifically we see something that’s called macrophage activation syndrome (MAS). MAS happens in a group of children who have a certain type of arthritis, though we did see it in other conditions as well. What happens is the immune system reacts to a trigger and either overreacts becoming very active or is unable to turn itself off and keeps producing levels of inflammation or in some degrees, both. We are seeing similar features in MAS and other types of significant inflammation in MIS-C patients.

How is MIS-C diagnosed?

A patient may undergo certain tests to look for inflammation or other symptoms. These tests might include:

  • Nose swab
  • Blood tests
  • Chest x-ray
  • Heart ultrasound
  • Abdominal ultrasound

Pavia: A PCR test looks for the virus that indicates an active infection. In these children, it’s present about a third of the time. The other two-thirds generally have antibodies but no virus, although some have both. The presence of antibodies indicates an infection in the past.

How is MIS-C being treated?

Pavia: Most children who become ill with MIS-C need treatment in the hospital. Some will need to be treated in the pediatric intensive care unit (ICU). The type of treatment currently being used for MIS-C patients is the treatment we use for Kawasaki Disease due to inflammation of the heart. Treatment has been effective. There have been a few deaths around the world so far and the majority of children have recovered well.

Truong: In terms of trial for MIS-C, we are still in the infancy of what we know. We don’t know what works best at this point, but so far there has been promising evidence that IVIG has helped children with fever and inflammation. 

MIS-C Cases

Pavia: One patient has been diagnosed with MIS-C in Utah. Earlier patients who presented with Kawasaki Disease will undergo testing to see if they actually had MIS-C. Worldwide, there are roughly 200 MIS-C cases.

Cases range to under one year up to 20 years of age. The average age is 7 to 8-years-old. This is different from Kawasaki Disease which usually affects preschool children, 2 to 3 years of age.

Of the Utah cases, how many have been severe?

Jill Sweney, MD: Of the handful of Utah patients, one required admission to the intensive care unit (ICU) and needed medication to support blood pressure. These patients usually turn around in 3-5 days, but some reported cases that we have been hearing about presented much sicker and required mechanical ventilation and ECMO support.

Pavia: Many of the patients that have been described so far have developed severe disease and have often ended up in the intensive care unit because of the heart muscle and the shock of low blood pressure.

What is the fatality rate?

Pavia: There are just a handful of deaths that have been reported from New York City, Italy and the UK. We can’t give an accurate estimate because we don’t know the true number of cases overall.

What is the threat level to children?

Pavia: The threat is going to depend on how many children become infected with coronavirus. There’s a lot we can do about that and can do to protect children such as social distancing, practicing good hand hygiene, and wearing masks. If we don’t control the spread of infection, then eventually we will see more cases.

Why does MIS-C affect children and not adults?

Pavia: We don’t know yet. There are a lot of things in the immune system in children that are quite different. The initial COVID-19 infection in children tends to be much milder – only 1-2% of cases in the US and around the world have been in children – and a very small percentage of children with the infection get sick enough to be hospitalized or receive intensive care. That’s very different even from young adults.

What should parents know about MIS-C?

Pavia: MIS-C appears to be rare, but parents should be attuned to sickness in their children. If a child has prolonged fever, severe abdominal pain, a rash, and/or red eyes – contact your health care provider.

What we don’t know about MIS-C

Pavia: MIS-C seems to follow at a substantial time after COVID-19 infection, but we don’t know the spectrum of the disease. We also don’t know what the long-term consequences, if any, are going to be.

What are doctors at U of U Health doing?

Pavia: We are trying to see if we can understand the immune system, how the virus triggers MIS-C weeks after the illness, what the best treatmenrs are, and if we can intervene early.

 

Andrew Pavia, MD, Chief of the Division of Pediatric Infectious Diseases

University of Utah Health and Primary Children’s Hospital

 

Dongngan Truong, MD, Pediatric Cardiologist

University of Utah Health and Primary Children’s Hospital

 

Jill Sweney, MD, Pediatric Critical Care Physician

University of Utah Health and Primary Children’s Hospital

 

Erin Treemarcki, DO, Pediatric Rheumatologist

University of Utah Health and Primary Children’s Hospital

 




Filters close

Showing results

110 of 5419
Released: 15-Apr-2021 4:10 PM EDT
Penn Study Suggests Those Who Had COVID-19 May Only Need One Vaccine Dose
Perelman School of Medicine at the University of Pennsylvania

New findings from Penn suggest that people who have recovered from COVID-19 may only need a single mRNA vaccine dose. However, those who did not have COVID-19 did not have a full immune response until after a second vaccine dose, reinforcing the importance of completing the two recommended doses.

Released: 15-Apr-2021 4:00 PM EDT
June 2021 Issue of AJPH Comprises the Effects of COVID-19 on Drug Overdoses, E-cigarette Use, and Public Health Measures and Strategies
American Public Health Association (APHA)

June 2021 AJPH Issue highlights COVID-19 concerns in relation to fatal drug overdoses, drops in youth e-cigarette use, importance of public health measures, and strategies to protect correctional staff.

Newswise: 262150_web.jpg
Released: 15-Apr-2021 3:20 PM EDT
COVID-19 reduces access to opioid dependency treatment for new patients
Princeton University

COVID-19 has been associated with increases in opioid overdose deaths, which may be in part because the pandemic limited access to buprenorphine, a treatment used for opioid dependency, according to a new study led by Princeton University researchers.

Newswise: UGA to Establish National NIH-funded Center to Fight Flu
Released: 15-Apr-2021 2:45 PM EDT
UGA to Establish National NIH-funded Center to Fight Flu
University of Georgia

The National Institutes of Health has awarded the University of Georgia a contract to establish the Center for Influenza Disease and Emergence Research (CIDER). The contract will provide $1 million in first-year funding and is expected to be supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, for seven years and up to approximately $92 million.

Released: 15-Apr-2021 2:15 PM EDT
Meatpacking plants increased COVID-19 cases in US counties
University of California, Davis

An estimated 334,000 COVID-19 cases are attributable to meatpacking plants, resulting in $11.2 billion in economic damage, according to a new study led by a researcher at the University of California, Davis.

Newswise: 262052_web.jpg
Released: 15-Apr-2021 1:55 PM EDT
How to build a city that prioritizes public health
Colorado State University

Most people by now have memorized the public health guidelines meant to help minimize transmission of COVID-19: wash your hands, wear a mask, keep six feet apart from others. That part is easy.

Released: 15-Apr-2021 1:45 PM EDT
Wake Forest School of Medicine Begins Study to Test New Mask for Healthcare Workers
Wake Forest Baptist Health

Open Standard Industries, Inc. (OSI), manufacturer of the OSR-M1 non-valved reusable elastomeric face mask, is pleased to formally announce the launch of its first Institutional Review Board (IRB)-approved user feasibility study. The trial is being led by the departments of Biomedical Engineering and Infectious Diseases at Wake Forest School of Medicine, part of Wake Forest Baptist Health. Recruitment in the study is underway, and enrollment is expected to be completed by May 28, 2021.

Newswise: Major clinical trial to test Pfizer-BioNTech COVID-19 vaccine opens for enrollment at UTHealth in Houston
Released: 15-Apr-2021 1:45 PM EDT
Major clinical trial to test Pfizer-BioNTech COVID-19 vaccine opens for enrollment at UTHealth in Houston
University of Texas Health Science Center at Houston

A large national clinical trial to evaluate the Pfizer-BioNTech COVID-19 vaccine for safety and efficacy in pregnant women is now open for enrollment at The University of Texas Health Science Center at Houston (UTHealth).

Released: 15-Apr-2021 1:15 PM EDT
For veterans, a hidden side effect of COVID: Feelings of personal growth
Yale University

The U.S. military veteran population is known to have abnormally high rates of suicide, so health officials have been concerned that the COVID-19 pandemic might elevate risk of psychiatric disorders, particularly among those suffering from post-traumatic stress and related disorders.

Newswise: 262026_web.jpg
Released: 15-Apr-2021 12:55 PM EDT
Significant spread of all coronavirus variants tracked in Houston area
Elsevier

In late 2020, several concerning SARS-CoV-2 variants emerged globally. They are believed to be more easily transmissible, and there is concern that some may reduce the effectiveness of antibody treatments and vaccines.


Showing results

110 of 5419

close
2.24744