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=== History and Symptoms ===
=== History and Symptoms ===
 
COVID-19 associated multisystem inflammatory syndrome is associated with the following symptoms:
*[[Fever]] lasting 24 hours or longer.
*[[Fever]] lasting 24 hours or longer.
*[[Vomiting]]
*[[Vomiting]]
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*[[Sore throat]]
*[[Sore throat]]
*[[Confusion|New onset confusion]]
*[[Confusion|New onset confusion]]
===Physical Examination===
===Physical Examination===
COVID-19 associated multisystem inflammatory syndrome is associated with the following physical examination findings:
*[[Skin rash]]
*[[Skin rash]]
*[[Conjuctivitis]]
*[[Conjuctivitis]]
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*[[Cyanosis]]
*[[Cyanosis]]
===Laboratory Findings===
===Laboratory Findings===
COVID-19 associated multisystem inflammatory syndrome is associated with the following laboratory findings:
*[[Erythrocyte sedimentation rate|High ESR]]
*[[Erythrocyte sedimentation rate|High ESR]]
'''Blood Investigations'''
*[[Lymphopenia]]
*[[Lymphopenia]], [[Neutrophilia]], [[Anemia]], [[Thrombocytopenia]] have been seen in MIS-C pateints. [[Fibrinogen|Abnormal fibrinogen]], [[Hypoalbuminaemia]], elevated [[Creatine kinase|creatiine kinase]] (CK), [[Lactate dehydrogenase|LDH]], [[Triglyceride|triglycerides]] have been observed in MIS-C patients.
* [[Neutrophilia]]
*[[Anemia]]
*[[Thrombocytopenia]]
Less common laboratory findings include:
* [[Fibrinogen|Abnormal fibrinogen]]
* [[Hypoalbuminaemia]]
* Elevated [[Creatine kinase|creatiine kinase]] (CK)
* Elevated [[Lactate dehydrogenase|LDH]]
* Elevated [[Triglyceride|triglycerides]]
==== Inflammatory biomarkers ====
==== Inflammatory biomarkers ====
Elevation of inflammatory markers including ESR, C reactive protein, and procalcitonin are usually seen in MIS-C. Increased level of  [[Interleukin-6]] (IL-6), Interleukin-10(IL-10) [[d-dimer]], serum [[ferritin]], [[prothrombin time]] have also been seen in MIS-C.
Elevation of inflammatory markers including ESR, C reactive protein, and procalcitonin are usually seen in MIS-C. Increased level of  [[Interleukin-6]] (IL-6), Interleukin-10(IL-10) [[d-dimer]], serum [[ferritin]], [[prothrombin time]] have also been seen in MIS-C.
==== Cardiac biomarkers ====
==== Cardiac biomarkers ====
Elevation of cardic enzymes including  [[Cardiac troponin|cardiac troponins]] ([[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponin I(cTnI) and cardiac troponin T (cTnT)]]) and [[Brain natriuretic peptide]] ([[BNP]])) has been observed in MIS-C patients.
Elevation of cardic enzymes including  [[Cardiac troponin|cardiac troponins]] ([[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponin I(cTnI) and cardiac troponin T (cTnT)]]) and [[Brain natriuretic peptide]] ([[BNP]])) has been observed in MIS-C patients.
* To view the complete physical examination in COVID-19, [[COVID-19 physical examination|click here]].
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].
===Electrocardiogram===
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]].<br />
===X-ray===
*
* To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]].<br />
===Echocardiography or Ultrasound===
*
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]].<br />
===CT scan===
* [[Computed tomography|CT scan]] imaging to the [[nasal cavity]] and [[sinus]] may be used to exclude other causes, for example, a case report that revealed [[Inflammation|inflammatory]] blockage of the olfactory cleft in one patient.<ref name="pmid32563019" />
*To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].
===MRI===
*
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
===Other Imaging Findings===


=== Radiological Findings ===
*
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]].<br />


* Following Radiological Findings are observed in MIS-C patients.
===Other Diagnostic Studies===


{| border="1" cellpadding="2"
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]].<br />
! width="225" |Test
! width="225" |Findings
|-
|Chest Xray||patchy symmetrical infiltrates, [[pleural effusion]]
|-
|Echocardiogram and EKG||[[myocarditis]], valvulitis, [[pericardial effusion]], coronary artery dilatation
|-
|Abdominal USG||[[colitis]], [[ileitis]], [[lymphadenopathy]], [[ascites]], [[hepatosplenomegaly]]
|}
'''Blood Culture, Viral PCR'''


* Absence of other potential causative organisms. IgG levels and IgM levels of [[SARS-CoV-2]] are detected.


== Treatment ==
== Treatment ==

Revision as of 20:40, 13 July 2020

Diagnosis

Diagnostic Criteria

In May 2020, the Centers for Disease Control and Prevention (CDC) set the criteria for multisystem inflammatory syndrome in children (MIS-C):[1]

  • Severe disease course leading to hospitalization
  • Individuals younger than 21 years old
  • Fever (body temperature, >38.0°C) or report of subjective fever present at least 24 hours
  • Laboratory evidence of inflammation
  • Multisystem organ involvement (at least two systems)
  • Laboratory-confirmed SARS-CoV-2 infection

History and Symptoms

COVID-19 associated multisystem inflammatory syndrome is associated with the following symptoms:

Physical Examination

COVID-19 associated multisystem inflammatory syndrome is associated with the following physical examination findings:

Laboratory Findings

COVID-19 associated multisystem inflammatory syndrome is associated with the following laboratory findings:

Less common laboratory findings include:

Inflammatory biomarkers

Elevation of inflammatory markers including ESR, C reactive protein, and procalcitonin are usually seen in MIS-C. Increased level of Interleukin-6 (IL-6), Interleukin-10(IL-10) d-dimer, serum ferritin, prothrombin time have also been seen in MIS-C.

Cardiac biomarkers

Elevation of cardic enzymes including cardiac troponins (cardiac troponin I(cTnI) and cardiac troponin T (cTnT)) and Brain natriuretic peptide (BNP)) has been observed in MIS-C patients.

  • To view the complete physical examination in COVID-19, click here.
  • To view the laboratory findings on COVID-19, click here.

Electrocardiogram

  • To view the electrocardiogram findings on COVID-19, click here.

X-ray

  • To view the x-ray finidings on COVID-19, click here.

Echocardiography or Ultrasound

  • To view the echocardiographic findings on COVID-19, click here.

CT scan

MRI

  • To view the MRI findings on COVID-19, click here.

Other Imaging Findings

  • To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies

  • To view other diagnostic studies for COVID-19, click here.


Treatment

Medical Therapy

  • All the children with MIS-C are treated as suspected COVID-19.
  • Mild to Moderate cases of MIS-C are managed supportively.[3][4]
  • Supplemental oxygen is required in children with low oxygen saturation.[4]
  • Fluid resuscitation in 10 ml/kg aliquots with reevaluation after each bolus. Maintain euvolemia. Avoid hypervolemia.[4]
  • Anti-inflammatory treatments with Intravenous immunoglobulin(IVIG) with or without corticosteroids have shown a good response rate.[3][4]
  • Aspirin has been used primarily for its antiplatelet effect. It is recommended in all patients with MIS-C.[3][4]
  • Anakinra is considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[3][4]
  • Tocilizumab is also considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[3][4]
  • Empiric antibiotics like vancomycin, ceftriaxone, and clindamycin are given for community-acquired shock presentation until cultures are negative for 48 hours.[3][4]
Presentation Treatment
Mild Disease
  • Symptomatic Treatment
Severe Disease

Prevention of MIS-C

  • MIS-C can be prevented by reducing the risk of child exposure to COVID-19 infection.

References

  1. ↑ Feldstein, Leora R.; Rose, Erica B.; Horwitz, Steven M.; Collins, Jennifer P.; Newhams, Margaret M.; Son, Mary Beth F.; Newburger, Jane W.; Kleinman, Lawrence C.; Heidemann, Sabrina M.; Martin, Amarilis A.; Singh, Aalok R.; Li, Simon; Tarquinio, Keiko M.; Jaggi, Preeti; Oster, Matthew E.; Zackai, Sheemon P.; Gillen, Jennifer; Ratner, Adam J.; Walsh, Rowan F.; Fitzgerald, Julie C.; Keenaghan, Michael A.; Alharash, Hussam; Doymaz, Sule; Clouser, Katharine N.; Giuliano, John S.; Gupta, Anjali; Parker, Robert M.; Maddux, Aline B.; Havalad, Vinod; Ramsingh, Stacy; Bukulmez, Hulya; Bradford, Tamara T.; Smith, Lincoln S.; Tenforde, Mark W.; Carroll, Christopher L.; Riggs, Becky J.; Gertz, Shira J.; Daube, Ariel; Lansell, Amanda; Coronado Munoz, Alvaro; Hobbs, Charlotte V.; Marohn, Kimberly L.; Halasa, Natasha B.; Patel, Manish M.; Randolph, Adrienne G. (2020). "Multisystem Inflammatory Syndrome in U.S. Children and Adolescents". New England Journal of Medicine. doi:10.1056/NEJMoa2021680. ISSN 0028-4793.
  2. ↑
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 "Emergency Department, ICU and Inpatient Clinical Pathway for Evaluation of Possible Multisystem Inflammatory Syndrome (MIS-C)". line feed character in |title= at position 61 (help)
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 "Evaluation and Management of COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C)" (PDF). line feed character in |title= at position 63 (help)



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Disease Name Age of Onset Gender Preponderance Signs/Symptoms Imaging Feature(s) Macroscopic Feature(s) Microscopic Feature(s) Laboratory Findings(s) Other Feature(s) ECG view
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