Sandbox:Sahar

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:^[1]

Physical Examination

COVID-19 associated multisystem inflammatory syndrome is associated with the following physical examination findings:^[1]

Skin rash
Conjuctivitis
Redness or swelling of the lips and tongue
Redness or swelling of the hands or feet
Lymphadenopathy
Lethargy
Cyanosis

Laboratory Findings

COVID-19 associated multisystem inflammatory syndrome is associated with the following laboratory findings:^[1]

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

X-ray of patients with COVID-19 associated multiorgan system inflammatory syndrome may be normal. When abnormal, findings may include the followings:^[2]
- Peribronchial cuffing
- Perihilar interstitial thickening
- Perihilar opacification
- Perihilar consolidation
- Low volume pleural effusion affecting both lungs
- Left lower lobe atelectasis

Echocardiography or Ultrasound

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

CT scan

To view the CT scan findings on COVID-19, click here.

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	Symptomatic Treatment IVIG(IV) Corticosteroids(IV/PO) Consider adding Anakinra or Tocilizumab if fever persist for more than 24 hours post steroids and IVIG use.

Prevention of MIS-C

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

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 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.
↑ Hameed, Shema; Elbaaly, Heba; Reid, Catriona E. L.; Santos, Rui M. F.; Shivamurthy, Vinay; Wong, James; Jogeesvaran, K. Haran (2020). "Spectrum of Imaging Findings on Chest Radiographs, US, CT, and MRI Images in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19". Radiology: 202543. doi:10.1148/radiol.2020202543. ISSN 0033-8419.
↑ ^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)
↑ ^4.0 ^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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Wikidoc Textbook of Medicine
Name/Project	Cardiology	Pulmonary	Infectious	Pediatrics	Emergency	ENT	Ob/Gyn	Dermatology	Rare disease
Leader of the Project
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N to be Reviewed
Name of Scholars working on the project


Wikidoc Textbook of Medicine
Name/Project	Hematology	Oncology	Gastroenterology	Nephrology	Neurology	Psychology	Endocrinology
Leader of the project
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N of complete Chapters
N of Incomplete Chapters
N to be reviewed Chapters
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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

[FeldsteinRose2020-1] 1.0 ^1.1 ^1.2 ^1.3 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.

[HameedElbaaly2020-2] Hameed, Shema; Elbaaly, Heba; Reid, Catriona E. L.; Santos, Rui M. F.; Shivamurthy, Vinay; Wong, James; Jogeesvaran, K. Haran (2020). "Spectrum of Imaging Findings on Chest Radiographs, US, CT, and MRI Images in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19". Radiology: 202543. doi:10.1148/radiol.2020202543. ISSN 0033-8419.

[A1-3] 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)

[A2-4] 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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