COVID-19-associated multisystem inflammatory syndrome

WikiDoc Resources for COVID-19-associated multisystem inflammatory syndrome
Articles
Most recent articles on COVID-19-associated multisystem inflammatory syndrome Most cited articles on COVID-19-associated multisystem inflammatory syndrome Review articles on COVID-19-associated multisystem inflammatory syndrome Articles on COVID-19-associated multisystem inflammatory syndrome in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on COVID-19-associated multisystem inflammatory syndrome Images of COVID-19-associated multisystem inflammatory syndrome Photos of COVID-19-associated multisystem inflammatory syndrome Podcasts & MP3s on COVID-19-associated multisystem inflammatory syndrome Videos on COVID-19-associated multisystem inflammatory syndrome
Evidence Based Medicine
Cochrane Collaboration on COVID-19-associated multisystem inflammatory syndrome Bandolier on COVID-19-associated multisystem inflammatory syndrome TRIP on COVID-19-associated multisystem inflammatory syndrome
Clinical Trials
Ongoing Trials on COVID-19-associated multisystem inflammatory syndrome at Clinical Trials.gov Trial results on COVID-19-associated multisystem inflammatory syndrome Clinical Trials on COVID-19-associated multisystem inflammatory syndrome at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on COVID-19-associated multisystem inflammatory syndrome NICE Guidance on COVID-19-associated multisystem inflammatory syndrome NHS PRODIGY Guidance FDA on COVID-19-associated multisystem inflammatory syndrome CDC on COVID-19-associated multisystem inflammatory syndrome
Books
Books on COVID-19-associated multisystem inflammatory syndrome
News
COVID-19-associated multisystem inflammatory syndrome in the news Be alerted to news on COVID-19-associated multisystem inflammatory syndrome News trends on COVID-19-associated multisystem inflammatory syndrome
Commentary
Blogs on COVID-19-associated multisystem inflammatory syndrome
Definitions
Definitions of COVID-19-associated multisystem inflammatory syndrome
Patient Resources / Community
Patient resources on COVID-19-associated multisystem inflammatory syndrome Discussion groups on COVID-19-associated multisystem inflammatory syndrome Patient Handouts on COVID-19-associated multisystem inflammatory syndrome Directions to Hospitals Treating COVID-19-associated multisystem inflammatory syndrome Risk calculators and risk factors for COVID-19-associated multisystem inflammatory syndrome
Healthcare Provider Resources
Symptoms of COVID-19-associated multisystem inflammatory syndrome Causes & Risk Factors for COVID-19-associated multisystem inflammatory syndrome Diagnostic studies for COVID-19-associated multisystem inflammatory syndrome Treatment of COVID-19-associated multisystem inflammatory syndrome
Continuing Medical Education (CME)
CME Programs on COVID-19-associated multisystem inflammatory syndrome
International
COVID-19-associated multisystem inflammatory syndrome en Espanol COVID-19-associated multisystem inflammatory syndrome en Francais
Business
COVID-19-associated multisystem inflammatory syndrome in the Marketplace Patents on COVID-19-associated multisystem inflammatory syndrome
Experimental / Informatics
List of terms related to COVID-19-associated multisystem inflammatory syndrome

Main article: COVID-19

For COVID-19 frequently asked inpatient questions, click here

For COVID-19 frequently asked outpatient questions, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords: Multisystem Inflammatory Syndrome in Children (MIS-C)

Overview

Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition that causes inflammation of some parts of the body like heart, blood vessels, kidneys, digestive system, brain, skin, or eyes. According to recent evidence, it is suggested that children with MISC had antibodies against COVID-19 suggesting children had COVID-19 infection in the past. This syndrome appears to be similar in presentation to Kawasaki disease, hence also called Kawasaki -like a disease. It also shares features with staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis, and macrophage activation syndromes.

Epidemiology and Demographics

• According to a recent study among the 186 children with MIS-C, the rate of hospitalization was 12% between March 16 and April 15 and 88% between April 16 and May 20.
• 80% of the children were admitted to the intensive care unit and 20% of the children required mechanical ventilation.
• 4% of the children required extracorporeal membrane oxygenation.
• The mortality rate among 186 children with MIS-C was 2%.

Age

• Among the 186 children with MIS-C distribution of age group was
  • <1yr-7%
  • 1-4yr-28%
  • 5-9yr-25%
  • 10-14yr-24%
  • 15-20yr-16%.

Gender

• Among the 186 children with MIS-C

Comorbidities

• Children with MIS-C had following underlying comorbidities.
  • Clinically diagnosed Obesity-8%
  • BMI-Based Obesity-29%
  • Cardiovascular diasease-3%
  • Respiratory disease-18%
  • Autoimmune disease or immunocompromising condition-5%

Organ System Involved

• 71% of children had involvement of at least four organ systems.

The most common organ system involved in MIS-C children among a total of 183 children were.

• Gastrointestinal(92%)
• Cardiovascular(80%)
• Hematologic(76%)
• Mucocutaneous(74%)
• Pulmonary(70%)

Pathophysiology

Symptoms

• Fever lasting 24 hours or longer.
• Vomiting
• Diarrhea
• Abdominal pain
• Skin rash
• Conjuctivitis
• High ESR
• Redness or swelling of the lips and tongue
• Lethargy
• Redness or swelling of the hands or feet
• Confusion
• Headache
• Sore throat
• Syncope
• Lymphadenopath

Emergency Warning Signs

• Difficulty Breathing
• Chest pain
• New onset confusion
• Lethargy
• Cyanosis
• Abdominal pain

Laboratory Findings

• Lymphopenia
• Neutrophilia
• Anemia
• Thrombocytopenia
• Abnormal fibrinogen
• High CRP
• High D Dimer
• High Ferritin
• Hypoalbuminaemia
• Elevated Procalcitonin
• High IL-10
• High IL-6
• Raised CK
• Raised LDH
• Raised triglycerides
• Raised troponin
• Elevated BNP
• Absence of other potential causative organisms.

'Radiological Findings

Test	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

Diagnosis

Preliminary WHO case definition: Children and adolescents

• 0–19 years of age with fever >3 days

AND

• Two of the following:

1. Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet)
2. Hypotension or shock
3. Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP)
4. Evidence of coagulopathy (by PT, PTT, elevated D-Dimers)
5. Acute gastrointestinal problems (diarrhea, vomiting, or abdominal pain)

AND

• Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin

AND

• No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes

AND

• Evidence of COVID-19 (RT-PCR, antigen test or serology-positive), or likely contact with patients with COVID-19

CDC Case Definition for MIS-C

• An individual aged <21 years presenting with fever, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological);

AND

No alternative plausible diagnoses;

AND

Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.

Classification of Disease Severity of MIS-C

• Mild Disease
• Children with MIS-C fall under this category who-
  • require minimal to no respiratory support.
  • minimal to no organ injury
  • normotensive
  • Do not meet the criteria for ICU admission.
• Severe Disease
• Children with MIS-C fall under this category who-
  • have significant oxygen requirements (HFNC, BiPAP, mechanical ventilation).
  • have a mild-severe organ injury and ventricular dysfunction.
  • have a vasoactive requirement.
  • meet the criteria for ICU admissions.

Treatment

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

Prsentation	Treatment
Mild Disease	Symptomatic Treatment
Severe Disease	Symptomatic Treatment IVIG(IV) Corticosteroids(IV/PO) Consider adding Anakinra or Tocilizumamb 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.

Complications of MIS-C

• Severe myocardial infarction
• Cardiac failure/arrest
• ARDS
• Fluid Overload
• Acute Kidney Injury
• Peritonitis
• Thrombotic complications.