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
- Fever lasting 24 hours or longer.
- Vomiting
- Diarrhea
- Abdominal pain
- Difficulty Breathing
- Chest pain
- Headache
- Sore throat
- New onset confusion
Physical Examination
- Skin rash
- Conjuctivitis
- Redness or swelling of the lips and tongue
- Redness or swelling of the hands or feet
- Lymphadenopathy
- Lethargy
- Cyanosis
Laboratory Findings
Blood Investigations
- Lymphopenia, Neutrophilia, Anemia, Thrombocytopenia have been seen in MIS-C pateints. Abnormal fibrinogen, Hypoalbuminaemia, elevated creatiine kinase (CK), LDH, triglycerides have been observed in MIS-C patients.
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.
Radiological Findings
- Following Radiological Findings are observed in MIS-C patients.
| 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 |
Blood Culture, Viral PCR
- Absence of other potential causative organisms. IgG levels and IgM levels of SARS-CoV-2 are detected.
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.[2][3]
- Supplemental oxygen is required in children with low oxygen saturation.[3]
- Fluid resuscitation in 10 ml/kg aliquots with reevaluation after each bolus. Maintain euvolemia. Avoid hypervolemia.[3]
- Anti-inflammatory treatments with Intravenous immunoglobulin(IVIG) with or without corticosteroids have shown a good response rate.[2][3]
- Aspirin has been used primarily for its antiplatelet effect. It is recommended in all patients with MIS-C.[2][3]
- Anakinra is considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[2][3]
- Tocilizumab is also considered if fevers last more than 24 hours post steroids/IVIG or in the moderate or severe presentation.[2][3]
- Empiric antibiotics like vancomycin, ceftriaxone, and clindamycin are given for community-acquired shock presentation until cultures are negative for 48 hours.[2][3]
| Presentation | Treatment |
|---|---|
| Mild Disease |
|
| Severe Disease |
|
Prevention of MIS-C
- MIS-C can be prevented by reducing the risk of child exposure to COVID-19 infection.
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 "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) - ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 "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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