Overview
Multisystem inflammatory syndrome in children (MIS-C) is a group of symptoms linked to inflamed organs or tissues in children. It was first detected in April 2020 and is currently linked to coronavirus disease 2019 (COVID-19). MIS-C occurs when the blood vessels, digestive system, skin, or eyes become swollen and irritated after infection with the COVID-19 virus. It is rare and most often happens within 2 months after having COVID-19. The child may have had a known infection or a close contact may have a confirmed infection. Symptoms can be serious and require hospitalization. If no other diagnosis fits, healthcare professionals may diagnose MIS-C. The exact cause is not yet known, but it is believed to be an overreaction of the immune system to the COVID-19 virus. Early diagnosis and treatment are important to prevent severe complications.
Understanding the disease
Symptoms
The symptoms of multisystem inflammatory syndrome in children (MIS-C) are serious and require hospitalization. These symptoms may include:
- Fever
- Blood test results showing a high level of inflammation throughout the body
- Heart problems
- Red, bloodshot eyes
- Redness or swelling of the lips and tongue
- Redness or swelling of the hands or feet
- Pain in the belly, vomiting, or diarrhea
- Problems with blood clotting
- Shock These symptoms may occur in kids who have had a known infection with the COVID-19 virus or have had close contact with someone who had a confirmed infection within the two months prior to hospitalization. If your child is not severely ill but shows other symptoms of MIS-C, contact their healthcare professional for advice.
Risk Factors
The exact cause of MIS-C is not yet known, but many children with MIS-C have had a recent or current infection with the COVID-19 virus. This condition seems to occur in response to an overactive immune system triggered by the COVID-19 virus, either from a current or earlier infection. Risk factors for developing MIS-C include being between the ages of 5 and 11, as most cases occur within this age range. However, cases have also been reported in children aged 1 to 15, as well as in older kids and babies.
Development
MIS-C in kids develops as a result of the COVID-19 virus. It is linked to a current or earlier infection with the virus that causes COVID-19. The exact cause of MIS-C is not yet known, but many children with MIS-C have had a recent infection with the COVID-19 virus, or may even have a current infection. MIS-C is thought to occur when the immune system overreacts to the infection, causing inflammation in various organs or tissues. The condition is rare and requires hospitalization for treatment.
Assessment and Diagnosis
Triage
If MIS-C in kids related to COVID-19 is suspected, you should see a doctor immediately if your child experiences any of the emergency warning signs, including severe stomach pain, chest pain or pressure, difficulty breathing, pale or blue-colored skin, confusion, or inability to wake up or stay awake. If your child shows other symptoms of MIS-C or has had a recent or current COVID-19 infection, contact your child's healthcare professional for advice, as they may recommend tests to check for inflammation and other signs of MIS-C.
Diagnosis
To diagnose Multisystem Inflammatory Syndrome in Children (MIS-C) related to COVID-19, healthcare providers will consider the child's symptoms and rule out similar conditions through a combination of lab tests and examination. They will use the following methods:
- Testing for the COVID-19 virus: Providers will test for the virus using a swab of the nose and the back of the throat to confirm active infection.
- Blood tests: Blood tests help to rule out other inflammatory conditions, such as Kawasaki disease, sepsis, and toxic shock syndrome.
- Antibody tests: If a child had COVID-19 but did not show symptoms, an antibody test can reveal proof of a prior infection. Additionally, observing infections among the child's close contacts can also provide evidence of a prior infection. It is important to note that many children with MIS-C may test negative for a current COVID-19 infection, but they often have a link to the virus within two months of getting sick.
Management and Treatment
Complications
MIS-C can lead to severe problems with vital organs, such as the heart. In rare cases, MIS-C could lead to permanent damage or even death. Without early diagnosis and treatment, the condition can cause complications. Early diagnosis and prompt medical care are crucial in managing MIS-C and preventing potential complications.
Prevention
Vaccines can help prevent COVID-19, including the MIS-C complication in kids. In the U.S., COVID-19 vaccines are offered to people aged 6 months and older. By getting vaccinated, individuals can protect themselves and others from getting or spreading the virus. Additionally, following preventive measures such as washing hands frequently, avoiding close contact with sick individuals, and wearing masks can help reduce the risk of contracting COVID-19, which may lead to MIS-C in some cases.
Treatment
Treatment for Multisystem Inflammatory Syndrome in Children (MIS-C) typically involves supportive care and efforts to lower inflammation in affected organs. Supportive care measures may include:
- Fluids to prevent or treat dehydration.
- Oxygen support for breathing difficulties.
- Blood pressure medication to address low blood pressure related to shock or to support heart function.
- A breathing machine called a ventilator, in severe cases. Additionally, medications may be provided to manage inflammation, lower the risk of blood clots, and treat any active infections. These may include:
- Antibiotics to treat bacterial infections.
- Steroid therapy to reduce inflammation.
- Intravenous immunoglobulin (IVIG) to provide antibodies.
- Blood thinners like aspirin or heparin to minimize blood clots. In rare cases, extracorporeal membrane oxygenation (ECMO) may be used, which involves a machine that takes over the work of the heart and lungs. It's important to note that MIS-C is a rare condition, and its exact treatment may vary depending on the specific symptoms, severity, and which organs are affected. Always consult with a healthcare professional for personalized guidance on your child's condition and treatment plan.