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Is multisystem inflammatory syndrome in children on the Kawasaki syndrome spectrum?
Rae Sm Yeung1, Polly J Ferguson2
1Department of Paediatrics, Immunology and Medical Science, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children infected with SARS-CoV-2 can develop a severe inflammatory syndrome, multisystem inflammatory syndrome in children (MIS-C), which shares features with Kawasaki disease (KD) but presents more severely. Understanding MIS-C
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- An increase in pediatric cases of severe hyperinflammation and multiorgan dysfunction post-SARS-CoV-2 infection has been noted.
- This condition, termed multisystem inflammatory syndrome in children (MIS-C), shares similarities with Kawasaki disease (KD).
- MIS-C cases often exhibit severe cardiovascular manifestations, including cardiogenic shock, placing them at the extreme end of the KD spectrum.
Purpose of the Study:
- To explore the clinical profiles of children with coronavirus disease 2019 (COVID-19).
- To analyze the relationship between MIS-C and Kawasaki disease (KD).
- To discuss the implications of classifying MIS-C as a distinct entity versus grouping it with KD for understanding its pathobiology.
Main Methods:
- Review of clinical profiles of pediatric patients with COVID-19.
- Comparative analysis of clinical features between MIS-C and Kawasaki disease (KD).
- Literature review and expert opinion on disease classification and pathobiology.
Main Results:
- MIS-C presents with significant fever, hyperinflammation, and multiorgan dysfunction, often requiring intensive care.
- Cardiovascular involvement in MIS-C is severe, with coronary dilatation and aneurysms frequently observed.
- Clinical presentations suggest MIS-C represents a severe manifestation potentially related to KD.
Conclusions:
- While separating MIS-C may aid clinical management, integrating it with KD research could enhance understanding of its underlying pathobiology.
- Further research is needed to elucidate the precise relationship between MIS-C and KD.
- The distinct severity and presentation of MIS-C warrant careful consideration in both clinical practice and scientific inquiry.
Abstract:
An alarming increase in children presenting with fever, hyperinflammation, and multiorgan dysfunction frequently requiring intensive care has been observed after severe acute respiratory syndrome coronavirus 2 infection. The illness resembles Kawasaki disease (KD), with coronary dilatation and aneurysm occurring in some. However, the cardiovascular manifestations were typically on the severe end of the KD spectrum, with cardiogenic shock a common presentation together with other features. This led to defining a unique syndrome named multisystem inflammatory syndrome in children (MIS-C). In this issue of the JCI, Lee and Day-Lewis et al. and Diorio et al. explored the clinical profiles associated with coronavirus disease 2019 in children. We posit that while splitting MIS-C into a separate disease may aid clinical management decisions, lumping it into the KD pot may better serve to understand pathobiology.
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