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Multisystem inflammatory syndrome in children with COVID-19
Michael Gottlieb1, Rachel Bridwell2, Joseph Ravera3
1Department of Emergency Medicine, Rush University Medical Center, USA.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a serious COVID-19 complication. This review details MIS-C diagnosis and acute care management, crucial for emergency clinicians.
Area of Science:
- Pediatric infectious diseases
- Critical care medicine
- Inflammatory syndromes
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication linked to COVID-19.
- This condition can affect multiple organ systems, presenting with diverse symptoms.
Purpose of the Study:
- To summarize the diagnosis and management of MIS-C.
- Focus on acute care setting management strategies.
Main Methods:
- Review of current literature on MIS-C diagnosis and treatment.
- Emphasis on clinical presentation, laboratory findings, and diagnostic criteria.
- Discussion of acute management protocols, including resuscitation and pharmacotherapy.
Main Results:
- MIS-C diagnosis relies on clinical and laboratory findings, often showing elevated inflammatory markers.
- Common symptoms include fever and gastrointestinal issues; neurological and dermatological findings are also noted.
- Acute management involves resuscitation, intravenous immunoglobulin, anticoagulation, and potentially corticosteroids or cytokine blockade for refractory cases.
Conclusions:
- MIS-C is an increasingly recognized condition associated with significant morbidity and mortality in pediatric COVID-19 patients.
- Emergency clinicians must be proficient in diagnosing and managing MIS-C.
- Prompt and appropriate management in the acute care setting is vital for patient outcomes.
Background:
Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19.
Objective:
The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting.
Discussion:
MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit.
Conclusion:
MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.
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