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Clinical features of multisystem inflammatory syndrome in children
Jordan E Roberts1, Lauren A Henderson
1Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition following SARS-CoV-2 exposure. Early recognition of varied symptoms and prompt treatment with IVIG and steroids are crucial for better outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Cardiology
- Pediatric Critical Care Medicine
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) emerged in 2020 as a severe hyperinflammatory condition linked to SARS-CoV-2.
- Diagnosis of MIS-C is challenging due to diverse clinical presentations and overlap with other diseases.
- Awareness of potential cardiac complications like coronary artery aneurysms and myocarditis is critical, even with mild symptoms.
Purpose of the Study:
- To review the diagnosis, clinical characteristics, and treatment of MIS-C associated with SARS-CoV-2.
- To highlight the diagnostic challenges and varied phenotypes of MIS-C.
- To emphasize the importance of prompt evaluation and management.
Main Methods:
- Literature review of studies on MIS-C and SARS-CoV-2.
- Analysis of clinical characteristics, diagnostic criteria, and treatment strategies.
- Synthesis of current evidence on MIS-C management.
Main Results:
- MIS-C presents with fever, shock, cardiac dysfunction, gastrointestinal symptoms, or mucocutaneous signs.
- Clinical presentations are highly variable, mimicking other infectious and rheumatologic conditions.
- Intravenous immunoglobulin (IVIG) is the recommended first-line therapy, with steroids as adjunctive treatment for severe cases.
Conclusions:
- Clinicians need a high index of suspicion for MIS-C in children with relevant symptoms and SARS-CoV-2 exposure.
- Prompt treatment is essential to prevent acute decompensation and long-term sequelae.
- Further research is needed for more precise diagnostic criteria and specific biomarkers for MIS-C.
Purpose Of Review:
To review diagnosis, clinical characteristics and treatment of multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Recent Findings:
MIS-C emerged in spring 2020 as a hyperinflammatory syndrome following SARS-CoV-2 exposure in children. Despite growing awareness of MIS-C, diagnosis remains challenging due to the range of phenotypes and severity. Fever accompanied by shock, cardiac dysfunction, gastrointestinal symptoms, or mucocutaneous signs suggestive of Kawasaki disease, especially in the presence of known or suspected coronavirus disease 2019 exposure, should trigger consideration of MIS-C. However, clinical presentations are highly varied and may overlap with other infectious diseases. Clinicians must maintain a high index of suspicion for MIS-C and be aware that patients may develop coronary artery aneurysms and myocarditis even with few or no Kawasaki disease symptoms. More precise diagnostic criteria and specific biomarkers are needed to aid diagnosis. Intravenous immunoglobulin (IVIG) is first-line therapy, and steroids should be considered as initial adjunctive treatment for patients with severe manifestations or other risk factors. Prompt treatment is essential, as patients may worsen acutely, though overall prognosis is reassuring.
Summary:
MIS-C associated with SARS-CoV-2 has varied clinical manifestations. Clinicians must be aware of the common presentation and potential for decompensation and cardiac sequalae to guide appropriate evaluation and treatment.
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