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Multisystem Inflammatory Syndrome in Children: A Year in Review
Vivekanand Tiwari1, Albert A Daniel1
1Section of Rheumatology, Dartmouth Hitchcock Medical Center, Medical Center Drive, Lebanon.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a condition linked to COVID-19. While it presents severely, MIS-C generally has a good prognosis, with ongoing research into its characteristics and treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- A novel clinical syndrome in children, termed multisystem inflammatory syndrome in children (MIS-C), emerged in association with the COVID-19 pandemic.
- MIS-C shares clinical features with other serious conditions like Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome.
Purpose of the Study:
- To define the case definition for MIS-C, as published by the Centers for Disease Control and Prevention in May 2020.
- To summarize the evolving understanding of MIS-C, including its association with SARS-CoV-2 infection.
Main Methods:
- Review of clinical reports and case definitions related to MIS-C.
- Analysis of diagnostic criteria, including SARS-CoV-2 serology and RT-PCR testing.
- Consideration of epidemiological links to COVID-19 in cases with negative diagnostic tests.
Main Results:
- MIS-C is characterized by multisystem involvement and hyperinflammation.
- While initial presentations can be severe and overlap with other syndromes, the overall prognosis for MIS-C is generally favorable.
- Most affected children test positive for SARS-CoV-2, but some may have negative tests with confirmed epidemiological links.
Conclusions:
- MIS-C represents a significant post-infectious complication of COVID-19 in children.
- Despite severe initial presentation, prompt recognition and management contribute to a good prognosis.
- Continued research is essential to fully elucidate the demographic characteristics, laboratory findings, and optimal treatment strategies for MIS-C.
Abstract:
Centers for Disease Control and Prevention published a case definition for the multisystem inflammatory syndrome in children in May 2020 when reports started pouring in about a clinical syndrome in children which was temporally associated with coronavirus disease 2019 infection. It has also been referred to as pediatric inflammatory multisystemic syndrome temporally associated with severe acute respiratory syndrome coronavirus 2. Most of these patients test positive for severe acute respiratory syndrome coronavirus 2 serology or reverse transcription-polymerase chain reaction, although a small number of patients could test negative which would require an epidemiological link to the coronavirus disease 2019 infection. The initial clinical presentation could overlap with Kawasaki disease, severe coronavirus disease 2019 infection, toxic shock syndrome, and macrophage activation syndrome. While multisystem inflammatory syndrome in children is characterized by multisystem involvement with hyper inflammation and severe clinical presentation initially, the prognosis is generally good. Since it was first described, there have been multiple studies describing the demographic characteristics, laboratory features, and treatment paradigm.
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