Multisystem inflammatory syndrome in children (MIS-C)

2. What is multi-system inflammatory syndrome
in children?
 MIS-C also called pediatric multi-system inflammatory syndrome, is
considered a syndrome -a group of signs and symptoms, not a
disease- because much is unknown about it, including its cause and
risk factors.
 MIS-C is an extremely rare condition in which different parts of the
body -including eyes, skin and some internal organs such as the
heart, lungs, blood vessels, kidneys, digestive system, brain, skin or
eyes -become severely inflamed.

3. MIS-C and COVID-19: What Is the
Connection?
 MIS-C, was first identified in April 2020 at children’s hospitals in the US and
the UK, temporally related to SARS CoV-2, and is a potentially serious illness
that appears to be a delayed, post-infectious complication triggered by the
COVID-19 infection.
 Most children with MIS-C are between the ages of 3 and 12 years old, with an
average age of 8 years old. Some cases have also occurred in older children
and in babies.
 Symptoms appear between 2-6 weeks (average 4 weeks) after COVID-19
infection. Most children with MIS-C have antibodies to the SARS CoV-2 virus.

4. What causes MIS-C in children?
 The exact cause of MIS-C is not known yet, but it appears to be an
excessive immune response related to COVID-19. Many children
with MIS-C have a positive antibody test result. This means they've
had a recent infection with the COVID-19 virus. Some may have a
current infection with the virus.
 Some researchers suspect that MIS-C is caused by a delayed
immune response to the coronavirus that somehow goes into
overdrive, causing inflammation that damages organs. It’s also
possible that the antibodies children make to the virus, or some of
their immune cells, are creating the illness. Since only a small
number of children develop MIS-C, it is possible that there are
genetic factors that make some children susceptible.

5. CDC Case Definition
 An individual aged <21 years presenting with fever*, laboratory evidence of
inflammation**, and evidence of clinically severe illness requiring hospitalization, with
multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic,
gastrointestinal, dermatologic or neurological); AND
 No alternative plausible diagnoses; AND
 Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen
test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to
the onset of symptoms.
 Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.
*Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
**Including, but not limited to, one or more of the following: an elevated CRP, ESR, fibrinogen, procalcitonin, d-dimer,
ferritin, LDH, or IL-6, elevated neutrophils, reduced lymphocytes and low albumin

6. Specific features of MIS-C may include:
 Skin/mucous membrane : Rash, bloodshot eyes, swollen or red
hands and feet, inflamed mucous membranes in the mouth, cracked
lips, and a swollen tongue that looks like a strawberry.
 Symptoms and signs of shock or cardiac problems: such as cold,
clammy skin, hypotension, dyspnea, dizziness or light headedness,
and tachycardia or arrhythmias.
 Gastrointestinal symptoms: diarrhea, vomiting, or abdominal pain.
 Respiratory symptoms such as cough and shortness of breath.
 New neurologic symptoms, such as headache, neck pain,
confusion, numbness/tingling in the hands and feet, or seizures.

7. Differential Diagnosis for patient with
possible MIS-C
 Although MIS-C is a rare complication of COVID-19, The
symptoms can overlap and mimics other conditions as:
 Infections “ sepsis / DIC like ”
 Inflammations “ Kawasaki like ”
 Autoimmune disorders

10. Prognosis of MIS-C
 Although MIS-C can be serious, even fatal, it is a treatable
condition and most children recover fully from this illness.
With prompt attention, medicines can control the inflammation
and help avoid lasting organ damage, especially involving the
heart.

11. How is MIS-C treated?
 Treatments have consisted primarily of supportive care and
directed care against the underlying inflammatory process.
 Supportive measures have included:
 Fluid resuscitation
 Inotropic support
 Respiratory support and
 In rare cases, extracorporeal membranous oxygenation (ECMO).

12.  Anti-inflammatory measures have included the frequent use of
IVIG and steroids. The use of other anti-inflammatory
medications ( as drugs blocking IL-1 or IL-6) and the use of
anti-coagulation treatments have been variable. Aspirin has
commonly been used due to concerns for coronary artery
involvement, and antibiotics are routinely used to treat
potential sepsis while awaiting bacterial cultures. Thrombotic
prophylaxis is often used given the hypercoagulable state
typically associated with MIS-C.

13. Thank you