What parents need to know about Multisystem Inflammatory Syndrome in Children (MIS-C)

Photo by Robina Weermeijer courtesy of Unsplash

As COVID-19 cases continue to increase throughout Utah, we will start seeing more cases of MIS-C, a severe inflammatory syndrome that follows 2-4 weeks after COVID-19 infection in some children. In fact, I was told on a conference call this morning that as of today (1/6/2021), we have had 41 children to date diagnosed with this illness in the state of Utah.

It’s really important for parents to know about MIS-C even if their child hasn’t had COVID or COVID symptoms. Some of these kids with MIS-C never had COVID symptoms, but virtually all of them (99%) were positive for COVID-19. Around the country we are seeing clusters of MIS-C break out about 2-4 weeks after the levels of COVID-19 get crazy in the area. That happened here in Utah, with a small explosion of cases happening the last several weeks.

Why is it important for parents to know the symptoms of MIS-C? Because these children can get very sick very quickly. Most dangerously, they can develop shock due to heart failure and heart attack. This syndrome can affect many other organ systems in the body as well including the kidneys, gastrointestinal system, skin, eyes, brain and lungs. Seventy percent of the children who have been diagnosed with it in the state of Utah have been admitted to the Intensive Care Unit (ICU). Thankfully, MIS-C is not common, affecting probably around 0.5-1% of children who get COVID-19 according to some study data. But as common as COVID itself is getting, we are seeing it.

So what exactly causes MIS-C? There is even less we know about MIS-C than COVID-19 itself. It seems to be related to the immune response the body generates against infection with the COVID-19 virus. This leads to inflammation that affects the lining of the gastrointestinal system, heart muscle, skin, and other areas. It’s important to note that it has not been reported in people after getting COVID-19 vaccination, though we don’t have data on children getting the vaccine yet.

What symptoms should parents watch for? All of these kids have fever that lasts an average of 4-6 days. But kids develop other symptoms within the first several days as well. Almost all of these kids have some degree of abdominal pain, vomiting and/or diarrhea (between 60-100%). They also commonly develop rash (46-75%), conjunctivitis (inflammation and redness of the eyes, between 30-80%), mouth sores or peeling (27-76%). They can have neurologic problems including headache, confusion, lethargy in 29-58% of cases. They don’t have to have typical COVID-19 symptoms, and it’s actually a small portion of children who have cough or other respiratory symptoms, aches, chills, or sore throat. A few can have swelling in the hands or feet. The most common age is 8-11 years old, but it can affect any ages from 1-20. Even a few adults have had it as well.

These kids are usually pretty ill-appearing, at least to an experienced clinician, so when in doubt, never be afraid to call for a visit, but remember there are a lot of other illnesses that can cause similar symptoms.

Kawasaki Disease, Henoch-Schonlein Purpura, Staph Scalded Skin Syndrome, Toxic Shock Syndrome, bacterial enteritis, hand/foot/mouth virus and many other infections are a few that can present similarly. To help tell these apart, we’ll check a COVID-19 test, lab work looking for very high inflammatory markers in the blood, abnormal blood counts, and signs of cardiac injury and kidney or liver injury. If a patient really seems to have MIS-C, they’ll likely be admitted to Primary Children’s where they can see an Infectious Disease specialist and Rheumatologists and be close to a PICU.

MIS-C is just one more way the COVID-19 is challenging us. The good news is that there is a lot we can do to prevent it. Keep taking the usual precautions you’ve been hearing about ad nauseum that are becoming our new normal: mask-wearing, social distancing, limiting gatherings, washing hands, etc. as those things do decrease the risk of COVID-19 infection and therefore MIS-C. And look forward to the day that enough people are vaccinated that the virus goes away or down to a very low level and this pandemic is over!

Read more here.

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