Multisystem inflammatory syndrome in children due to COVID-19
In children, infections with the SARS-CoV-2 coronavirus usually take a harmless course and adolescents are considered to be significantly less susceptible to serious illnesses from COVID-19. But in some children the SARS-CoV-2 infection can lead to a life-threatening multisystem inflammatory syndrome (Multisystem Inflammatory Syndrome in Children; MIS-C).
If gastrointestinal complaints, conjunctivitis or a rash are observed in addition to fever, this can indicate a MIS-C and an examination in the emergency room of a children’s clinic is urgently recommended, reports the specialist magazine “BMJ“In a recent post. The MIS-C is a new symptom that is directly related to SARS-CoV-2 infections, but can occur up to six weeks after the actual infection.
Often unspecific in children
Although children with COVID-19 often show no or rather unspecific symptoms, fever and respiratory symptoms as well as loss of taste or smell are typical signs of COVID-19 for them too. In very rare cases, children also develop noticeable symptoms that indicate a type of hyperinflammatory syndrome, which is known in the professional world as MIS-C and was first described in April 2020.
What are the characteristics of a MIS-C?
The MIS-C can still occur about two to six weeks after the SARS-CoV-2 infection and, according to the “BMJ”, is characterized by the following factors:
- Fever for more than 24 hours,
- increased markers of inflammation,
- Multi-organ dysfunction (in more than two areas; cardiac, dermatological, gastrointestinal, renal, respiratory, hematological and / or neurological),
- lack of plausible alternative diagnosis,
- test positive for SARS-CoV-2 or close contact with a person with COVID-19 within four weeks of the onset of symptoms.
Typically school-age children are affected (median age eight years), although cases in infancy and young adulthood have also been documented, reports the “BMJ”. Children with MIS-C show persistent fever and most often have gastrointestinal symptoms (e.g. abdominal pain, vomiting, diarrhea), changes in the mucous membrane (e.g. skin rash, conjunctivitis) and can also have neurological symptoms (e.g. headache, meningism ), explains the specialist magazine.
MIS-C is a progressive disease and people who initially have mild symptoms can develop severe multi-organ dysfunction within a few days of the onset of symptoms. “Critical signs can include hemodynamic instability, tachycardia, left ventricular dysfunction and shortness of breath, which can be primarily caused by cardiac dysfunction,” according to the BMJ.
Which examinations are advisable?
If MIS-C is suspected, it is important to conduct laboratory tests to identify signs of inflammation, cardiac and other organ dysfunction. In addition, diagnostic imaging based on the findings of the physical exam and laboratory results is also recommended. “All patients who are strongly suspected of having MIS-C should have an echocardiogram performed to assess cardiac function and look for signs of coronary artery dilation,” reports the BMJ.
Overall, MIS-C is rare
Overall, MIS-C is a rare complication in SARS-CoV-2 infections, but this critical diagnosis must currently be considered in regions with active corona events in every child with fever, signs of inflammation and organ dysfunction. After an appropriate diagnosis, immediate treatment with intravenous immunoglobulin and steroids can reduce the inflammatory reaction and positively influence the course of the disease, the “BMJ” continues.
Further studies needed
The findings on the effect of the treatment approaches with MIS-C remain limited and additional studies are urgently required in order to understand the pathophysiology of MIS-C and to determine the most effective therapeutic measures, according to the “BMJ”. It is reassuring, however, that the mortality rate among children and adolescents remains very low overall and that adolescents in the USA, for example, account for less than one percent of all deaths in connection with SARS-CoV-2. (fp)
Author and source information
This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.
Dipl. Geogr. Fabian Peters
- British Medical Journal (BMJ): Acute covid-19 and multisystem inflammatory syndrome in children (veröffentlicht 01.03.2021), bmj.com
This article is for general guidance only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.