Coronavirus pandemic is no longer a disease largely confiined to adult people. There’s growing evidence that a rare, mysterious illness appearing in children may be linked to the virus.
It’s been dubbed Pediatric Multisystem Inflammatory Syndrome (MIS-C), abbreviated as PMIS or PIMS. The U.S. Centers for Disease Control and Prevention issued an advisory to doctors about it on May 14.
CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.
Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C) by CDC
- 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 COVID-19 exposure within the 4 weeks prior to the onset of symptoms
“We want to reassure families that this complication is very rare,” said Roshni Mathew, MD, clinical assistant professor of infectious disease at Stanford Children’s Health. Her team is closely monitoring reports about the disease as scientists around the world work to understand MIS-C. “Even though this is rare, and we don’t want parents to become alarmed, it’s wise for them to know what to watch for,” Mathew said.
Physicians in New York, London and elsewhere have described the symptoms of MIS-C as: persistent fever, a rash or changes in skin color, red eyes or conjunctivitis, abdominal pain, and swollen lymph nodes. If parents notice any of these symptoms, they should call their pediatrician for advice on next steps.
“The key is to identify this early so the child can receive appropriate treatments to help with the body’s inflammatory response.” said Mathew. Kids admitted to the hospital would also be carefully monitored for complications such as cardiac problems.
Children with MIS-C don’t always show respiratory symptoms of COVID-19, according to news reports.
COVID-19 and Kawasaki disease
Parents may also be wondering about a widely-reported case of an infant treated in early March at Lucile Packard Children’s Hospital Stanford for Kawasaki disease, which is also a pediatric inflammatory condition. The infant was admitted through the Stanford Emergency Department.
Following admission protocol, she underwent testing for the novel coronavirus, SARS-CoV-2, and was found to have the virus. The care team noted that she did not have the typical respiratory symptoms associated with COVID-19. She received anti-inflammatory treatment for Kawasaki disease and quickly recovered.
Because the cases of MIS-C in Europe and New York have similar features to Kawasaki disease, this case has drawn a lot of attention. However, unlike patients elsewhere who have become very ill, the patient at Packard Children’s Hospital was very stable, so it’s not clear whether she had the new inflammatory problem.
“What we saw was classic Kawasaki disease,” Mathew said. “It appears that what they’re seeing in New York has Kawasaki-like features but is more severe. Drawing these distinctions is tricky in a pandemic because we are learning as we go.”
Complete clinical descriptions of the children in New York have yet to be published, making it difficult for experts to know exactly how the cases compare, Mathew added. Doctors also note that although kids seem to be getting somewhat sicker than they do with classic Kawasaki disease, the vast majority seem to be recovering.