A Pediatric Hematologist Explains Multisystem Inflammatory Syndrome In Children

The recent pandemic has confined people all over the world to the indoors to try to keep the virus from spreading. Older adults have been the most commonly affected age group with the virus, but more recently, a strange presentation of COVID-19 has been seen in children.

New York City first reported 15 similar cases that occurred between April 16 and May 4 for the first time in the United States. New York State health officials were investigating 102 cases as of May 12. Multiple reports thereafter from overseas and other states of the U.S. ensued that reported similar symptoms and presentations in children who were also were testing positive for COVID-19.

It mirrors the presentation of a dramatic disease of children called Kawasaki disease, where the body goes into an overdrive leading to overactivation of inflammation. This new disease has been given a name: multisystem inflammatory syndrome in children (MIS-C) and the CDC recently issued guidance to diagnose children with MIS-C if they have the following:

• Age <21 years 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)
• No plausible alternative diagnoses
• Positive for current or recent SARS-CoV-2 infection by a reverse-transcriptase polymerase chain reaction, serology or antigen test; or COVID-19 exposure within the four weeks prior to the onset of symptoms

Simply put if a child develops high-grade fever (38 degrees Celsius or 100.4 degrees Fahrenheit or higher for children), fever, a rash, swollen hands and feet, red eyes, swollen lymph nodes and red, swollen or cracked lips, mouth, throat, and tongue, etc. immediate help with the pediatrician should be sought to identify the cases earlier as prompt and early treatment leads to full recovery in children in most cases and delay on the other hand can lead to life-threatening cardiac complications. Treatment with medications called immunoglobulins and supportive care in a hospital setting is needed.

Special populations of children with chronic diseases like Type 1 diabetes, sickle cell anemia, pediatric cancer, and other blood disorders are immunocompromised and are furthermore at risk for COVID infection and its effects. Special precautions with social distancing measures and hand hygiene are needed around such patients, more than ever. Always consult your primary care doctor and specialist for the latest guidance and management strategies that are constantly evolving as more information comes in.

Akshat Jain is a pediatric hematology-oncology physician.

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