Multi-Inflammatory Syndrome in Children (MIS-C)

From the Michigan Department of Health & Human Services

The CDC Health Alert Network released a document characterizing the history and presentation of the syndrome (May 14, 2020)

This JEMS report provides EMS professionals with situational awareness of COVID-19 illness in pediatric patients (June 9, 2020)

AAP News (May 14, 2020)

Health officials are advising clinicians about a rare but serious inflammatory condition seen in children and linked to COVID-19. The Centers for Disease Control and Prevention (CDC) is calling the condition multisystem inflammatory syndrome in children (MIS-C) and is urging clinicians to report suspected cases so officials can learn more.

MIS-C Case Tracking Dashboard (NYC Department of Health)

Children's Hospital of Philadelphia (May 2020)

Brad Sobolewski (PEM Blog. May 15th, 2020)

European Centre for Disease Prevention and Control (May 15, 2020)

Several countries affected by the coronavirus disease (COVID-19) pandemic recently reported cases of children that were hospitalised in intensive care due to a rare paediatric inflammatory multisystem syndrome (PIMS). The presenting signs and symptoms are a mix of the ones for Kawasaki disease (KD) and toxic shock syndrome (TSS) and are characterised, among others, by fever, abdominal pain and cardiac involvement. A possible temporal association with SARS-COV-2 infection has been hypothesised because some of the children that were tested for SARS-CoV-2 infection were either positive by polymerase chain reaction (PCR) or serology.

World Health Organization (WHO) Global COVID-19 Clinical Platform (June 1, 2020)

AAP News. Melissa Jenco, News Content Editor. (May 20, 2020)

Experts are shedding more light on a rare but serious inflammatory syndrome linked to COVID-19 that is affecting children.

CDC Health Alert Network (May 14, 2020)

Summary
The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. 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.

HealthyChildren.org (May 15, 2020)

Zahra Belhadjer, MD, et al. Circulation. June 1, 2020.

Background: Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention.

Pediatric Intensive Care Society. May 14, 2020.

This paper is not a clinical guideline. It summarises the knowledge, practice and experience discussed at the session, including an analysis of the web chat content, and these may change in this rapidly developing situation. It also highlights emerging unanswered questions where data sharing and research may help to inform clinical practice.

Diagnostic and Interventional Cardiology. Dave Fornell, Editor. May 20, 2020.

What we know about multi-system inflammatory syndrome in children (MIS-C)

American Academy of Pediatrics (free access)

As a trusted pediatric publisher of peer-reviewed research, clinical references, patient education and coding & payment resources, the American Academy of Pediatrics is dedicated to providing AAP members, physicians, and health care providers with the latest open access research and guidance recommendations related to COVID-19. As the world responds to the pandemic, we are committed to fast-tracking COVID-19 research articles and publishing them free to read in this collection. The latest research will pre-publish on pediatrics.org and be deposited to PubMed upon final publication.

Alan R. Schroeder, MD; Karen M Wilson, MD MPH; Shawn L. Ralston, MD Hospital Pediatrics. May 2020.

World Health Organization. May 15, 2020.

Scientific Brief

Lucio Verdoni, MD, Angelo Mazza, MD, Annalisa Gervasoni, MD, et al. The Lancet. May 13, 2020.

Background: The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic.

Charlene A. Wong, David Ming, Gary Maslow and Elizabeth J. Gifford. Pediatrics. April 2020.

The Lancet. May 07, 2020.

South Thames Retrieval Service in London, UK, provides paediatric intensive care support and retrieval to 2 million children in South East England. During a period of 10 days in mid-April, 2020, we noted an unprecedented cluster of eight children with hyperinflammatory shock, showing features similar to atypical Kawasaki disease, Kawasaki disease shock syndrome, or toxic shock syndrome (typical number is one or two children per week). This case cluster formed the basis of a national alert.

Jones VG, Mills M, Suarez D, et al. COVID-19 and Kawasaki disease: novel virus and novel case. Hosp Pediatr. April 2020.

Abstract: In the midst of the coronavirus disease (COVID-19) pandemic, we are seeing widespread disease burden affecting patients of all ages across the globe. However, much remains to be understood as clinicians, epidemiologists, and researchers alike are working to describe and characterize the disease process while caring for patients at the frontlines. We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease (KD), who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms. The patient was treated per treatment guidelines, with intravenous immunoglobulin (IVIG) and high-dose aspirin (ASA), and subsequently defervesced with resolution of her clinical symptoms. The patient’s initial echocardiogram was normal, and she was discharged within 48 hours of completion of her IVIG infusion, with instruction to quarantine at home for 14 days from the date of her positive testing for COVID-19. Further study of the clinical presentation of pediatric COVID- 19 and the potential association with KD are warranted, as are the indications for COVID-19 testing in the febrile infant.