Relationship characteristics between pediatric multisystem inflammatory disease and COVID-19

Investigators at the US Centers for Disease Control and Prevention (CDC) and Boston Children’s Hospital were prospectively retrospectively tracking MIS-C and COVID-19 data from March 15 to May 20, 2020 to determine disease I’ve summarized what is known about relationships. Their six criteria include serious illness leading to hospitalization, under 21 years of age, fever lasting more than 24 hours, confirmed evidence of inflammation, involvement of multisystem organs, and COVID-19 based on PCR and antibody tests. Evidence of infection, or another person who has developed COVID-19 in the past month.

Children with this hyperinflammatory syndrome People with Kawasaki disease, Written by the authors of the study, it is similar to MIS-C in that there is no diagnostic confirmation test.

Clinicians from 26 states reported 186 cases of MIS-C reported in COVID-19 overriding studies and CDC, the study authors said. The median age of patients was approximately 8, with 115 male patients, and three-quarters of the group were previously healthy. In addition, study authors reported that 19% were white, 25% were black, 5% were another race, 31% were Hispanic or Latino, and 22% were unknown.

The majority of these patients were admitted later in the study period from April 16th to May 20th. The study authors noted that a peak incidence of MIS-C occurs when COVID-19 activity is reduced. Most COVID-19 cases are confirmed by PCR tests, antibody tests, or both, and about half may be associated with other infected people.

The study authors also identified 14 patients with documented COVID-19 symptoms prior to the onset of MIS-C. They stated that the median time from the onset of COVID-19 to the onset of MIS-C was 25 days.

Three-quarters of COVID-19 patients involved at least four organ systems, most often the gastrointestinal, cardiovascular, blood, mucosal, and respiratory systems. The researchers report that the majority of patients were treated with ICU and 20% received invasive mechanical ventilation. At the end of the observation period, the study authors said 130 patients were alive and discharged, 52 remained hospitalized, and 4 died. The study authors said that all the patients who died were between 10 and 16 years old and two more had underlying disease.

The majority of MIS-C patients had fever for more than 5 days, and almost all had fever for more than 4 days. Cardiovascular disorders were common in 4 of 5 patients, and 90 patients received vasoactive support, the study authors write. They added that 109 patients had or had respiratory failure, of which 85 had no underlying respiratory status. From that group, 37 patients underwent invasive mechanical ventilation and 32 patients underwent non-invasive mechanical ventilation.

Most patients also had four or more laboratory markers of inflammation, the study authors said, with C-reactive protein levels, lymphopenia, neutrophilia, elevated ferritin levels, and low levels. Levels including albuminemia, elevated alanine aminotransferase levels, anemia, thrombocytopenia and elevated d-dimers, long-term international normalized ratios, or elevated fibrinogen levels.
They write that MIS-C patients were treated with immunomodulators such as intravenous immunoglobulin (77%) and systemic glucocorticoids (49%).

The authors of the study suggested that providers could consider following Kawasaki disease guidelines for follow-up care until further knowledge about the long-term cardiac mechanisms behind MIS-C is known.
“Clinical and laboratory characteristics of hyperinflammation, timing of onset associated with SARS-CoV-2 infection, and similarity to disease pattern in Covid-19 adults indicate that MIS-C is a consequence of immunity.” The hypothesis supports the intervening injury caused by SARS-CoV-2 infection,” the authors conclude.