Coronavirus disease 2019 (COVID-19) has taken the world by storm for over a year; however, its presence has brought on consequences that many people are unaware about. One of the potential aftermaths of COVID-19 is seen in adolescence: Multisystem inflammatory syndrome in children (MIS-C).
There has not been much research on MIS-C, since it has just been discovered in the past year, nor is there much knowledge on the topic within the general population. This condition caught my eye after reading an article on a 10 year old boy having to undergo four limb, both hands and legs, amputations after developing MIS-C. He only had a fever and headache before being admitted to the hospital.
MIS-C is a serious condition that appears to be linked to COVID-19; the physiology is not fully known but considered to be a dysregulated generalized immune response following COVID-19. Different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. It is not certain what causes MIS-C; however, doctors and scientists have noticed that many children with MIS-C had COVID-19 or had been exposed to someone with COVID-19. MIS-C can be serious and even deadly.
Dr. Christina Miseo from Morristown Medical Center helped answer some questions about this condition. Her specialty is in Pediatric Emergency Medicine in Morristown Medical Center, where there have been a handful of MIS-C cases.
How does MIS-C develop? According to Dr. Miseo, “most people who become sick with an infectious agent will develop an immune response, which is vital and life saving to protect us,” but for some reason, there are certain people who have abnormal immune responses, like those with Type I diabetes. In this case, the body’s immune response to COVID-19 will become exacerbated and eventually sets off this dangerous cascade.
Is there an age group for MIS-C? Dr. Miseo claimed that generally older school aged children, around 8 to 11 years, is the most common age group in cases that they have seen. There have been reports in children from 1 year up to 20 years of age.
Morristown Medical Center, ranked the #1 hospital in New Jersey, has had several cases regarding MIS-C. “Luckily, our patients have done well and gone home after a stay in hospital,” Dr. Miseo said; however, there have been children who have gotten much sicker and are reported in the literature. “Many of our patients have required intensive care for blood pressure support and closing monitoring IV treatments.”
Parents and children themselves should look for certain symptoms. “MIS-C occurs several weeks to months following COVID-19, so knowing about this history is key,” Dr. Miseo mentioned, “the symptoms include fever in all patients, MIS-C has not been reported without fever.” Generally, Morristown Medical Center has noted that most of their patients have multiple days of fevers associated with other symptoms, such as vomiting, diarrhea, or rash.
As for treatment, patients are treated with steroids and intravenous immunoglobulin (IVIG). “Steroids are often used in autoimmune diseases to slow the immune response and IVIG is a pooled sample of immunoglobulins and antibodies from other people, a purified blood product,” Dr. Miseo said. The purified blood product is a type of treatment of Kawasaki disease, which is said to be similar to MIS-C. According to Dr. Miseo, this approach to treatment helped most of their patients fully return to normal.
This is an immune response, so someone who has MIS-C will not pass it to others, “Please be aware that this is not a contagious entity,” Dr. Miseo affirmed. The patients with MIS-C do not actively have COVID-19. Preventing infection of COVID-19 in the first place would aid in the prevention of MIS-C.
Dr. Miseo concluded the interview, mentioning that there is no specific “test” for MIS-C. A series of blood tests are performed to reflect any inflammation occurring in the body. If there is a “widespread elevation of these numbers in the appropriate clinical setting [that] is how the diagnosis is made.”
The illness is so new and symptoms are still being documented, so they may vary from child to child. The main thing to watch for is a persistent fever (lasting more than 24 hours and usually present for several days), feeling fatigued or ill, loss of appetite, or not having enough fluids. Some other symptoms that may be present but not in all cases are vomiting, diarrhea, pain in the stomach, skin rash, fast heartbeat, rapid breathing, red eyes, redness or swelling of the lips and tongue, redness or swelling of the hands or feet, dizziness, and enlarged lymph nodes. Adults can also obtain MIS but in adults (MIS-A).
The U.S Centers for Disease Control and Prevention (CDC) and the National Institutes of Health are working with doctors and researchers across the country to learn more about MIS-C in order to improve diagnosis and treatment. If you think you or someone has MIS, contact your doctor, nurse, or clinic right away.
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