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Tue Jun 30, 2020, 12:28 AM

NEJM: Childhood Multisystem Inflammatory Syndrome

Childhood Multisystem Inflammatory Syndrome — A New Challenge in the Pandemic
Michael Levin, F.Med.Sci., Ph.D.
June 29, 2020
DOI: 10.1056/NEJMe2023158

Link: https://www.nejm.org/doi/full/10.1056/NEJMe2023158?af=R&rss=currentIssue

The recognition and description of new diseases often resemble the parable of the blind men and the elephant, with each declaring that the part of the beast they have touched fully defines it. As the coronavirus disease 2019 (Covid-19) pandemic has evolved, case reports have appeared describing children with unusual febrile illnesses that have features of Kawasaki’s disease, toxic shock syndrome, acute abdominal conditions, and encephalopathy, along with other reports of children with fever, elevated inflammatory markers, and multisystem involvement. It is now apparent that these reports were describing different clinical presentations of a new childhood inflammatory disorder.

A case definition for the emerging disorder was published in late April 2020, after U.K. pediatricians alerted the National Health Service to an unusual inflammatory illness, termed “pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2),” or PIMS-TS. Similar cases were rapidly reported from many other countries.3,4 The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) subsequently published their own differing definitions of the disorder, which they named multisystem inflammatory syndrome in children (MIS-C).
Overall, a consistent clinical picture is emerging. MIS-C occurs 2 to 4 weeks after infection with SARS-CoV-2. The disorder is uncommon (2 in 100,000 persons <21 years of age) as compared with SARS-CoV-2 infection diagnosed in persons younger than 21 years of age over the same period (322 in 100,000). Most patients with MIS-C have antibodies against SARS-CoV-2, and virus is detected in a smaller proportion. A relatively high proportion of cases have occurred among black, Hispanic, or South Asian persons.

Critical illness leading to intensive care develops in some patients, with prominent cardiac involvement and coronary-artery aneurysms in 10 to 20%. Elevated levels of troponin and B-type natriuretic peptide are common in severely affected patients, particularly those with cardiac dysfunction, and most have elevations in levels of C-reactive protein, ferritin, lactate dehydrogenase, and d-dimers, as well as in neutrophil counts. Anemia, lymphopenia, hypoalbuminemia, and abnormal coagulation indexes are also common. Most patients have recovered with intensive care support and after treatment with a range of immunomodulatory agents (including intravenous immune globulin, glucocorticoids, anti–tumor necrosis factor, and interleukin-1 or 6 inhibitors). A small percentage of patients have received extracorporeal membrane oxygenation support, and 2 to 4% have died.

Read more at the link. Good to see solid progress toward a better understanding of this frightening disorder for parents of young kids.

Hopefully some of our DUers with medical knowledge can condense this down for us laymen.


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