‘A massive systemic inflammatory response.’

While on the whole the United States is seeing a decline in COVID cases, this most recent wave of the Delta variant has seen an unprecedented number of children infected and hospitalized for COVID-19.

While children generally fare better than adults from the virus, infection may make them susceptible to a rare condition known as multisystem inflammatory syndrome in children (MIS-C).

This rare but serious condition was described by Shields and colleagues in our May issue as “a massive systemic inflammatory response that has physiologic correlations to Kawasaki disease, Kawasaki disease shock syndrome, toxic shock syndrome, macrophage activation syndrome, and cytokine release syndrome.”

The CDC reports that, as of October 4, the number of patients meeting the case definition for MIS-C was 5,217 (up from 4,000 reported in June) and the total number of deaths meeting the case definition was 46.

The CDC case definition includes the following:

  • An individual age 21 years or younger presenting with fever, laboratory evidence of inflammation (such as an elevated C-reactive protein erythrocyte sedimentation rate, fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase, or interleukin 6, elevated neutrophils, reduced lymphocytes and low albumin), and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological); AND
  • No alternative plausible diagnoses; AND
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms.

Early intervention is key.

Early intervention for suspected MIS-C is key to mitigating severe problems of major organs, permanent damage, and risk of death from the illness. In May, AJN published an informative review of MIS-C, by Kerry Shields, Kristin Atlas, Jessica Strohm, and Ruth Lebet from the Children’s Hospital of Philadelphia. The article, available for free here, includes epidemiology, pathophysiology, signs and symptoms, alternative possible diagnoses, and treatment options of MIS-C and more.

Below are some key points from the article.

Common symptoms include:

  • Fever
  • Abdominal pain
  • Emesis
  • Diarrhea
  • Erythematous or polymorphic rash
  • Strawberry tongue, cracked lips, mucous membrane
    involvement
  • Nonexudative conjunctivitis or conjunctival infection
  • Cardiac dysfunction or myocarditis
  • Headache
  • Vision changes
  • Irritability
  • Altered mental status
  • Hypoxia
  • Cervical lymphadenopathy

Treatment includes:

  • Supportive care may be sufficient for mild-to-moderate cases
  • Antibiotics
  • Immunoglobulin and steroids
  • IL antagonists
  • Anticoagulants

For more on the topic, listen to a podcast with AJN editor-in-chief Shawn Kennedy and authors Kerry Shields and Kristin Atlas.

By Christine Moffa, PhD, APRN, PMHNP-BC, AJN senior clinical editor