COVID-19 continues to devastate communities across the globe. People who get infected often experience changes in their physical, mental, physiologic, and psychological domains. To date, it is still not clear how long these changes might last and the impact they might have on us in the long run.
Now, imagine a scenario where you have a perfectly healthy child. You do everything in your power to keep them safe. You provide everything they ask for like any other responsible parent out there. You generally feel happy about your life and your family because everything is slowly stabilizing in the wake of the COVID-19 pandemic. Then, out of nowhere, you realize your child has these mild symptoms. Concerned as any parent would be, you take your child to a pediatrician for a check-up. Upon a thorough assessment, you get the news that your child has a serious and rare condition associated with COVID-19.
Not knowing about the future can be frightening, but what is even worse is not knowing whether your child will recover from a condition that even the CDC is still trying to understand. This has been the fate of thousands of parents whose young ones have developed multisystem inflammatory syndrome in children (MIS-C). The disease was first diagnosed in the United Kingdom around April 2020. At that time, parents reported their children experiencing symptoms similar to those observed in Kawasaki disease or toxic shock syndrome. After that, more cases emerged in different parts of the world.
What is Multisystem Inflammatory Syndrome in Children (MIS-C)?
Multisystem inflammatory syndrome in children, also known as MIS-C, is a severe COVID-19 complication. Sometimes, it is referred to as pediatric multisystem inflammatory syndrome (PMIS). This disease generally causes inflammation on multiple body systems: the brain, lungs, heart, kidneys, skin, gastrointestinal tract, and eyes. The disease often develops about four weeks after a COVID-19 infection. In rare cases, MIS-C might occur 8-10 weeks later.
According to the CDC, only about 1000 cases of MIS-C had been diagnosed in the United States as of October 4, 2020. However, the situation has worsened the following year, with more children presenting with symptoms fitting the current definition for MIS-C.
As of August 30, 2023, records show that MIS-C has affected 9,538 children, with 79 succumbing to the condition in the United States alone. According to the CDC, most of those who develop this condition are aged 5-11 years. Even so, MIS-C affects children of all ages, including infants. Currently, California has the most reported cases of MIS-C in the United States, with Texas recording the second most cases. Georgia, Florida, New York, and Ohio then follow suit.
So far, all U.S. states have reported cases of this disease. Virgin Islands and Guam have also documented at least one case. However, U.S territories of American Samoa, Palau, Northern Mariana Islands, Republic of the Marshall Islands, and Federated States of Micronesia have not recorded any MIS-C cases.
Risk Factors for MIS-C
MIS-C predominantly occurs in children who test positive for COVID-19. However, evidence now shows that being in contact with a person who is COVID-19 positive increases the risk of developing this disorder. In fact, reports show that two percent of MIS-C patients seemed perfectly healthy and had not been infected with COVID-19. However, they recently had contact with a COVID-19 infected person.
The male gender also is a risk factor for developing MIS-C. According to the current reported data, 61 percent of the patients have been male, with female children accounting for 39 percent of the cases.
Race or ethnicity has also remained a defining factor, with non-Hispanic blacks, Latinos, and non-Hispanic whites accounting for most MIS-C cases. However, the condition affects non-Hispanic blacks and Latinos more consistent with the high COVID-19 prevalence in these populations.
Usually, children with MIS-C present with different symptoms. Over time, the CDC has isolated the most common signs and symptoms based on the recently established MIS-C surveillance system. These include:
- Fever (>38.0°C)
- Skin rash
- Bloodshot eyes
- Abdominal pain
Parents should watch for these symptoms in their children and seek immediate medical attention. The onset of more serious MIS-C symptoms might signal the need for emergency care. These signs generally include:
- Persistent chest pain
- Shortness of breath
- Hypersomnia or inability to stay awake
- Observable color changes on the lips, nail bed, or the child’s skin
This list only provides symptoms indicative of severe MIS-C disease. Even so, a child might present with other worrying signs. Parents should particularly stay vigilant if a child recently had a COVID-19 diagnosis. They should contact a pediatrician if they have concerns about the possibility of their child having MIS-C.
The exact cause of MIS-C remains a mystery a few years since the first diagnosis. The disease is serious and life-threatening if not treated early, given that it affects several vital organs. Usually, children diagnosed with this condition get better with appropriate treatment.
Evidence shows that MIS-C is treatable, with full recovery expected in most children. Usually, treatment starts with supportive care to help manage symptoms. A child with this condition often receives different drugs to assist in treating inflammation. The objective here is to avert permanent organ damage. In most cases, hospitalization is necessary, with severe cases requiring admission to the pediatric intensive care unit.
The supportive care interventions comprise respiratory support, inotropic support, and fluid resuscitation. Sometimes, patients may require extracorporeal membrane oxygenation or life support depending on the severity of their disease.
Children diagnosed with MIS-C should not engage in physical exercise for about 3-6 months. They require cardiology clearance before participating in sporting activities or physical activity. They need this long break to ensure their heart has fully recovered.
A recent study conducted among 64 children and adolescents previously admitted to Boston Children’s Hospital with MIS-C found abnormal neuropsychological findings (motor coordination problems, impaired memory, and gait disturbances) not observed in those who had not contracted MIS-C.
The children and adolescents in this study also experienced psychosomatic symptoms, depression, ADHD, and anxiety more often than those who did not develop MIS-C. The researchers recommended regular neurological assessments and proper support for all children and adolescents who had MIS-C. A follow-up study is underway and will help establish whether MIS-C caused structural changes in the same group.