- SARS-CoV-2 multisystem inflammatory syndrome (MIS) in children (MIS-C) is associated with delayed onset, multi-organ system damage in previously healthy children and adolescents.
- Related study and editorial: MIS-C is distinct from Kawasaki’s disease.
- MIS-C is linked to older age, more intense inflammation and myocardial injury, and different racial/ethnic predominance.
Why this matters
- Echocardiograms should be performed in all patients presenting with MIS-C.
- Kawasaki’s disease guidelines can be used for follow-up.
- 186 patients, 26 US states.
- Median age, 8.3 (interquartile range, 3.3-12.5) years.
- 70% tested positive for SARS-CoV-2.
- 7% had symptoms before MIS-C onset (median interval, 25 days).
- 73% were previously healthy.
- 2% (4 patients) died.
- 71% (132) had >4 organ systems involved, including:
- 92% gastrointestinal.
- 80% cardiovascular.
- 76% hematologic.
- 74% mucocutaneous.
- 70% respiratory.
- Median (interquartile range) hospital duration:
- 7 days (4-10) among those discharged alive.
- 5 days (2-5) for those who died.
- Treatment: 98%-100% intravenous Ig, ~49% glucocorticoids, 8% IL-6 inhibitors, 13% IL-1Ra inhibitor.
- 48% with cardiovascular involvement received vasoactive support.
- 73% (94/128) had elevated B-type natriuretic peptide, 50% (77/153) elevated troponin.
- Coronary artery aneurysm z score >2.5 in left artery in 8% and right artery in 9%.
- 59% had respiratory insufficiency/failure.
- 78% had no underlying respiratory conditions.
- Targeted epidemiological surveillance study characterizing MIS-C epidemiology, clinical characteristics.
- Funding: CDC.
- Underestimated cases.
- Limited generalizability.