Children's Hospital Colorado

What We Know About Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

Children's Hospital Colorado | May 21, 2020
Dr. Sam Dominguez is pictured wearing a lab coat and face mask as he gestures in explanation.

Most children with COVID-19, commonly called the coronavirus, are either asymptomatic (meaning they don’t have any symptoms) or have mild infections. Rarely, some children are hospitalized and can get very sick. In some of those cases, doctors are seeing a newly identified condition called pediatric multisystem inflammatory syndrome in children, or MIS-C.

“Much remains unknown about how exactly this develops, but it’s related to the body’s attempts to fight an invader,” reports The Denver Post in an interview with Sam Dominguez, MD, a pediatric infectious disease specialist at Children’s Colorado.

Multisystem inflammatory syndrome in children may be connected to the coronavirus

Some children reported to have MIS-C have tested positive for COVID-19, while others have not. Although doctors do suspect a connection between the two conditions, there are many unanswered questions, and information is changing rapidly.

Doctors are working to identify treatments

Across the country, pediatric hospitals are working together to understand MIS-C. Our physician-scientists are working with others around the world to understand MIS-C and how best to treat it.

 “This is a very rare disease, and we’re working hard to find the best approach to caring for these children,” said Dr. Sam Dominguez, speaking to CBS News.

Most children with MIS-C are being treated with medicines, such as immune globulin (IVIG) or other anti-inflammatory medications, that are used for Kawasaki disease and toxic shock syndrome (TSS). Fortunately, most children have responded well to those treatments. Children’s Colorado is an expert in these areas. Our own Jim Todd, MD discovered TSS and identified the first case of Kawasaki disease in continental North America. Mimi Glode, MD pioneered the use of IVIG for the treatment for Kawasaki disease, and we have a nationally recognized Kawasaki disease clinical and research teams. We also formed a multidisciplinary team of specialists who drafted guidelines to assist in recognizing and treating patients with MIS-C.

Symptoms of multisystem inflammatory syndrome in children

The CDC lists the following symptoms of MIS-C:

  • Fever lasting 24 hours or more, high levels of inflammation in lab tests, and evidence of a COVID-19 infection
  • At least two of the following:
    • Rash, red eyes, puffiness of hands or feet, heart problems, trouble breathing, seeming confused or overly sleepy, or digestive problems like stomachache or vomiting

MIS-C is being compared to Kawasaki disease because both are inflammatory conditions that occur primarily in children. Currently, it’s unclear if MIS-C affects only children or if it also occurs in adults. We do know that immunocompromised children are more susceptible to MIS-C and can be affected more severely.

“There’s a great deal of overlap between Kawasaki disease and this new inflammatory syndrome,” said Sara Saporta-Keating, MD, a pediatric infectious disease specialist at our hospital Colorado Springs, speaking to FOX21. “A lot of the overlapping symptoms include fever, rash, some swelling of extremities and red eyes. Normally Kawasaki disease doesn’t require blood pressure support, but that’s the more typical presentation of this new syndrome.”

What to do if you think your child has MIS-C

If your child has any symptoms of the coronavirus or MIS-C, call your doctor's office first and they can recommend appropriate care. In a life-threatening emergency, always call 911.

"Pediatrician's offices are a safe place to be,” said Dr. Saporta-Keating speaking to KOAA. “We encourage parents to continue to seek medical care when they think it's warranted. Going through the pediatrician first, unless there's an emergency, is the best thing to do. The biggest takeaway for parents is not to panic."

Listen to our Charting Pediatrics podcast about MIS-C.

 

Watch an interview with Dr. Dominguez on CBS News

Editor's note: This page was updated on May 21, 2020. Due to the nature of the coronavirus pandemic, recommendations can change quickly. Please follow all rules and guidelines set by state and local public health and safety authorities. Reference the Centers for Disease Control and Prevention (CDC) and the Colorado Department of Public Health and Environment (CDPHE) for immediate updates on COVID-19.

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