Last Updated on 11/24/2020 @ 2:38 PM EST
Multisystem Inflammatory Syndrome in Adults (MIS-A)
COVID-19 in Pediatric Patients
- Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19
- Multisystem Inflammatory Syndrome in Children: A Systematic Review
- CDC Case Tracker
- CDC Case Definition
- Patients <21 years presenting with fever of >38.0°C for ≥24 hours or subjective fever ≥24 hours; AND
- Laboratory evidence of inflammation including, but not limited to, one or more of the following: an elevated CRP, ESR, fibrinogen, procalcitonin, d-dimer, ferritin, LDH, or IL-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
- Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.
- 5/19 – CDC COCA Webinar: Multisystem Inflammatory Syndrome in Children (MIS-C)
A discussion of the clinical characteristics of multisystem inflammatory syndrome in children, how cases have been diagnosed and treated, and how clinicians are responding to recently reported cases associated with COVID-19.
- 5/14 – CDC Alert: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19
The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.
- 5/13 – Updated NY DOH Advisory with Case Definition
See CDC Case Definitoin Above.
- 5/6 – NY DOH Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19 in Children
As of May 5, 2020, 64 suspected pediatric clinical cases compatible with multi-system inflammatory syndrome associated with COVID-19 have been reported in children in New York State hospitals, including New York City.
- 5/4 – NYC Health Department Health Alert on Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19
Fifteen cases compatible with multi-system inflammatory syndrome have been identified in children in New York City hospitals. Characterized by persistent fever and features of Kawasaki disease and/or toxic shock syndrome; abdominal symptoms common. Cases may require intensive care unit admission for cardiac and/or respiratory support. Polymerase chain reaction testing for SARS-CoV-2 may be positive or negative. Notably, 6 patients with negative testing by PCR were positive by serology. Early recognition and specialist referral are essential, including to critical care if warranted. Immediately report cases to the New York City Health Department.
- 5/1 – RCPCH: Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19
Document includes a case definition and approach to clinical management.
- 4/27 – PICSUK Statement on Increased Novel Presentation of Multi-system Inflammatory Disease in COVID-19
NHS England has highlighted a small rise in the number of cases of critically ill children presenting with features of toxic shock
syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 (elevated CRP, ESR, and ferritin). Additionally, abdominal pain and gastrointestinal symptoms have been a common feature as has myocarditis with raised troponin and proBNP. Some patients have an coronary arteries with appearance consistent with Kawasaki Disease.
- MIS-C Case Series and Reviews
- Aronoff SC, et al. The Natural History of SARS-Cov-2 Related Multisystem Inflammatory Syndrome in Children (MIS-C): A Systematic Review. J Pediatric Infect Dis Soc. Sep 2020. (Systematic Review)
- De Souza TH, et al. Clinical Manifestations of Children with COVID-19: a Systematic Review. Pediatr Pulmonol. Jun 2020. (Systematic Review)
- Feldstein L, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. Jun 2020. (186 Cases)
- Dufort EM, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. Jun 2020. (99 Cases)
- Whittaker E, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. Jun 2020. (58 Cases)
- Miller J, et al. Gastrointestinal Symptoms as a Major Presentation Component of a Novel Multisystem Inflammatory Syndrome in Children (MIS-C) that is Related to COVID-19: A Single Center Experience of 44 Cases. Gastroenterology. Jun 2020. (44 Cases)
- Belhadjer Z, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children (MIS-C) in the Context of Global SARS-CoV-2 Pandemic. Circulation. May 17 2020. (35 Cases)
- Toubiana J, et al. Kawasaki-Like Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic in Paris, France: Prospective Observational Study. BMJ. Jun 2020. (21 Cases)
- Cheung EW, et al. Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City. JAMA. Jun 2020. (17 Cases)
- Verdoni L, et al. An Outbreak of Severe Kawasaki-like Disease at the Italian Epicentre of the SARS-CoV-2 Epidemic: An Observational Cohort Study. Lancet. May 13, 2020. (10 Cases)
- Riphagen S, et al. Hyperinflammatory Shock in Children During COVID-19 Pandemic. Lancet. May 7 2020. (8 Cases)
- Chiotos K, et al. Multisystem Inflammatory Syndrome in Children during the COVID-19 pandemic: a case series. J Pediatric Infect Dis Soc. May 28 2020. (6 Cases)
- Tiwari L, et al. COVID-19 Associated Arterial Ischaemic Stroke and Multisystem Inflammatory Syndrome in Children: A Case Report. Lancet Child Adolesc Health. Oct 2020. (Case Report)
- Dolinger MT, et al. Pediatric Crohn’s Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Treated with Infliximab. J Pediatr Gastroenterol Nutr. May 22 2020. (Case Report)
- Deza leon MP, et al. COVID-19 Associated Pediatric Multi-System Inflammatory Syndrome. J Pediatric Infect Dis Soc. May 22 2020. (Case Report)
- Jones VG, et al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hosp Pediatr. Apr 7 2020. (Case Report)
- Rauf A, et al. Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during COVID-19 Pandemic. Indian J Pediatr. May 28, 2020. (Case Report)
- MIS-C Research
Age-dependent ACE2 Expression in Nasal Epithelium May Explain the Lower Prevalence of Pediatric Infections
Children with COVID-19 May Present with Neurological Symptoms and Splenial Changes on Imaging
Pediatric COVID-19 Case Series
- COVID-19 in Children: Initial Characterization of the Pediatric Disease
- A Clinical Pathway for Hospitalized Pediatric Patients With Initial SARS-CoV-2 Infection
- A Significant Portion of Pediatric COVID-19 Patients Appear to Develop Conjunctivitis