Infectious Disease

An inflammatory response to COVID-19 an infection in kids can have an effect on the resume and different techniques

March 10, 2021

4 min read

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Thacker does not report any relevant financial information.

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Hospitals in the United States and the CDC have reported an increasing incidence of multisystem inflammatory syndrome in children following COVID-19 infection.

According to the CDC, multisystem inflammatory syndrome in children (MIS-C) is a disease in which organs and systems such as the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs can become inflamed.

Deepika Thacker, MD, Pediatric Cardiologist at Nemours / Alfred I. duPont Children’s Hospital in Wilmington, Delaware.

Healio spoke to Deepika Thacker, MD, Pediatric Cardiologist at Nemours / Alfred I. duPont Children’s Hospital in Wilmington, Delaware, on the rising incidence of MIS-C and what clinicians and parents need to look out for.

Healio: How common is MIS-C in this patient population?

Thacker: MIS-C is still pretty rare. The CDC regularly updates its website with ongoing data from the reporting requirements of all states. As of February 8, the CDC had reported a total of 2,060 cases nationwide. The number can lag behind as it takes us a few weeks, even at Nemours, to get all the necessary data out. You will see a higher number when we do the final settlement.

The prevalence of MIS-C isn’t particularly high considering that approximately 3.1 million US children have been diagnosed with COVID-19.

Healio: What is the underlying mechanism behind MIS-C in children with COVID-19?

Thacker: Children’s immune systems react differently to different viruses and bacteria. There are several other conditions that follow a similar pattern in children. One of them, Kawasaki disease, is a condition that involves inflammation of the coronary arteries and that typically occurs in children under 5 years of age.

There is another disease that has been around for much longer, namely rheumatic fever, which is caused by the body’s immune response, which attacks its own tissues after a strep infection. The streptococcus shares some antigens with the body and the body’s immune response, and then attacks the cells of the person’s body itself, such as the heart, joints, and skin. There is likely a similar mechanism in COVID-19. The body tries to develop an immune response to a foreign virus, attacking some of the host’s own tissue, leading to this syndrome.

Healio: Is there a trend in patients with COVID-19 as to which systems are being attacked?

Thacker: Yes there are many. The pattern is a little different from what we saw under the other conditions I mentioned. One of the most commonly attacked systems is the gastrointestinal system. Many of these children experience abdominal pain, vomiting, and diarrhea. Some of them have features that mimic appendicitis very closely. One of our children presented to an external hospital after an appendix removal and found after the operation that the appendix was normal and the child continued to clinically deteriorate. They transported the child to us for further administration. The child was diagnosed and treated for MIS-C and was fine.

The other affected and most worrying organ is the heart. More than half of these children with MIS-C have a heart involved. Heart function may be impaired and the coronary arteries may be slightly enlarged.

Other features that we see often are less of a concern, such as conjunctivitis. The eyes and mouth may appear red; there may be a rash on the body; Some children experience irritability and headaches. and a smaller number with impaired kidney function. Some of our children had to be treated for kidney function but have recovered.

Healio: Are there common risk factors in these children?

Thacker: From data across the country reflecting what we’re also seeing, nearly 60% to 70% of these children are from ethnic minority groups: Hispanic and non-Hispanic black populations. The more severe MIS-C cases we saw at Nemours had occurred in children over 10 years of age. However, we have seen the condition in all age groups. Our youngest patients were 4 months old and our oldest were 18 years old. MIS-C was also more severe in boys than in girls.

Healio: What is your facility doing to care for these patients?

Thacker: We identified our first case of COVID-19-related MIS-C in April 2020 before it was reported by the CDC or other centers across the country. We have teamed up with specialists from various departments such as rheumatology, infectious diseases, intensive care, cardiology and ED and put together management protocols. We have created order sets and training courses for our employees. We focus on training other clinicians as well as the community. We have gone to great lengths to educate not only pediatricians but parents about COVID-19 related MIS-C and we are heavily involved in the research of why it happens, in whom it happens, and what we can do about it to prevent it. We identified best practices for managing MIS-C, all of our children did well, and we arranged outpatient follow-up visits for them.

Healio: Should other hospital systems step up screening for COVID-19-related MIS-C?

Thacker: I think you already have it. In the Delaware Valley, we have held discussions, held large rounds and communicated with other institutions, and they are stepping up their screening efforts. Pediatricians are now aware and we have made a lot of contact, but we need to create more public awareness as this is a condition that usually occurs 2 to 6 weeks after the first COVID-19 infection. It is usually not part of the initial diagnosis. Many of our children are asymptomatic or have a mild COVID-19 infection. Some didn’t know they had COVID-19 but their family members were exposed and 4 weeks later the child showed symptoms of MIS-C.

The constant vigilance of the family is especially important in this window. If a child is diagnosed with COVID-19 after 2 to 6 weeks, the fever should be taken more seriously, especially if there is a rash, conjunctivitis, or abdominal symptoms. At this point, they should seek a visit to their pediatrician.

Healio: Is there anything else you would like to add?

Thacker: The best way to prevent MIS-C or MIS-C complications is to prevent COVID-19. The focus is again on masking, social distancing, hand hygiene, and quarantine when appropriate for someone with COVID-19 or in close contact. If the vaccines are available, get yourself vaccinated. I know we don’t have one for kids, but if we can protect the adults in the community, the kids are less likely to get it, which MIS-C would also prevent.

References:

For more informations:

Deepika Thacker, MDcan be reached at dthacker@nemours.org.

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