Materiały źródłowe

• #1 Multisystem Inflammatory Syndrome in Children (MIS-C) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/mis-c

  Multisystem inflammatory syndrome in children (MIS-C), also called pediatric multi-system inflammatory syndrome temporally related to SARS CoV-2 (PMIS or PIMS-TS), is a potentially serious illness in children that appears to be a delayed, post-infectious complication of COVID-19 infection. […] If you think your child might have MIS-C, consult with your primary care provider or bring your child to the Emergency Department. Blood tests may be recommended, depending on your child’s symptoms. […] While Boston Children’s Hospital and other medical centers are still actively collecting data on MIS-C, it seems so far to be rare. […] Symptoms of MIS-C may vary from child to child. The main symptoms to watch for are a persistent fever (lasting more than 24 hours and usually present for several days), your child appearing fatigued and ill, rash, red eyes, abdominal pain, vomiting, diarrhea, or loss of appetite or not drinking enough fluids.

• #2 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/symptoms-causes/syc-20502550

  Multisystem inflammatory syndrome in children (MIS-C) is a group of symptoms linked to swollen, called inflamed, organs or tissues. […] MIS-C is currently linked to coronavirus disease 2019 (COVID-19). […] Most children who catch the COVID-19 virus have only a mild illness. But in children with MIS-C, after infection with the COVID-19 virus, the blood vessels, digestive system, skin or eyes become swollen and irritated. […] MIS-C is rare. It most often happens within 2 months after having COVID-19. […] Most children who have MIS-C eventually get better with medical care. […] The symptoms of MIS-C are serious and are treated in the hospital. […] Health care professionals may diagnose MIS-C if a child: Either had COVID-19 or has a close contact who had COVID-19 in the 2 months before hospitalization.

• #3 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Hospital of Philadelphia

  https://pathways.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway

  MIS-C occurs approximately 2-6 wks after the initial SARS-CoV-2 infection. […] Review the following clinical and laboratory criteria when there is concern for diagnosis of MIS-C. […] When the disease is suspected, consult local experts in rheumatology, infectious disease, and cardiology to guide laboratory testing, diagnosis, and treatment. […] Meeting a case definition is not equivalent to diagnostic criteria. The MIS-C case definition may be less predictive of an MIS-C diagnosis currently since the prevalence of MIS-C is thought to be extremely low. […] Illness characterized by all of the following, in the absence of a more likely alternative diagnosis: Subjective or documented fever, T 38.0C. […] Clinical severity requiring hospitalization or resulting in death. […] Evidence of systemic inflammation indicated by CRP 3.0 mg/dL.

• #4 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 26 weeks. The median age of patients with MIS-C is 611 years. Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] The mortality rate is 13%. Management and prognosis of MIS-C are similar to that of Kawasaki disease (KD). MIS-C and KD may share a common pathogenic process. […] There is not a universally accepted case definition for MIS-C. The most commonly adopted case definitions are those proposed by CDC and by WHO. […] Major differences between the 2 definitions include age (19 years for WHO vs. 20 years for CDC), duration of fever (3 days for WHO vs. 1 day for CDC), requiring hospitalization for CDC and more extensive and specific laboratory criteria for the CDC definition.

• #5 Multisystem Inflammatory Syndrome in Children (MIS-C) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/multisystem-inflammatory-syndrome-in-children-mis-c

  MIS-C is a serious though rare condition in children in which the body’s own immune system overreacts to a SARS-CoV-2 infection, resulting in inflammation of multiple organ systems throughout the body. […] MIS-C shows similarities to other known inflammatory disorders, including Kawasaki disease and toxic shock syndrome. […] According to Centers for Disease Control and Prevention (CDC), as of May 2021, there have been over 3,700 cases of MIS-C in the United States, which has resulted in 35 deaths. […] MIS-C can occur in children with no known underlying health conditions, though children who are overweight or obese may be at slightly elevated risk for developing the syndrome. […] Although the cause of MIS-C is not yet known, it is considered to be a late immune response to SARS-CoV-2 infection.

• #6 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.123 […] Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).123 […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.124 […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.5

• #7 Multisystem Inflammatory Syndrome In Children (MIS-C) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24592-multisystem-inflammatory-syndrome-in-children

  Multisystem inflammatory syndrome in children (MIS-C) is a rare side effect of COVID-19. It causes inflammation in several parts of your child’s body. MIS-C can be life-threatening if symptoms are severe, so contact a healthcare provider if your child has signs of it. Treatment takes place in a hospital. Most children make a full recovery. […] A healthcare provider will diagnose MIS-C in your child after a physical exam and testing. They’ll review your child’s symptoms and ask you questions about how long they’ve had a fever and if and when they tested positive for COVID-19. If your child actively has COVID-19, tell their care team immediately. […] Treatment for MIS-C may include: Receiving fluids from an IV (a needle placed into a vein in your child’s arm). Taking medications (oral or IV) to reduce inflammation (corticosteroids, immune globulin IVIG and glucocorticoids). Antiviral therapy (remdesivir) to treat COVID-19 if your child has an active infection. Receiving oxygen from an assisted breathing device (ventilator).

• #8 Multisystem Inflammatory Syndrome in Children (MIS-C) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/multisystem-inflammatory-syndrome-in-children-mis-c

  In nearly all known cases, children with MIS-C have had a fever of 100.4F or higher for at least 24 hours. […] There is no diagnostic test for MIS-C. Doctors instead diagnose the condition by assessing the child’s history, conducting a physical examination, and evaluating a series of lab tests. […] The hallmark of MIS-C is widespread inflammation across multiple organ systems. […] Treatment typically includes supportive care, which means that the focus is on relieving symptoms and preventing complications while the patient recovers. […] Though MIS-C is a serious condition that usually requires hospitalization, with prompt medical attention, the vast majority of children with it recover.

• #9 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  A significant proportion of the reported MIS-C cases could not fulfil the diagnostic criteria for MIS-C. […] The incidence of MIS-C is higher in children living in socioeconomically deprived condition. […] The median age of patients with MIS-C is 611 years. […] Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] According to the case definition, fever is present in 100% of patients and usually lasts for 17 days. […] The gastrointestinal system is the most commonly involved organ system. Vomiting, diarrhea and abdominal pain are reported in over 50% of patients. […] More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. […] The prognosis of MIS-C is generally good. Most cases show resolution of inflammation and related symptoms within 14 weeks after the onset of illness. […] Reported mortality rate ranged between 1% and 3%, slightly higher than that for Kawasaki disease with current treatment recommendations.

• #10 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection 2023 Case Definition | CDC

  https://ndc.services.cdc.gov/case-definitions/multisystem-inflammatory-syndrome-in-children-mis-c-2023/

  Mortality among MIS-C patients has been estimated to be 12%. […] Comparative cohort studies of MIS-C and acute pediatric COVID-19 have suggested that mucocutaneous, cardiovascular, and hematologic organ system involvement, as well as the presence of abdominal pain, vomiting, or diarrhea are features that raise the likelihood of a diagnosis of MIS-C. […] However, the prevalence of renal and neurologic involvement appears to be similar in MIS-C and COVID-19. […] Further, respiratory organ system involvement is more common in COVID-19 than in MIS-C and its inclusion in the MIS-C case definition may contribute to misclassification. […] Position statement 22-ID-02 establishes a standardized case definition for MIS-C associated with SARS-CoV-2 infection for state, local, territorial, and tribal public health departments to use for routine or targeted surveillance.

• #11 MIS-C Diagnosis and Treatment | Children’s Hospital Los Angeles

  https://www.chla.org/heart-institute/diagnostic-services-and-treatments/mis-c-diagnosis-and-treatment

  Multisystem inflammatory syndrome in children, or MIS-C, is a rare but serious condition that appears to be related to COVID-19. […] There is no single test that can diagnose MIS-C. Instead, doctors use a combination of tests that check for inflammation and rule out other health conditions. […] Doctors collect blood or urine samples and send them to our in-house laboratory. These samples can reveal signs of inflammation in the body. […] Since the beginning of the coronavirus pandemic, CHLA has provided rapid, in-house testing for COVID-19. […] MIS-C can affect the heart, so doctors may use an echocardiogram (echo) to check your child’s heart function. […] An electrocardiogram (EKG) is a noninvasive test that measures the heart’s electrical activity. […] Our pediatric specialists may perform a physical exam to look for symptoms of MIS-C.

• #12 Multisystem Inflammatory Syndrome In Children (MIS-C) – MN Dept. of Health

  https://www.health.state.mn.us/diseases/misc/index.html

  MIS-C stands for multisystem inflammatory syndrome in children, a rare and serious inflammatory syndrome that affects children and young adults. […] There is no specific test to diagnosis MIS-C. The diagnosis is made using a combination of signs and symptoms along with blood tests. […] The Council of State and Territorial Epidemiologists (CSTE) and CDC have developed a standardized surveillance case definition for multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection, effective January 1, 2023.

• #13 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 26 weeks. The median age of patients with MIS-C is 611 years. Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] The mortality rate is 13%. Management and prognosis of MIS-C are similar to that of Kawasaki disease (KD). MIS-C and KD may share a common pathogenic process. […] There is not a universally accepted case definition for MIS-C. The most commonly adopted case definitions are those proposed by CDC and by WHO. […] Major differences between the 2 definitions include age (19 years for WHO vs. 20 years for CDC), duration of fever (3 days for WHO vs. 1 day for CDC), requiring hospitalization for CDC and more extensive and specific laboratory criteria for the CDC definition.

• #14 Multisystem Inflammatory Syndrome in Children (MIS-C) | IntechOpen

  https://www.intechopen.com/chapters/86668

  Clinical and laboratory criteria were developed to have suspicion and early diagnosis. These recommendations were initially published by WHO and the Centers of Disease Control and Prevention (CDC) and then massified by countless guidelines of pediatric scientific societies and health services throughout the world. […] MIS-C is rare; however, it is a differential diagnosis that should be taken into account in pediatric patients, while there is circulation of SARS-CoV-2 in the world. This diagnostic suspicion should be greater in any country with temporary peaks of infection and mainly in countries with low vaccination rates where high viral circulation can cause an increase in the presence of new variants. […] The CDC or WHO criteria are the most commonly used case definition. Regardless of the institution that defines the case, all definitions have some pillars to make the diagnosis. The first is a pediatric patient with fever. The second is to have inflammation of at least two systems, by clinical presentation or by laboratory test. The third is to have altered laboratory parameters that show a systemic and generalized process of inflammation. The fourth is to have ruled out any infection that is not COVID and finally any epidemiological association with SARS-CoV2 infection.

• #15 Multisystem Inflammatory Syndrome in Children (MIS-C) – HAN

  https://www.chicagohan.org/covid-19/mis-c

  In suspected cases of MIS-C, strongly recommend the following additional laboratory testing due to the potential for myocardial involvement: BNP and Troponin. […] It is important to evaluate children with suspected MIS-C for alternative diagnoses particularly as MIS-C clinical manifestations overlap with those of other etiologies. […] CDC Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C) Any illness in a person aged less than 21 years that meets: The clinical AND the laboratory criteria (Confirmed), OR The clinical criteria AND epidemiologic linkage criteria (Probable), OR The vital records criteria (Suspect). […] An illness characterized by all of the following, in the absence of a more likely alternative diagnosis: Subjective or documented fever (temperature 38.0 C), Clinical severity requiring hospitalization or resulting in death, Evidence of systemic inflammation indicated by C-reactive protein 3.0 mg/dL (30 mg/L).

• #16 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection 2023 Case Definition | CDC

  https://ndc.services.cdc.gov/case-definitions/multisystem-inflammatory-syndrome-in-children-mis-c-2023/

  Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a severe delayed hyperinflammatory condition in children and adolescents occurring 26 weeks after antecedent SARS-CoV-2 infection. […] Associated MIS-C is characterized by fever, elevated laboratory markers of systemic inflammation, and multiple organ system dysfunction including cardiovascular, mucocutaneous, gastrointestinal, hematologic, neurologic, and renal involvement. […] Some patients with MIS-C may also present with respiratory failure or radiographic pulmonary abnormalities indicative of pulmonary inflammation, a phenotypic overlap with Coronavirus Disease 2019 (COVID-19) viral pneumonia, or cardiogenic pulmonary edema. […] Patients with MIS-C are often critically ill, with the majority requiring admission to an intensive care unit (ICU) and 13% requiring extracorporeal membrane oxygenation (ECMO).

• #17 Multisystem inflammatory syndrome in children – WikEM

  https://wikem.org/wiki/Multisystem_inflammatory_syndrome_in_children

  In April 2020 during the SARS-CoV-2 outbreak UK pediatricians alerted the National Health Service of a new systemic inflammatory condition similar to Kawasaki disease in children testing positive for the virus. […] Patients with MIS-C are significantly more likely to present with dyspnea, vomiting, diarrhea, lymphopenia, and elevated LDH and D-dimer compared to patients with COVID-19 without MIS-C. […] An individual aged 21 years presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem 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. […] AND Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin. […] AND Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.

• #18 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  https://ceufast.com/course/multisystem-inflammatory-syndrome-in-children-mis-c-associated-with-covid-19

  92% of participants will know how to identify MIS-C. […] Define diagnostic criteria for MIS-C. […] To diagnose MIS-C, the CDC provides specific clinical criteria. […] Clinical criteria for MIS-C as defined by the CDC include (CDC, 2023): Age 21 years, Fever for 1 day, Multisystem organ involvement, Laboratory evidence of inflammation, Clinical severity requiring hospitalization, Positive SARS-CoV-2 antigen/antibody test and/or evidence of COVID-19 exposure within 4 weeks of the onset of symptoms. […] When diagnosing MIS-C, it must be differentiated from other systemic inflammatory disorders and infections that include (Lee Hsueh, 2023; Rabb Kimmel, 2023; Childrens Minnesota, 2024): Kawasaki Disease, Viral infections, Stevens-Johnson Syndrome, Toxic shock syndrome, Systemic juvenile idiopathic arthritis, Bacterial sepsis. […] The most reliable evidence for a diagnosis of MIS-C is a recent infection with SARS-CoV-2 (La Torre et al., 2023; Lee Hsueh, 2023).

• #19 Multisystem Inflammatory Syndrome in Children (MIS-C) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/mis-c

  Multisystem inflammatory syndrome in children (MIS-C), also called pediatric multi-system inflammatory syndrome temporally related to SARS CoV-2 (PMIS or PIMS-TS), is a potentially serious illness in children that appears to be a delayed, post-infectious complication of COVID-19 infection. […] If you think your child might have MIS-C, consult with your primary care provider or bring your child to the Emergency Department. Blood tests may be recommended, depending on your child’s symptoms. […] While Boston Children’s Hospital and other medical centers are still actively collecting data on MIS-C, it seems so far to be rare. […] Symptoms of MIS-C may vary from child to child. The main symptoms to watch for are a persistent fever (lasting more than 24 hours and usually present for several days), your child appearing fatigued and ill, rash, red eyes, abdominal pain, vomiting, diarrhea, or loss of appetite or not drinking enough fluids.

• #20 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.123 […] Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).123 […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.124 […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.5

• #21 Multisystem Inflammatory Syndrome in Children (MIS-C) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/multisystem-inflammatory-syndrome-in-children-mis-c

  In nearly all known cases, children with MIS-C have had a fever of 100.4F or higher for at least 24 hours. […] There is no diagnostic test for MIS-C. Doctors instead diagnose the condition by assessing the child’s history, conducting a physical examination, and evaluating a series of lab tests. […] The hallmark of MIS-C is widespread inflammation across multiple organ systems. […] Treatment typically includes supportive care, which means that the focus is on relieving symptoms and preventing complications while the patient recovers. […] Though MIS-C is a serious condition that usually requires hospitalization, with prompt medical attention, the vast majority of children with it recover.

• #22 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.123 […] Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).123 […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.124 […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.5

• #23 Multisystem inflammatory syndrome in children – Wikipedia

  https://en.wikipedia.org/wiki/Multisystem_inflammatory_syndrome_in_children

  All affected children have persistent fever. Other clinical features vary. The first symptoms often include acute abdominal pain with diarrhea or vomiting. Muscle pain and general fatigue are frequent, and low blood pressure is also common. Symptoms can also include pink eye, rashes, enlarged lymph nodes, swollen hands and feet, and „strawberry tongue”. Various mental disturbances are possible. A cytokine storm may take place, in which the child’s innate immune system stages an excessive and uncontrolled inflammatory response. Heart failure is common. Clinical complications can include damage to the heart muscle, respiratory distress, acute kidney injury, and increased blood coagulation. Coronary artery abnormalities can develop (ranging from dilatation to aneurysms). […] This life-threatening disease has proved fatal in under 2% of reported cases. Early recognition and prompt specialist attention are essential. Anti-inflammatory treatments have been used, with good responses being recorded for intravenous immunoglobulin (IVIG), with or without corticosteroids. Oxygen is often needed. Supportive care is key for treating clinical complications. Most children who receive expert hospital care survive.

• #24 multisystem inflammatory syndrome (MIS-C) | Dayton Children’s Hospital

  https://www.childrensdayton.org/multisystem-inflammatory-syndrome-mis-c

  MIS-C can present itself in different ways, and can copycat other conditions such as Kawasaki disease, toxic shock syndrome or macrophage activation syndrome. […] If a doctor suspects MIS-C, they will run testing to look for inflammation in the body. These tests may include: Blood and urine tests, COVID-19 testing and antibody testing, Chest X-ray, Testing to look at the heart including electrocardiogram (ECG) and echocardiogram (ultrasound of the heart), Abdominal ultrasound.

• #25 Multisystem Inflammatory Syndrome in Children (MIS-C) | IntechOpen

  https://www.intechopen.com/chapters/86668

  Because it is a disease that can have many clinical presentations, there are many possible differential diagnoses but there are some of them that are essential to rule out. In many cases, the disease simulates sepsis or septic shock, both by its clinical presentation or by laboratory tests in ranges that simulate bacterial infection. The main difference is that in MIS-C there is no bacterial infectious focus and that no infectious agent is isolated. The association with SARS-CoV-2 as the only infectious agent it is absolutely necessary.

• #26 Multisystem Inflammatory Syndrome In Children (MIS-C) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24592-multisystem-inflammatory-syndrome-in-children

  Multisystem inflammatory syndrome in children (MIS-C) is a rare side effect of COVID-19. It causes inflammation in several parts of your child’s body. MIS-C can be life-threatening if symptoms are severe, so contact a healthcare provider if your child has signs of it. Treatment takes place in a hospital. Most children make a full recovery. […] A healthcare provider will diagnose MIS-C in your child after a physical exam and testing. They’ll review your child’s symptoms and ask you questions about how long they’ve had a fever and if and when they tested positive for COVID-19. If your child actively has COVID-19, tell their care team immediately. […] Treatment for MIS-C may include: Receiving fluids from an IV (a needle placed into a vein in your child’s arm). Taking medications (oral or IV) to reduce inflammation (corticosteroids, immune globulin IVIG and glucocorticoids). Antiviral therapy (remdesivir) to treat COVID-19 if your child has an active infection. Receiving oxygen from an assisted breathing device (ventilator).

• #27 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.123 […] Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).123 […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.124 […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.5

• #28 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  A significant proportion of the reported MIS-C cases could not fulfil the diagnostic criteria for MIS-C. […] The incidence of MIS-C is higher in children living in socioeconomically deprived condition. […] The median age of patients with MIS-C is 611 years. […] Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] According to the case definition, fever is present in 100% of patients and usually lasts for 17 days. […] The gastrointestinal system is the most commonly involved organ system. Vomiting, diarrhea and abdominal pain are reported in over 50% of patients. […] More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. […] The prognosis of MIS-C is generally good. Most cases show resolution of inflammation and related symptoms within 14 weeks after the onset of illness. […] Reported mortality rate ranged between 1% and 3%, slightly higher than that for Kawasaki disease with current treatment recommendations.

• #29 A systematic review on Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Development of a scoring system for clinical diagnosis | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.04.23.21255879.full

  We observed that cardiac dysfunctions are very common in the MIS-C group as compared to non-MIS-C group. […] Our study revealed that the traditional inflammatory markers such as raised ESR, CRP, IL-6 and Procalcitonin are observed in children with MIS-C. […] Children with COVID-19 and MIS-C required aggressive management strategies. […] The recovery rate was higher in the non-MIS-C group and overall mortality was only 1.8%, while the mortality was almost 10% in children with MIS-C. […] The clinical spectrum of MIS-C appears to differ from typical Kawasaki presentation reiterating that MIS-C could be a peculiar phenomenon of COVID-19. […] The information generated in this review should act as a primer to consider MIS-C as a distinct presentation of COVID-19 in pediatric age groups.

• #30 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.123 […] Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).123 […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.124 […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.5

• #31 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  A significant proportion of the reported MIS-C cases could not fulfil the diagnostic criteria for MIS-C. […] The incidence of MIS-C is higher in children living in socioeconomically deprived condition. […] The median age of patients with MIS-C is 611 years. […] Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] According to the case definition, fever is present in 100% of patients and usually lasts for 17 days. […] The gastrointestinal system is the most commonly involved organ system. Vomiting, diarrhea and abdominal pain are reported in over 50% of patients. […] More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. […] The prognosis of MIS-C is generally good. Most cases show resolution of inflammation and related symptoms within 14 weeks after the onset of illness. […] Reported mortality rate ranged between 1% and 3%, slightly higher than that for Kawasaki disease with current treatment recommendations.

• #32 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Patients with MIS-C usually present with fever and some combination of abdominal pain, vomiting, diarrhea, skin rash, and mucocutaneous lesions (i.e., conjunctivitis). In severe cases, children can present with hypotension and shock.123 […] Patients with MIS-C have elevated laboratory markers of inflammation (e.g., C-reactive protein, ferritin); many have laboratory markers indicating damage to the heart (e.g., elevated troponin), and many have low platelet or absolute lymphocyte counts (thrombocytopenia and lymphopenia, respectively).123 […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm.124 […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.5

• #33 Kawasaki Disease and Multisystem Inflammatory Syndrome in Children: An Overview and Comparison | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0900/p244.html

  The Centers for Disease Control and Prevention case definition of MIS-C is presented in Table 3. […] A recent systematic review reported that 36% of patients with MIS-C had symptoms consistent with KD (6% with classic KD and 30% with incomplete KD). […] Diagnostic workup for children with suspected MIS-C should include complete blood count, complete metabolic panel, erythrocyte sedimentation rate, C-reactive protein, and SARS-CoV-2 polymerase chain reaction and/or serologies. […] Treatment for MIS-C is a topic of ongoing research and is based largely on expert opinion and therapies used in KD and other childhood inflammatory conditions.

• #34 Multisystem Inflammatory Syndrome in Children (MIS-C) | Department of Health

  https://coronavirus.health.ny.gov/multisystem-inflammatory-syndrome-children-mis-c

  MIS-C is a rare condition that sometimes occurs in children who have had COVID-19 infection. Symptoms of MIS-C typically develop two or more weeks following infection with COVID-19 and involves inflammation of different parts of the body, such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal system. What causes some children to develop MIS-C is not known. MIS-C can be serious or even deadly, but most children recover with medical care. […] Of the children confirmed as MIS-C cases, 93 percent tested positive for COVID-19 either by diagnostic tests (PCR or antigen), antibody tests or both. […] Early recognition by pediatricians and referral to a specialist including to critical care are essential. […] The MIS-C case definition includes clinical, general/virologic laboratory, and epidemiological criteria.

• #35 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Hospital of Philadelphia

  https://pathways.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway

  New onset manifestations in at least two of the following categories: Cardiac involvement indicated by Left ventricular ejection fraction 55% or Coronary artery dilation or aneurysm or Elevated troponin level. […] Detection of SARS-CoV-2 RNA in a clinical specimen up to 60 days prior to or during hospitalization or in a post-mortem specimen using a diagnostic molecular amplification test. […] Detection of SARS-CoV-2 specific antigen in a clinical specimen up to 60 days prior to or during hospitalization or in a post-mortem specimen. […] Detection of SARS-CoV-2 specific antibodies in serum, plasma or whole blood associated with current illness resulting in or during hospitalization. […] Close contact with a confirmed or probable case of COVID-19 disease in the 60 days prior to hospitalization.

• #36 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20492798/

  Multisystem inflammatory syndrome in children (MIS-C) diagnosis is based on a childs symptoms and on ruling out similar conditions. Lab tests can help this process. […] Providers rule out active cases of COVID-19 by testing for the virus with a swab of the nose. They also may swab the back of the throat. Providers also use blood tests to rule out inflammatory conditions such as Kawasaki disease, sepsis or toxic shock syndrome. […] Many children with MIS-C test negative for a current infection with the COVID-19 virus. But proof of a prior infection can be gathered from an antibody test if a child had COVID-19 but didnt have any symptoms. It also can be collected by noting infections among a childs close contacts. Most kids who get MIS-C have a link to the virus that causes COVID-19 within 2 months of getting sick.

• #37 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/multisystem-inflammatory-syndrome-children-mis-c-and-covid-19

  Multisystem inflammatory syndrome in children (MIS-C) diagnosis is based on a child’s symptoms and on ruling out similar conditions. Lab tests can help this process. […] Providers rule out active cases of COVID-19 by testing for the virus with a swab of the nose. They also may swab the back of the throat. Providers also use blood tests to rule out inflammatory conditions such as Kawasaki disease, sepsis or toxic shock syndrome. […] Many children with MIS-C test negative for a current infection with the COVID-19 virus. But proof of a prior infection can be gathered from an antibody test if a child had COVID-19 but didn’t have any symptoms. It also can be collected by noting infections among a child’s close contacts. Most kids who get MIS-C have a link to the virus that causes COVID-19 within 2 months of getting sick.

• #38 MIS-C Diagnosis and Treatment | Children’s Hospital Los Angeles

  https://www.chla.org/heart-institute/diagnostic-services-and-treatments/mis-c-diagnosis-and-treatment

  Multisystem inflammatory syndrome in children, or MIS-C, is a rare but serious condition that appears to be related to COVID-19. […] There is no single test that can diagnose MIS-C. Instead, doctors use a combination of tests that check for inflammation and rule out other health conditions. […] Doctors collect blood or urine samples and send them to our in-house laboratory. These samples can reveal signs of inflammation in the body. […] Since the beginning of the coronavirus pandemic, CHLA has provided rapid, in-house testing for COVID-19. […] MIS-C can affect the heart, so doctors may use an echocardiogram (echo) to check your child’s heart function. […] An electrocardiogram (EKG) is a noninvasive test that measures the heart’s electrical activity. […] Our pediatric specialists may perform a physical exam to look for symptoms of MIS-C.

• #39 MIS-C and COVID-19 in Children | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/mis-c-covid-19-in-children/

  Most experts think that MIS-C is caused by the immune system reacting to having had an infection with SARS-CoV-2, the coronavirus that causes COVID-19. […] As the name implies, MIS-C affects children and adolescents under 21 years old. […] Most kids and teens diagnosed with MIS-C had mild symptoms of COVID-19 or were asymptomatic, meaning they had no symptoms at all. […] Yes. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care. […] Doctors may do certain tests to look for signs of inflammation or other health problems. These tests could include: Blood tests, Chest X-ray, Heart ultrasound (echocardiogram), Abdominal imaging, like an ultrasound or computed tomography (CT) scan. […] Doctors may provide supportive care for symptoms (medicine and/or fluids to make your child feel better) and may use immune globulin (IVIG), infliximab, steroids or other medications that strengthen the immune system that are used for Kawasaki disease and toxic shock syndrome.

• #40 MIS-C Diagnosis and Treatment | Children’s Hospital Los Angeles

  https://www.chla.org/heart-institute/diagnostic-services-and-treatments/mis-c-diagnosis-and-treatment

  Multisystem inflammatory syndrome in children, or MIS-C, is a rare but serious condition that appears to be related to COVID-19. […] There is no single test that can diagnose MIS-C. Instead, doctors use a combination of tests that check for inflammation and rule out other health conditions. […] Doctors collect blood or urine samples and send them to our in-house laboratory. These samples can reveal signs of inflammation in the body. […] Since the beginning of the coronavirus pandemic, CHLA has provided rapid, in-house testing for COVID-19. […] MIS-C can affect the heart, so doctors may use an echocardiogram (echo) to check your child’s heart function. […] An electrocardiogram (EKG) is a noninvasive test that measures the heart’s electrical activity. […] Our pediatric specialists may perform a physical exam to look for symptoms of MIS-C.

• #41 Multisystem Inflammatory Syndrome: Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/pediatrics/rheumatology/multisystem-inflammatory-syndrome-mis-c/treatment

  How is MIS-C Diagnosed? […] MIS-C is diagnosed through a variety of lab and imaging tests. Depending on what symptoms are present, tests may include: […] Antibody test for COVID-19 virus to find out if the child has or had the COVID-19 virus infection. […] Lab tests: Blood test, Urine test. […] Imaging tests: Chest x-ray, Heart ultrasound (echocardiogram), Abdominal ultrasound. […] Children who have MIS-C are treated in the hospital where doctors can continuously monitor their condition. […] MIS-C treatment should begin as soon as possible to reduce recovery time and the risk of complications. […] At the hospital, medications may be used to treat inflammation and prevent damage to the heart, kidneys, and other organs. […] Medications may include intravenous immunoglobulin, steroids and other anti-inflammatory drugs.

• #42 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20492798/

  Providers also may order tests to look for inflammation and other signs of MIS-C: […] Lab tests, such as blood and urine tests, including tests for the level of an inflammatory protein in the blood. […] Imaging tests, such as a chest X-ray, an echocardiogram, an abdominal ultrasound or a CT scan. […] Other tests, depending on symptoms.

• #43

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/multisystem-inflammatory-syndrome-in-children-mis-c-and-covid-19

  Providers also may order tests to look for inflammation and other signs of MIS-C: Lab tests, such as blood and urine tests, including tests for the level of an inflammatory protein in the blood. Imaging tests, such as a chest X-ray, an echocardiogram, an abdominal ultrasound or a CT scan. Other tests, depending on symptoms.

• #44 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20492798/

  Providers also may order tests to look for inflammation and other signs of MIS-C: […] Lab tests, such as blood and urine tests, including tests for the level of an inflammatory protein in the blood. […] Imaging tests, such as a chest X-ray, an echocardiogram, an abdominal ultrasound or a CT scan. […] Other tests, depending on symptoms.

• #45 First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00243-5

  Children with multisystem inflammatory syndrome (MIS-C) tend to develop a clinical condition of fluid overload due both to contractile cardiac pump deficit and to endotheliitis with subsequent capillary leak syndrome. […] We suggest PoCUS as a useful tool in the first evaluation of children with suspected MIS-C for the initial therapeutic management and the following monitoring of possible cardiovascular deterioration. […] The diagnosis of MIS-C at admission to the ED is presumptive. […] PoCUS showed pathological findings in 11/11 (100%). According to RUSH protocol, cardiac hypokinesis was detected in 5/11 (45%) and inferior vena cava dilatation in 3/11 (27%). […] In our case-series, PoCUS was performed in 11 children with MIS-C within 24 h from hospitalization. […] However, the development of cardiac injury in all children during hospitalization (median NT-pro BNP level of more than 8500 ng/l) is consistent with the already reported clinical instability of MIS-C patients, who are at risk for sudden cardiovascular worsening.

• #46 Multisystem inflammatory syndrome in children – Wikipedia

  https://en.wikipedia.org/wiki/Multisystem_inflammatory_syndrome_in_children

  Knowledge of this newly described syndrome is evolving rapidly. Its clinical features may appear somewhat similar to Kawasaki disease, a rare disease of unknown origin that typically affects young children, in which blood vessels become inflamed throughout the body. It can also show features of other serious inflammatory conditions of childhood, including toxic shock and macrophage activation syndromes. Nevertheless, it appears to be a separate syndrome. Older children tend to be affected. […] Diagnosis is by specialist clinical evaluation. Diagnostic suspicion may be raised by unexplained persistent fever and clinically concerning symptoms following exposure to COVID-19. Families need to seek immediate medical care, as the child’s condition can deteriorate rapidly. Pediatricians’ first involvement is often in the emergency department. Early recognition and multidisciplinary referral to pediatric specialists (in intensive care, infectious diseases, cardiology, haematology, rheumatology, etc.) is essential. Examinations may include blood tests, chest x-ray, heart ultrasound (echocardiography), and abdominal ultrasound. Clinicians worldwide have been urged to consider this condition in children who display some or all the features of Kawasaki disease or toxic shock syndrome.

• #47 Understanding the Necessity to Recognize Multisystem Inflammatory Syndrome in Children (MIS-C) in Emerging Infectious Diseases based on the Lessons Learned from COVID-19: A Letter to the Editor

  https://openpublichealthjournal.com/VOLUME/17/ELOCATOR/e18749445346904/FULLTEXT/

  One of the challenges in managing MIS-C is the lack of specific diagnostic criteria. The symptoms of MIS-C can overlap with other pediatric inflammatory conditions, making it difficult to differentiate and diagnose. […] It is imperative for healthcare providers to be vigilant and consider MIS-C in children presenting with prolonged fever and systemic inflammation, especially if they have had a recent history of COVID-19 infection or exposure. […] The lessons learned from the COVID-19 pandemic emphasize that timely recognition of MIS-C is essential for improving outcomes in affected children, underscoring the importance of ongoing education and training for healthcare professionals regarding the clinical features and diagnostic criteria associated with this syndrome. […] By applying these lessons to the recognition and management of MIS-C, healthcare systems can enhance their preparedness for future outbreaks, ensuring that children receive timely and appropriate care.

• #48 Multisystem Inflammatory Syndrome (MIS-C and MIS-A)

  https://elsevier.health/en-US/preview/india-multisystem-inflammatory-syndrome-in-children-mis-c

  MIS is characterized by persistent fever, elevated laboratory markers of inflammation, and evidence of organ dysfunction, including myocarditis; acute gastrointestinal symptoms (eg, vomiting, diarrhea) or abdominal pain are common presenting manifestations. […] Diagnosis is based on case definition comprised of a constellation of clinical, laboratory, echocardiographic, and epidemiologic factors. Most patients have evidence of recent SARS-CoV-2 infection and no evidence of alternate microbial or alternate cause for illness. […] Tiered testing strategy is suggested for most patients with suspected MIS-C. Second tier testing is indicated if results of first tier testing are concerning for MIS-C development. […] First line treatment for patients fulfilling criteria for diagnosis of MIS-C is IV immunoglobulin and methylprednisolone.

• #49 Multisystem inflammatory syndrome in children (MIS-C)

  https://elsevier.health/en-US/preview/multisystem-inflammatory-syndrome-in-children-mis-c

  MIS is characterized by persistent fever, elevated laboratory markers of inflammation, and evidence of organ dysfunction, including myocarditis; acute gastrointestinal symptoms (eg, vomiting, diarrhea) or abdominal pain are common presenting manifestations. […] Diagnosis is based on case definition comprised of a constellation of clinical, laboratory, echocardiographic, and epidemiologic factors. Most patients have evidence of recent SARS-CoV-2 infection and no evidence of alternate microbial or alternate cause for illness. […] Tiered testing strategy is suggested for most patients with suspected MIS-C. Second tier testing is indicated if results of first tier testing are concerning for MIS-C development. […] First line treatment for patients fulfilling criteria for diagnosis of MIS-C is IV immunoglobulin and methylprednisolone.

• #50 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Hospital of Philadelphia

  https://pathways.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway

  MIS-C occurs approximately 2-6 wks after the initial SARS-CoV-2 infection. […] Review the following clinical and laboratory criteria when there is concern for diagnosis of MIS-C. […] When the disease is suspected, consult local experts in rheumatology, infectious disease, and cardiology to guide laboratory testing, diagnosis, and treatment. […] Meeting a case definition is not equivalent to diagnostic criteria. The MIS-C case definition may be less predictive of an MIS-C diagnosis currently since the prevalence of MIS-C is thought to be extremely low. […] Illness characterized by all of the following, in the absence of a more likely alternative diagnosis: Subjective or documented fever, T 38.0C. […] Clinical severity requiring hospitalization or resulting in death. […] Evidence of systemic inflammation indicated by CRP 3.0 mg/dL.

• #51 Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): a diagnostic and treatment guidance from the Rheumatology Study Group of the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-021-00980-2

  Italy was the first Western country to be hit by the SARS-CoV-2 epidemic. There is now mounting evidence that a minority of children infected with SARS-CoV2 may experience a severe multisystem inflammatory syndrome, called Multisystem inflammatory Syndrome associated with Coronavirus Disease 2019 (MIS-C). To date no universally agreed approach is available for this disease. […] We propose a diagnostic algorithm, to help case definition and guide work-up, and a therapeutic approach. MIS-C should be promptly recognized, based on the presence of systemic inflammation and specific organ involvement. Early treatment is crucial, and it will be based on the combined use of corticosteroids, high-dose immunoglobulins and anti-cytokine treatments, depending on the severity of the disease. […] To date, although diagnostic and therapeutic recommendations have been proposed by various pediatric societies, no universally agreed approach is available.

• #52 Multisystem Inflammatory Syndrome in Children (MIS-C) | IntechOpen

  https://www.intechopen.com/chapters/86668

  Because it is a disease that can have many clinical presentations, there are many possible differential diagnoses but there are some of them that are essential to rule out. In many cases, the disease simulates sepsis or septic shock, both by its clinical presentation or by laboratory tests in ranges that simulate bacterial infection. The main difference is that in MIS-C there is no bacterial infectious focus and that no infectious agent is isolated. The association with SARS-CoV-2 as the only infectious agent it is absolutely necessary.

• #53 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  https://ceufast.com/course/multisystem-inflammatory-syndrome-in-children-mis-c-associated-with-covid-19

  92% of participants will know how to identify MIS-C. […] Define diagnostic criteria for MIS-C. […] To diagnose MIS-C, the CDC provides specific clinical criteria. […] Clinical criteria for MIS-C as defined by the CDC include (CDC, 2023): Age 21 years, Fever for 1 day, Multisystem organ involvement, Laboratory evidence of inflammation, Clinical severity requiring hospitalization, Positive SARS-CoV-2 antigen/antibody test and/or evidence of COVID-19 exposure within 4 weeks of the onset of symptoms. […] When diagnosing MIS-C, it must be differentiated from other systemic inflammatory disorders and infections that include (Lee Hsueh, 2023; Rabb Kimmel, 2023; Childrens Minnesota, 2024): Kawasaki Disease, Viral infections, Stevens-Johnson Syndrome, Toxic shock syndrome, Systemic juvenile idiopathic arthritis, Bacterial sepsis. […] The most reliable evidence for a diagnosis of MIS-C is a recent infection with SARS-CoV-2 (La Torre et al., 2023; Lee Hsueh, 2023).

• #54 Proteomic profiling reveals diagnostic signatures and pathogenic insights in multisystem inflammatory syndrome in children | Communications Biology

  https://www.nature.com/articles/s42003-024-06370-8

  Multisystem inflammatory syndrome in children (MIS-C) is a severe disease that emerged during the COVID-19 pandemic. […] Furthermore, the absence of a diagnostic test can lead to delayed immunotherapy. […] Using state-of-the-art mass-spectrometry proteomics, assisted by artificial intelligence (AI), we aimed to identify a diagnostic signature for MIS-C and to gain insights into disease mechanisms. […] We identified a highly specific 4-protein diagnostic signature in children with MIS-C. […] Our findings emphasize the potential of AI-assisted proteomics as a powerful and unbiased tool for assessing disease pathogenesis and suggesting avenues for future interventions and impact on pediatric disease trajectories through early diagnosis. […] The lack of a diagnostic test for MIS-C can lead to delayed lifesaving immunomodulating therapy and prolonged unnecessary courses of broad-spectrum antibiotics.

• #55 Diagnosis of Multisystem Inflammatory Syndrome in Children by a Whole-Blood Transcriptional Signature – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37255317/

  Background: To identify a diagnostic blood transcriptomic signature that distinguishes multisystem inflammatory syndrome in children (MIS-C) from Kawasaki disease (KD), bacterial infections, and viral infections. […] Results: In the discovery set, 5696 genes were SDE between MIS-C and combined comparator disease groups. Five genes were identified as potential MIS-C diagnostic biomarkers (HSPBAP1, VPS37C, TGFB1, MX2, and TRBV11-2), achieving an AUC of 96.8% (95% CI: 94.6%-98.9%) in the discovery set, and were translated into RT-qPCR assays. […] Conclusions: MIS-C can be distinguished from KD, DB, and DV groups using a 5-gene blood RNA expression signature. The small number of genes in the signature and good performance in both discovery and validation sets should enable the development of a diagnostic test for MIS-C.

• #56 Diagnosis of Multisystem Inflammatory Syndrome in Children by a Whole-Blood Transcriptional Signature – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37255317/

  Background: To identify a diagnostic blood transcriptomic signature that distinguishes multisystem inflammatory syndrome in children (MIS-C) from Kawasaki disease (KD), bacterial infections, and viral infections. […] Results: In the discovery set, 5696 genes were SDE between MIS-C and combined comparator disease groups. Five genes were identified as potential MIS-C diagnostic biomarkers (HSPBAP1, VPS37C, TGFB1, MX2, and TRBV11-2), achieving an AUC of 96.8% (95% CI: 94.6%-98.9%) in the discovery set, and were translated into RT-qPCR assays. […] Conclusions: MIS-C can be distinguished from KD, DB, and DV groups using a 5-gene blood RNA expression signature. The small number of genes in the signature and good performance in both discovery and validation sets should enable the development of a diagnostic test for MIS-C.

• #57 Proteomic profiling reveals diagnostic signatures and pathogenic insights in multisystem inflammatory syndrome in children | Communications Biology

  https://www.nature.com/articles/s42003-024-06370-8

  We employed AI-assisted proteomics to develop a unique diagnostic signature for children with MIS-C and to gain insight into the underlying disease mechanisms. […] The 4-protein diagnostic signature holds promising avenues for developing a rapid, and low-cost, diagnostic bedside test with important implications for early recognition and targeted treatment. […] The diagnostic signature found in this study was based on only four plasma proteins, of which three were involved in the immune response. […] The 4-protein diagnostic signature had high accuracy in children with MIS-C 24 days following initiation of immunomodulating therapy. […] This demonstrates its robustness to delayed sample collection and partial clinical recovery. […] The significant alterations in proteins related to cell growth, cell death, and/or cell remodeling in children with MIS-C are unprecedented but align with the profound dysregulation of cellular and immunological processes and the multiorgan nature of the disease.

• #58 Proteomic profiling reveals diagnostic signatures and pathogenic insights in multisystem inflammatory syndrome in children | Communications Biology

  https://www.nature.com/articles/s42003-024-06370-8

  We employed AI-assisted proteomics to develop a unique diagnostic signature for children with MIS-C and to gain insight into the underlying disease mechanisms. […] The 4-protein diagnostic signature holds promising avenues for developing a rapid, and low-cost, diagnostic bedside test with important implications for early recognition and targeted treatment. […] The diagnostic signature found in this study was based on only four plasma proteins, of which three were involved in the immune response. […] The 4-protein diagnostic signature had high accuracy in children with MIS-C 24 days following initiation of immunomodulating therapy. […] This demonstrates its robustness to delayed sample collection and partial clinical recovery. […] The significant alterations in proteins related to cell growth, cell death, and/or cell remodeling in children with MIS-C are unprecedented but align with the profound dysregulation of cellular and immunological processes and the multiorgan nature of the disease.

• #59 Proteomic profiling reveals diagnostic signatures and pathogenic insights in multisystem inflammatory syndrome in children | Communications Biology

  https://www.nature.com/articles/s42003-024-06370-8

  The study demonstrated the potential of proteomics to impact pediatric disease trajectories through early diagnosis as we identified a 4-protein diagnostic signature that was accurate in distinguishing MIS-C from children with phenotypically similar diseases. […] We provided a global characterization of proteomic changes in the pathogenesis of MIS-C, emphasizing AI-assisted proteomics as a powerful and unbiased tool for assessing disease pathogenesis and potentially paving the way for more efficient future interventions.

• #60 A systematic review on Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Development of a scoring system for clinical diagnosis | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.04.23.21255879.full

  There is growing evidence of Multisystem Inflammatory Syndrome in Children (MIS-C) resembling Kawasaki disease in children infected with SARS-CoV-2. […] The review was undertaken to evaluate the case definition, the spectrum of clinical presentations and current management practices in children with COVID-19 presenting with or without MIS-C. […] We devised a scoring system as per WHO criteria to classify the patients as MIS-C or without MIS-C. […] Based on these criteria, a minimum score of 6 was essential to classify the child as MIS-C. […] Based on this score, 18% (52/289) of cases were identified to be MIS-C. […] The children with COVID-19 having cardiac and/or gastrointestinal involvement are more likely to develop MIS-C. […] The scoring system developed herein will aid clinicians in patient diagnosis and timely management.

• #61 A systematic review on Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Development of a scoring system for clinical diagnosis | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.04.23.21255879v1

  There is growing evidence of Multisystem Inflammatory Syndrome in Children (MIS-C) resembling Kawasaki disease in children infected with SARS-CoV-2. […] The review was undertaken to evaluate the case definition, the spectrum of clinical presentations and current management practices in children with COVID-19 presenting with or without MIS-C. […] We devised a scoring system as per WHO criteria to classify the patients as MIS-C or without MIS-C. A score of 3 was given for the presence of fever (24h) and a score of 1 for lab-confirmed diagnosis of SARS-CoV-2. […] Based on these criteria, a minimum score of 6 was essential to classify the child as MIS-C. […] Based on this score, 18% (52/289) of cases were identified to be MIS-C. […] The children with COVID-19 having cardiac and/or gastrointestinal involvement are more likely to develop MIS-C. […] The scoring system developed herein will aid clinicians in patient diagnosis and timely management.

• #62 A systematic review on Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Development of a scoring system for clinical diagnosis | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.04.23.21255879.full

  The case definition proposed by WHO and CDC have notable differences. […] Thus, there is a need to revisit the case definition and classification of MIS-C. […] The ultimate goal is to evolve a scoring system that would aid clinicians to classify MIS-C in their routine practice and identify the clinical characteristics of MIS-C. […] We next used our scoring system to compare the presentation of 52 children with MIS-C vs 237 non-MIS-C cases. […] This scoring system was implemented on the primary data collected for 333 children and two authors accurately classified 52 children having MIS-C. […] Overall our study estimated the prevalence of MIS-C in 21% of children with symptomatic COVID-19. […] Clinicians should be alert to notice signs and symptoms such as nausea/vomiting, abdominal pain and diarrhea for an impending MIS-C.

• #63

  https://link.springer.com/article/10.1007/s12519-022-00681-8

  In multisystem inflammatory syndrome in children (MIS-C), diagnostic delay could be associated with severity. This study aims to measure the time to diagnosis in MIS-C, assess its impact on the occurrence of cardiogenic shock, and specify its determinants. […] Time to diagnosis6 days was independently associated with cardiogenic shock in MIS-C. Early diagnosis and treatment are crucial to avoid the use of inotropes and limit morbidity, especially in older children. […] The diagnosis of MIS-C can be difficult. Early diagnosis would allow rapid treatment. Anti-inflammatory treatment, including corticosteroids and intravenous immunoglobulins, resulted in rapid recovery and improved outcomes. However, the delayed diagnosis could lead to delayed treatment and an unfavorable outcome. […] This study demonstrated for the first time that diagnostic delay was associated with cardiogenic shock.

• #64 Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): a diagnostic and treatment guidance from the Rheumatology Study Group of the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-021-00980-2

  We propose to consider MIS-C diagnosis in the presence of: A child or adolescent with Fever (38C) lasting for more than 24h. […] As many of the signs and symptoms listed are not specific, MIS-C diagnosis should rely on a high index of suspicion and cautious clinical judgement, taking into account the patients history, the severity of organ involvement, the inflammatory markers level and other possible mimickers. […] To date, there is limited evidence to establish the optimal therapeutic approach to a child with MIS-C. Given the partial overlap of the clinical manifestations of MIS-C with those of Kawasaki disease, the majority of patients have been treated with the standard therapeutic protocols for the latter illness. […] The clinical experience indicates that prompt recognition and timely treatment are crucial to achieve good outcomes. Given the frequent overlap of clinical manifestations between MIS-C and Kawasaki disease, patients with the hyperinflammatory syndrome have generally been treated with the therapeutic protocols used in Kawasaki disease. […] The final decision about the optimal management should be taken by the caring physician, based on the disease characteristics and severity of each individual patient.

• #65 Diagnosis of Multisystem Inflammatory Syndrome in Children with Gastrointestinal Manifestations – Clinical Case Reports Journal (ISSN 2767-0007)

  https://clinicalcasereportsjournal.com/article/1000217/diagnosis-of-multisystem-inflammatory-syndrome-in-children-with-gastrointestinal-manifestations

  Most children affected with COVID-19 have mild symptoms; however, a small number of these children may develop Multisystem Inflammatory Syndrome (MIS-C). […] Therefore, our case aims to highlight the importance of maintaining a high degree of suspicion for MIS-C and close monitoring for deterioration of patients with a history of COVID-19 infection and gastrointestinal symptoms, knowing that early detection is key to treatment in most developing countries. […] With the presence of multisystem involvement and raised inflammatory markers, attention was shifted to the possibility of MIS-C. […] This patients second admission and subsequent complication could have been avoided by keeping a high index of suspicion for MIS-C in a case of persistent diarrhea with a history of COVID-19 infection/ close contact, especially in view of a history of raised inflammatory markers. […] Therefore, a high index of suspicion for MIS-C is the need of the hour, especially in the presence of rising COVID-19 cases. This will facilitate early detection in low-level and mid-level income countries and lead to a favorable prognosis.

• #66

  https://link.springer.com/article/10.1007/s12519-022-00681-8

  In multisystem inflammatory syndrome in children (MIS-C), diagnostic delay could be associated with severity. This study aims to measure the time to diagnosis in MIS-C, assess its impact on the occurrence of cardiogenic shock, and specify its determinants. […] Time to diagnosis6 days was independently associated with cardiogenic shock in MIS-C. Early diagnosis and treatment are crucial to avoid the use of inotropes and limit morbidity, especially in older children. […] The diagnosis of MIS-C can be difficult. Early diagnosis would allow rapid treatment. Anti-inflammatory treatment, including corticosteroids and intravenous immunoglobulins, resulted in rapid recovery and improved outcomes. However, the delayed diagnosis could lead to delayed treatment and an unfavorable outcome. […] This study demonstrated for the first time that diagnostic delay was associated with cardiogenic shock.

• #67

  https://link.springer.com/article/10.1007/s12519-022-00681-8

  A predictive score including time to diagnosis6 days, age8 years and NT-proBNP at diagnosis11,254 ng/L had a sensitivity of 89% and a specificity of 91% for cardiogenic shock. […] In conclusion, for MIS-C, children with a time to diagnosis of at least six days had a higher risk of developing cardiogenic shock, especially children over eight years of age, with an NT-proBNP at diagnosis11,254 ng/L.

• #68 SciELO Brazil – Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the e

  https://www.scielo.br/j/rpp/a/FL8MSQtszPK5rbJ5gG8vKTJ/

  In conclusion, the gastrointestinal and mucocutaneous features, blood abnormalities, altered inflammatory and coagulation markers, coronary artery abnormalities, ventricular dysfunction, and intensive care unit admission were frequent, which should highlight the importance of early clinical suspicion.

• #69 MIS-C FAQs | Rush

  https://www.rush.edu/patients-visitors/covid-19-resources/covid-19-resources-health-care-providers/mis-c-faqs

  If an alternative source is identified such as a viral or bacterial infection that explains the child’s illness no further workup for MIS-C is necessary. […] While optimal treatment is not yet known, most children with MIS-C have done well with good supportive care typically in the intensive care unit. […] Rush University Medical Center is working with state and local health departments, professional societies, scientists and other hospitals nationally and across the Chicagoland area to collect data on children with MIS-C to help understand which children are most at risk for this rare disorder, the best therapies, and the best ways to provide care for children in the hospital and long-term.

• #70 Multisystem inflammatory syndrome in children in Singapore – Annals Singapore

  https://annals.edu.sg/multisystem-inflammatory-syndrome-in-children-in-singapore/

  We identified 12 cases of MIS-C. The summary of findings of their clinical characteristics, disease course, treatment received and outcomes are presented in online Supplementary Materials. […] All patients had evidence of prior COVID-19 infection with a positive anti-N SARS-Cov-2 immunoglobulin G antibody. […] Both diagnosis of MIS-C and administration of treatment were done within a median of 2.00 days from admission. All patients received one dose of 2g/kg of intravenous immunoglobulin (IVIg). Eleven patients (91.70%) received steroids in the form of IV methylprednisolone with subsequent conversion to oral prednisolone. […] All patients survived and were discharged after a median hospital stay of 6.00 days. […] Our study shows that children in Singapore are vulnerable to developing MIS-C especially during widespread community transmission of COVID-19, which may intensify with the arrival of new VOCs and relaxation of pandemic restrictions. Physicians should suspect MIS-C in febrile children with features of KD, and in children with recent COVID-19 infection together with gastrointestinal symptoms, shock, and haematologic abnormalities of coagulopathy, lymphopaenia and thrombocytopaenia to diagnose MIS-C early and initiate prompt treatment with IVIg and steroids.

• #71 Diagnosis of Multisystem Inflammatory Syndrome in Children with Gastrointestinal Manifestations – Clinical Case Reports Journal (ISSN 2767-0007)

  https://clinicalcasereportsjournal.com/article/1000217/diagnosis-of-multisystem-inflammatory-syndrome-in-children-with-gastrointestinal-manifestations

  Most children affected with COVID-19 have mild symptoms; however, a small number of these children may develop Multisystem Inflammatory Syndrome (MIS-C). […] Therefore, our case aims to highlight the importance of maintaining a high degree of suspicion for MIS-C and close monitoring for deterioration of patients with a history of COVID-19 infection and gastrointestinal symptoms, knowing that early detection is key to treatment in most developing countries. […] With the presence of multisystem involvement and raised inflammatory markers, attention was shifted to the possibility of MIS-C. […] This patients second admission and subsequent complication could have been avoided by keeping a high index of suspicion for MIS-C in a case of persistent diarrhea with a history of COVID-19 infection/ close contact, especially in view of a history of raised inflammatory markers. […] Therefore, a high index of suspicion for MIS-C is the need of the hour, especially in the presence of rising COVID-19 cases. This will facilitate early detection in low-level and mid-level income countries and lead to a favorable prognosis.

• #72 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Hospital of Philadelphia

  https://pathways.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway

  MIS-C occurs approximately 2-6 wks after the initial SARS-CoV-2 infection. […] Review the following clinical and laboratory criteria when there is concern for diagnosis of MIS-C. […] When the disease is suspected, consult local experts in rheumatology, infectious disease, and cardiology to guide laboratory testing, diagnosis, and treatment. […] Meeting a case definition is not equivalent to diagnostic criteria. The MIS-C case definition may be less predictive of an MIS-C diagnosis currently since the prevalence of MIS-C is thought to be extremely low. […] Illness characterized by all of the following, in the absence of a more likely alternative diagnosis: Subjective or documented fever, T 38.0C. […] Clinical severity requiring hospitalization or resulting in death. […] Evidence of systemic inflammation indicated by CRP 3.0 mg/dL.

• #73 Multisystem Inflammatory Syndrome in Children (MIS-C): What Physicians Need to Know  | Children’s Hospital Los Angeles

  https://www.chla.org/blog/experts/peds-practice-tips/multisystem-inflammatory-syndrome-children-mis-c-what-physicians-need

  The disease can appear similar to Kawasaki disease, and follows a COVID-19 infection in children. […] On March 14, 2020, The Centers for Disease Control and Prevention (CDC) described the condition and named it multisystem inflammatory syndrome in children, or MIS-C, but it has been reported under other names and acronyms (pediatric inflammatory multisystem syndrome, PMIS, PIMS, PIMS-TS, etc.). […] It is crucial to remember that MIS-C remains an emerging phenotype, and the CDC and WHO case definitions are purposefully broad and inclusive for this reason. […] Ultimately, the big question we all have is: What are the consequences of under-diagnosis or over diagnosis of this condition? […] Patients come to medical attention via different pathways, and every child should continue to receive the best available treatment as determined by the medical team. With a history, physical examination and laboratory evidence of MIS-C, an echocardiogram is indicated to look for coronary artery involvement, as this may change treatment.

• #74 Multisystem Inflammatory Syndrome in Children (MIS-C): What Physicians Need to Know  | Children’s Hospital Los Angeles

  https://www.chla.org/blog/experts/peds-practice-tips/multisystem-inflammatory-syndrome-children-mis-c-what-physicians-need

  A multidisciplinary team at CHLA cares for these patients. […] The cornerstone of therapy is astute observation to identify all aspects of their clinical syndrome, with supportive care and customized subspecialty care as needed. […] For patients who appear to have KD or incomplete KD, IVIG and moderate dose aspirin is added to their treatment. […] When there is an inadequate response to IVIG, other medications may be used, including methylprednisolone, infliximab, anakinra or tocilizumab. […] To avoid being trapped in this dilemma, and to avoid cognitive bias, it is crucial to have a high index of suspicion for disease relating to this novel condition when evaluating children with fever and signs of inflammation, and in those who have unusual symptoms or severity compared to the expected course for the presumed diagnosis.

• #75 Multisystem inflammatory syndrome in children – Wikipedia

  https://en.wikipedia.org/wiki/Multisystem_inflammatory_syndrome_in_children

  Knowledge of this newly described syndrome is evolving rapidly. Its clinical features may appear somewhat similar to Kawasaki disease, a rare disease of unknown origin that typically affects young children, in which blood vessels become inflamed throughout the body. It can also show features of other serious inflammatory conditions of childhood, including toxic shock and macrophage activation syndromes. Nevertheless, it appears to be a separate syndrome. Older children tend to be affected. […] Diagnosis is by specialist clinical evaluation. Diagnostic suspicion may be raised by unexplained persistent fever and clinically concerning symptoms following exposure to COVID-19. Families need to seek immediate medical care, as the child’s condition can deteriorate rapidly. Pediatricians’ first involvement is often in the emergency department. Early recognition and multidisciplinary referral to pediatric specialists (in intensive care, infectious diseases, cardiology, haematology, rheumatology, etc.) is essential. Examinations may include blood tests, chest x-ray, heart ultrasound (echocardiography), and abdominal ultrasound. Clinicians worldwide have been urged to consider this condition in children who display some or all the features of Kawasaki disease or toxic shock syndrome.

• #76 Multisystem inflammatory syndrome in children (MIS-C) – Children’s Health Cardiology

  https://www.childrens.com/specialties-services/conditions/multisystem-inflammatory-syndrome-in-children

  Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition that sometimes develops in children who have or recently had COVID-19. […] Our experts from multiple medical specialties have streamlined our care so our teams can quickly recognize, diagnose and treat MIS-C. […] The CDC has created guidelines to help doctors diagnose MIS-C. Your child must meet all these criteria for a confirmed diagnosis of MIS-C: […] Your doctor will perform tests to find out if your child meets these criteria. Tests may include: […] It’s not yet clear what causes MIS-C. However, evidence suggests that MIS-C occurs when a child’s immune system has an extreme response to the coronavirus SARS-CoV-2 (the virus that causes COVID-19). […] There is no cure for MIS-C, but the experts at Children’s Health have developed a comprehensive approach to treating it.

• #77 Case study describes unexpected diagnosis of one of the first cases of MIS-C in US

  https://medicalxpress.com/news/2020-09-case-unexpected-diagnosis-cases-mis-c.html

  At the height of the COVID-19 pandemic in April, a 14-year-old boy was admitted to the emergency department at Nemours Children’s Health System in Delaware with mysterious symptoms in what would later be identified as one of the first cases of multisystem inflammatory syndrome in children (MIS-C) in the U.S. His care and retrospective diagnosis have been published in Progress in Pediatric Cardiology as a timely case study linking COVID-19 to the highly dangerous syndrome which is rare in children and causes inflammation of the heart, lungs and other vital organs. […] Based on the team’s experience with this patient and others, as well as data from other centers, Nemours’ physicians developed a clinical pathway for early recognition and treatment of MIS-C to speed the diagnosis and care of children with this new presentation of COVID-19. […] „In the three months since this patient was in critical care, we have learned so much about diagnosing and treating this novel presentation of COVID-19 in children,” said Thacker. „This information-sharing has undoubtedly saved lives.”

• #78 Multisystem inflammatory syndrome in children in Singapore – Annals Singapore

  https://annals.edu.sg/multisystem-inflammatory-syndrome-in-children-in-singapore/

  We identified 12 cases of MIS-C. The summary of findings of their clinical characteristics, disease course, treatment received and outcomes are presented in online Supplementary Materials. […] All patients had evidence of prior COVID-19 infection with a positive anti-N SARS-Cov-2 immunoglobulin G antibody. […] Both diagnosis of MIS-C and administration of treatment were done within a median of 2.00 days from admission. All patients received one dose of 2g/kg of intravenous immunoglobulin (IVIg). Eleven patients (91.70%) received steroids in the form of IV methylprednisolone with subsequent conversion to oral prednisolone. […] All patients survived and were discharged after a median hospital stay of 6.00 days. […] Our study shows that children in Singapore are vulnerable to developing MIS-C especially during widespread community transmission of COVID-19, which may intensify with the arrival of new VOCs and relaxation of pandemic restrictions. Physicians should suspect MIS-C in febrile children with features of KD, and in children with recent COVID-19 infection together with gastrointestinal symptoms, shock, and haematologic abnormalities of coagulopathy, lymphopaenia and thrombocytopaenia to diagnose MIS-C early and initiate prompt treatment with IVIg and steroids.

• #79 Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management | Pediatric Research

  https://www.nature.com/articles/s41390-022-02263-w

  Further collaborative networks for children with MIS-C or MIS-N to understand the immune function and optimal therapies are vital. […] Understanding immune function would also allow the monitoring of disease progress and response to therapy with biomarkers such as cytokines. […] Multisystem inflammation following COVID-19 is not common but can be associated with high morbidity and mortality.

• #80 Multisystem Inflammatory Syndrome In Children (MIS-C) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24592-multisystem-inflammatory-syndrome-in-children

  Most children diagnosed with MIS-C make a complete recovery. It can be life-threatening and severe in rare cases. They’ll need treatment in a healthcare facility, most likely a hospital. Your child may need to see their primary care provider after they’ve completed treatment for MIS-C. Research is still ongoing to learn if there are any long-term side effects, so their provider will provide a physical exam to verify they’re in good health a few months following treatment.

• #81 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  A significant proportion of the reported MIS-C cases could not fulfil the diagnostic criteria for MIS-C. […] The incidence of MIS-C is higher in children living in socioeconomically deprived condition. […] The median age of patients with MIS-C is 611 years. […] Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] According to the case definition, fever is present in 100% of patients and usually lasts for 17 days. […] The gastrointestinal system is the most commonly involved organ system. Vomiting, diarrhea and abdominal pain are reported in over 50% of patients. […] More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. […] The prognosis of MIS-C is generally good. Most cases show resolution of inflammation and related symptoms within 14 weeks after the onset of illness. […] Reported mortality rate ranged between 1% and 3%, slightly higher than that for Kawasaki disease with current treatment recommendations.

• #82 Multisystem inflammatory syndrome in children (MIS-C) – Children’s Health Cardiology

  https://www.childrens.com/specialties-services/conditions/multisystem-inflammatory-syndrome-in-children

  Most children with MIS-C spend 7-10 days in the hospital, including 3-4 days in the ICU, but some severe cases need more time to improve. […] Most kids who get MIS-C show no symptoms or mild symptoms of COVID-19. […] No. MIS-C is still rare but serious and can be life-threatening without care. […] No, MIS-C is not contagious. It is the result of an immune system reaction to the virus that causes COVID-19.

• #83 Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9841678/

  A significant proportion of the reported MIS-C cases could not fulfil the diagnostic criteria for MIS-C. […] The incidence of MIS-C is higher in children living in socioeconomically deprived condition. […] The median age of patients with MIS-C is 611 years. […] Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. […] According to the case definition, fever is present in 100% of patients and usually lasts for 17 days. […] The gastrointestinal system is the most commonly involved organ system. Vomiting, diarrhea and abdominal pain are reported in over 50% of patients. […] More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. […] The prognosis of MIS-C is generally good. Most cases show resolution of inflammation and related symptoms within 14 weeks after the onset of illness. […] Reported mortality rate ranged between 1% and 3%, slightly higher than that for Kawasaki disease with current treatment recommendations.

• #84 Multisystem Inflammatory Syndrome In Children (MIS-C) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24592-multisystem-inflammatory-syndrome-in-children

  Most children diagnosed with MIS-C make a complete recovery. It can be life-threatening and severe in rare cases. They’ll need treatment in a healthcare facility, most likely a hospital. Your child may need to see their primary care provider after they’ve completed treatment for MIS-C. Research is still ongoing to learn if there are any long-term side effects, so their provider will provide a physical exam to verify they’re in good health a few months following treatment.

• #85 Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): a systematic review | BMJ Paediatrics Open

  https://bmjpaedsopen.bmj.com/content/8/1/e002344

  This systematic review aims to provide a comprehensive review of the currently available literature on MIS-C and examine the clinical and diagnostic features, management and outcomes associated with the disease. […] The primary outcome of this study is pooled mortality among patients diagnosed with MIS-C. […] The most common specific therapies provided to patients with MIS-C included IVIG (87.5%; 95% CI 82.9% to 91%; 101 studies) and steroids (74.7%; 95% CI 68.7% to 79.9%; 100 studies). […] The studies reported a mortality rate of 1.3% (95% CI 0.9% to 1.9%; 16 studies) in HIC and 7.4% (95% CI 5.1% to 10.6%; 28 studies) in MIC. […] This comprehensive systematic review presents all the available global data on MIS-C in the English language, delving into the clinical and diagnostic features, management strategies and patient outcomes.

• #86 Multisystem inflammatory syndrome in children (MIS-C)

  https://www.aboutkidshealth.ca/multisystem-inflammatory-syndrome-in-children-mis-c

  Some children may require treatment in the form of medication. […] The focus of treatment is to reduce inflammation using intravenous immunoglobulin (IVIG) and/or corticosteroids and potentially other medicines that suppress the immune system. […] Children diagnosed with MIS-C need follow-up in a multidisciplinary clinic where they will have repeat bloodwork, monitoring of their heart and assessment by a specialized team.

• #87 Multisystem Inflammatory Syndrome (MIS-C and MIS-A)

  https://elsevier.health/en-US/preview/india-multisystem-inflammatory-syndrome-in-children-mis-c

  Second line treatment for refractory disease is intensified IV methylprednisolone, anakinra, or infliximab. […] Most patients have responded well to therapy and have favorable short-term prognosis, but mortality is 1% to 2% in children and 7% in adults; minority of survivors have sequelae as late as 6 to 12 months post diagnosis. […] Cardiology follow-up with serial echocardiography is recommended after recovery from acute phase of MIS-C to monitor for latent development and evolution of coronary artery aneurysms and monitor cardiac function. […] COVID-19 vaccination is effective in preventing MIS-C in children aged 5 to 18 years, and is likely effective at preventing MIS overall by lowering risk of preceding COVID-19 infection.

• #88 Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): a diagnostic and treatment guidance from the Rheumatology Study Group of the Italian Society of Pediatrics | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-021-00980-2

  We propose to consider MIS-C diagnosis in the presence of: A child or adolescent with Fever (38C) lasting for more than 24h. […] As many of the signs and symptoms listed are not specific, MIS-C diagnosis should rely on a high index of suspicion and cautious clinical judgement, taking into account the patients history, the severity of organ involvement, the inflammatory markers level and other possible mimickers. […] To date, there is limited evidence to establish the optimal therapeutic approach to a child with MIS-C. Given the partial overlap of the clinical manifestations of MIS-C with those of Kawasaki disease, the majority of patients have been treated with the standard therapeutic protocols for the latter illness. […] The clinical experience indicates that prompt recognition and timely treatment are crucial to achieve good outcomes. Given the frequent overlap of clinical manifestations between MIS-C and Kawasaki disease, patients with the hyperinflammatory syndrome have generally been treated with the therapeutic protocols used in Kawasaki disease. […] The final decision about the optimal management should be taken by the caring physician, based on the disease characteristics and severity of each individual patient.

• #89 Multisystem Inflammatory Syndrome in Children (MIS-C): What Physicians Need to Know  | Children’s Hospital Los Angeles

  https://www.chla.org/blog/experts/peds-practice-tips/multisystem-inflammatory-syndrome-children-mis-c-what-physicians-need

  A multidisciplinary team at CHLA cares for these patients. […] The cornerstone of therapy is astute observation to identify all aspects of their clinical syndrome, with supportive care and customized subspecialty care as needed. […] For patients who appear to have KD or incomplete KD, IVIG and moderate dose aspirin is added to their treatment. […] When there is an inadequate response to IVIG, other medications may be used, including methylprednisolone, infliximab, anakinra or tocilizumab. […] To avoid being trapped in this dilemma, and to avoid cognitive bias, it is crucial to have a high index of suspicion for disease relating to this novel condition when evaluating children with fever and signs of inflammation, and in those who have unusual symptoms or severity compared to the expected course for the presumed diagnosis.

• #90 Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management | Pediatric Research

  https://www.nature.com/articles/s41390-022-02263-w

  Further collaborative networks for children with MIS-C or MIS-N to understand the immune function and optimal therapies are vital. […] Understanding immune function would also allow the monitoring of disease progress and response to therapy with biomarkers such as cytokines. […] Multisystem inflammation following COVID-19 is not common but can be associated with high morbidity and mortality.

• #91 Proteomic profiling reveals diagnostic signatures and pathogenic insights in multisystem inflammatory syndrome in children | Communications Biology

  https://www.nature.com/articles/s42003-024-06370-8

  The study demonstrated the potential of proteomics to impact pediatric disease trajectories through early diagnosis as we identified a 4-protein diagnostic signature that was accurate in distinguishing MIS-C from children with phenotypically similar diseases. […] We provided a global characterization of proteomic changes in the pathogenesis of MIS-C, emphasizing AI-assisted proteomics as a powerful and unbiased tool for assessing disease pathogenesis and potentially paving the way for more efficient future interventions.

• #92 Clinical Overview of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-overview/index.html

  Children with MIS-C can also have neurologic involvement which is usually transient and presents as headache or altered mental status.78 […] Other severe neurologic manifestations may include encephalopathy, stroke, demyelination, and fulminant cerebral edema, although this is rare.78 […] Multiple studies91011 have found that COVID-19 vaccination is effective at reducing the risk of MIS-C, with one CDC study finding that two doses of Pfizer-BioNTech COVID-19 vaccine had a greater than 90% estimated effectiveness at preventing MIS-C. 12 […] While MIS-C following vaccination is very rare,13 CDC and FDA require that MIS-C occurring after COVID-19 vaccination be reported to the Vaccine Adverse Event Reporting System.

• #93 Multisystem Inflammatory Syndrome (MIS-C and MIS-A)

  https://elsevier.health/en-US/preview/india-multisystem-inflammatory-syndrome-in-children-mis-c

  Second line treatment for refractory disease is intensified IV methylprednisolone, anakinra, or infliximab. […] Most patients have responded well to therapy and have favorable short-term prognosis, but mortality is 1% to 2% in children and 7% in adults; minority of survivors have sequelae as late as 6 to 12 months post diagnosis. […] Cardiology follow-up with serial echocardiography is recommended after recovery from acute phase of MIS-C to monitor for latent development and evolution of coronary artery aneurysms and monitor cardiac function. […] COVID-19 vaccination is effective in preventing MIS-C in children aged 5 to 18 years, and is likely effective at preventing MIS overall by lowering risk of preceding COVID-19 infection.

• #94 Study Suggests How Post-COVID Syndrome, MIS-C, Gets Started in Children | Columbia University Irving Medical Center

  https://www.cuimc.columbia.edu/news/study-suggests-how-post-covid-syndrome-children-gets-started

  A clue to what causes MIS-C may lie in the different immune cells found in MIS-C patients compared with other patients. […] Notably, interleukin-27, an inflammatory molecule, was very highly upregulated in patients with MIS-C but not in other febrile children. […] If validated, these findings may allow researchers to run a simple, easily available test to readily confirm MIS-C in patients when they are in the emergency department. […] The Columbia researchers postulate that MIS-C and adult COVID-19 infection may be more similar than is currently believed. […] In both adults and children, however, this second phase immune signature appears quite similar.

• #95 Understanding the Necessity to Recognize Multisystem Inflammatory Syndrome in Children (MIS-C) in Emerging Infectious Diseases based on the Lessons Learned from COVID-19: A Letter to the Editor

  https://openpublichealthjournal.com/VOLUME/17/ELOCATOR/e18749445346904/FULLTEXT/

  One of the challenges in managing MIS-C is the lack of specific diagnostic criteria. The symptoms of MIS-C can overlap with other pediatric inflammatory conditions, making it difficult to differentiate and diagnose. […] It is imperative for healthcare providers to be vigilant and consider MIS-C in children presenting with prolonged fever and systemic inflammation, especially if they have had a recent history of COVID-19 infection or exposure. […] The lessons learned from the COVID-19 pandemic emphasize that timely recognition of MIS-C is essential for improving outcomes in affected children, underscoring the importance of ongoing education and training for healthcare professionals regarding the clinical features and diagnostic criteria associated with this syndrome. […] By applying these lessons to the recognition and management of MIS-C, healthcare systems can enhance their preparedness for future outbreaks, ensuring that children receive timely and appropriate care.

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