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. […] MIS-C has varied symptoms that affect several organs and systems in the body. Many children have symptoms resembling toxic shock syndrome or Kawasaki disease, in which the coronary arteries enlarge or form aneurysms. Also common are heart inflammation with impaired heart function and low blood pressure, rash or red eyes, and gastrointestinal symptoms. These symptoms can occur in different combinations. […] 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. MIS-C symptoms can get worse quickly, so seek timely medical attention if you see anything concerning.

• #2 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. […] MIS-C is rare. It affects an estimated 1 out of every 3,000 to 4,000 children who had the COVID-19 virus. […] Symptoms of MIS-C include having a fever for at least 24 hours and more than one of the following: Stomach or abdominal pain, Vomiting, Diarrhea, Lightheadedness or feeling dizzy, A skin rash, Bloodshot or red eyes, Loss of appetite. […] Visit the emergency room or call 911 immediately if your child shows any of the following signs: Difficulty breathing, Chest pain that doesn’t go away, Confusion, Severe stomach or abdominal pain, Trouble staying awake or not being able to wake up, Blue, gray or a pale tone to their skin, lips or fingernails.

• #3 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. Respiratory tract, neurological system, musculoskeletal system, and kidney are less frequently affected. Mucocutaneous manifestations and coronary artery abnormalities characteristic for Kawasaki disease (KD) may be observed in a significant proportion of MIS-C patients that may make the differential diagnosis be difficult for some patients, especially in the post-pandemic era. The mortality rate is 13%. Management and prognosis of MIS-C are similar to that of KD. MIS-C and KD may share a common pathogenic process. Based on the observation of MIS-C-like illness in uninfected neonates, i.e. multisystem inflammatory syndrome in neonates, both MIS-C and KD may be a consequence of dysregulated, over-exaggerated humoral immune responses triggered by a specific infectious agent.

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

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

  Currently, the exact causes of MIS-C are unknown. The condition may be related to COVID-19, but more research is necessary to find the exact cause and understand why some children who have COVID-19 become ill with MIS-C, while others are unaffected. […] Risk factors for developing MIS-C are: COVID-19 infection – The primary risk factor for MIS-C is being infected with COVID-19 (the SARS-CoV-2 virus), Race and ethnic group – In the U.S., Black and Hispanic/Latino children are more likely to be diagnosed with MIS-C compared to other groups, Age – The average age of children with MIS-C is 8-9 years old, and most children are between the ages of 3 and 12 years old. Infants and young adults may also develop the condition. […] Based on what is known about MIS-C, the best way to minimize the risk of developing MIS-C is to prevent the spread of COVID-19 in children, families, and their direct contacts. The best prevention against COVID-19 is to get vaccinated. […] The COVID-19 vaccine helps the body to develop protection from the virus that causes COVID-19 and significantly lowers the risk of getting very sick and possibly dying from COVID-19 and its related complications, including MIS-C and MIS-A.

• #5 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. […] MIS-C is rare. It affects an estimated 1 out of every 3,000 to 4,000 children who had the COVID-19 virus. […] Symptoms of MIS-C include having a fever for at least 24 hours and more than one of the following: Stomach or abdominal pain, Vomiting, Diarrhea, Lightheadedness or feeling dizzy, A skin rash, Bloodshot or red eyes, Loss of appetite. […] Visit the emergency room or call 911 immediately if your child shows any of the following signs: Difficulty breathing, Chest pain that doesn’t go away, Confusion, Severe stomach or abdominal pain, Trouble staying awake or not being able to wake up, Blue, gray or a pale tone to their skin, lips or fingernails.

• #6 MIS-C Review Finds Severe Symptoms, Low Fatality Rate

  https://www.contagionlive.com/view/mis-c-review-finds-severe-symptoms-low-fatality-rate

  A review of approximately 1000 children with multisystem inflammatory syndrome (MIS-C) from SARS-Cov-2 finds low fatality with aggressive treatment. […] A systematic review of reports comprising almost 1,000 children affected with multisystem inflammatory syndrome (MIS-C) subsequent to SARS-CoV-2 infection details its presentations and finds that aggressive treatment has kept the fatality rate low. […] The principle presentations of MIS-C were fever (99.4%), gastrointestinal (85.6%), cardiocirculatory manifestations (79.3%) and increased inflammatory biomarkers. […] Although MIS-C is not associated with the pulmonary manifestations typical of COVID-19, the reviewers also found respiratory symptoms in 50.3% of these children. […] While the condition is relatively rare, the severity is reflected in over half of patients (56.3%) presenting with shock and most (73.3%) requiring intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%.

• #7 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. […] MIS-C has varied symptoms that affect several organs and systems in the body. Many children have symptoms resembling toxic shock syndrome or Kawasaki disease, in which the coronary arteries enlarge or form aneurysms. Also common are heart inflammation with impaired heart function and low blood pressure, rash or red eyes, and gastrointestinal symptoms. These symptoms can occur in different combinations. […] 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. MIS-C symptoms can get worse quickly, so seek timely medical attention if you see anything concerning.

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

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

  A rare but serious condition that can occur in children diagnosed with COVID-19. Symptoms include a high fever for at least 24 hours and low blood pressure. […] 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. It can affect the heart, blood vessels, gastrointestinal organs, lungs and other respiratory organs, kidneys, skin, eyes, and nervous system, and it can lead to shock, impaired organ function, and even organ failure. In most cases, though, children experience inflammation in only a few of these organs. […] In nearly all known cases, children with MIS-C have had a fever of 100.4F or higher for at least 24 hours. In most cases, the fever persists for 4 to 7 days. Other symptoms associated with MIS-C may include but are not limited to: diarrhea, vomiting, or stomach pain; skin rash; red eyes (conjunctival hyperemia); cough; respiratory problems, including feeling short of breath or having an increased rate of breathing; chest pain or discomfort; swollen hands or feet; swollen lymph nodes in the neck; red, cracked lips; swollen red tongue with bumps that resembles a strawberry (known as strawberry tongue); headache; confusion; fatigue; sore throat; myalgia (muscle pain). […] Symptoms of MIS-C usually begin 2 to 5 weeks after infection with the novel coronavirus.

• #9

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

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

  Specific features of MIS-C may include: Rash, bloodshot eyes, swollen or red hands and feet, inflamed mucous membranes in the mouth, cracked lips, and a swollen tongue that looks like a strawberry. […] Symptoms and signs of shock or heart problems, such as cold, clammy skin, very low blood pressure, difficulty breathing, severe shortness of breath with exertion, dizziness or light headedness, and a very high heart rate or irregular heartbeat. […] Gastrointestinal symptoms: diarrhea, vomiting, or abdominal pain. […] Respiratory symptoms such as cough and shortness of breath. […] New neurologic symptoms, such as headache, neck pain, confusion, numbness/tingling in the hands and feet, or seizures.

• #11 What Parents Need to Know About Multi-system Inflammatory Syndrome in Children (MIS-C) | Children’s Hospital of Philadelphia

  https://www.chop.edu/what-parents-should-know-about-misc

  Multi-system inflammatory syndrome in children (MIS-C) is an extremely rare condition in which different parts of the body including eyes, skin and some internal organs become inflamed. MIS-C is a serious condition requiring hospital care. […] Symptoms of MIS-C may include: High fever that lasts for several days, Gastrointestinal distress, including diarrhea and abdominal pain (sometimes severe), Swollen lymph nodes, Changes in hands and feet, Rash, Conjunctivitis, Cracked lips, Extreme fatigue and/or irritability. […] Some children with MIS-C also experience shock, which affects blood pressure and heart function. These children require critical care in the Intensive Care Unit (ICU). […] Multi-system inflammatory syndrome in children is treated with medications typically used to treat Kawasaki disease, including steroids and intravenous immunoglobin (IVIG). These medications reduce the body’s excessive immune response, lowering fever and inflammation and allowing heart function to return to normal. Most patients diagnosed with MIS-C recover quickly with treatment.

• #12 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/

  A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2178.7; p=0.034).

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

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

  Specific features of MIS-C may include: Rash, bloodshot eyes, swollen or red hands and feet, inflamed mucous membranes in the mouth, cracked lips, and a swollen tongue that looks like a strawberry. […] Symptoms and signs of shock or heart problems, such as cold, clammy skin, very low blood pressure, difficulty breathing, severe shortness of breath with exertion, dizziness or light headedness, and a very high heart rate or irregular heartbeat. […] Gastrointestinal symptoms: diarrhea, vomiting, or abdominal pain. […] Respiratory symptoms such as cough and shortness of breath. […] New neurologic symptoms, such as headache, neck pain, confusion, numbness/tingling in the hands and feet, or seizures.

• #14

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

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

  More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. Hypotension may result from myocardial dysfunction or preload reduction due to inflammation-associated vasodilation. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. High ferritin and high fibrinogen levels are also frequent findings. Myocardial injury and hypotension are predominant features of MIS-C, over half of patients has elevated troponin and/or pro-brain natriuretic peptide (proBNP) level. […] 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. Progression of coronary artery abnormalities may occur after discharge, suggesting possible long-term complications. A 6-month follow-up study showed a significant proportion of patients has emotional difficulty, exercise intolerance and mild impairment of neurological functions.

• #16 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/

  A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2178.7; p=0.034).

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

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

  More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. Hypotension may result from myocardial dysfunction or preload reduction due to inflammation-associated vasodilation. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. High ferritin and high fibrinogen levels are also frequent findings. Myocardial injury and hypotension are predominant features of MIS-C, over half of patients has elevated troponin and/or pro-brain natriuretic peptide (proBNP) level. […] 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. Progression of coronary artery abnormalities may occur after discharge, suggesting possible long-term complications. A 6-month follow-up study showed a significant proportion of patients has emotional difficulty, exercise intolerance and mild impairment of neurological functions.

• #18 Multisystem Inflammatory Syndrome in Children (MIS-C)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8938222/

  Gastrointestinal symptoms are a predominant clinical manifestation in MIS-C patients, and include abdominal pain, vomiting, and diarrhea. […] The exact pathophysiology of MIS-C remains unknown. However, post-infectious immune dysregulation, particularly involving the innate immune system is implicated given that the majority of patients improve drastically with immunomodulatory agents. […] MIS-C is a rare, recently recognized pediatric hyperinflammatory disorder affecting patients several weeks after infection with, or exposure to SARS-CoV-2 (COVID-19). Many patients present with features that overlap with Kawasaki disease, a pediatric vasculitis mainly affecting the coronary arteries, and shock. Significant differences in patients with MIS-C compared to those with Kawasaki disease include older age at onset, severe myocardial involvement, severe inflammation, and higher incidence among Blacks and Hispanics.

• #19 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. It is associated with SARS-CoV-2, the virus that causes COVID-19 and usually occurs 2-6 weeks after infection with SARS-CoV-2. […] It causes fever and inflammation and can affect different body parts, such as the heart, skin, eyes, and gastrointestinal organs. […] The most commonly reported symptoms are: Fever, Abdominal pain, Vomiting, Diarrhea, Rash, Bloodshot eyes. […] Patients with MIS-C have persistent fever, sometimes for 3 or 4 days. They may have dizziness or lightheadedness, which can be signs of low blood pressure. They may have excessive fatigue. […] Some findings in MIS-C are similar to a type of toxic shock syndrome seen with staph or strep bacteria.

• #20 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. […] MIS-C is rare. It affects an estimated 1 out of every 3,000 to 4,000 children who had the COVID-19 virus. […] Symptoms of MIS-C include having a fever for at least 24 hours and more than one of the following: Stomach or abdominal pain, Vomiting, Diarrhea, Lightheadedness or feeling dizzy, A skin rash, Bloodshot or red eyes, Loss of appetite. […] Visit the emergency room or call 911 immediately if your child shows any of the following signs: Difficulty breathing, Chest pain that doesn’t go away, Confusion, Severe stomach or abdominal pain, Trouble staying awake or not being able to wake up, Blue, gray or a pale tone to their skin, lips or fingernails.

• #21 What parents need to know about multisystem inflammatory syndrome in children (MIS-C) | Texas Children’s

  https://www.texaschildrens.org/content/wellness/what-parents-need-know-about-multisystem-inflammatory-syndrome-children-mis-c

  Common symptoms of MIS-C include fever, GI symptoms (such as abdominal pain, vomiting or diarrhea), red eyes (conjunctivitis) or skin rash. […] Symptoms usually present three to six weeks after a mild COVID infection or exposure to COVID-19. […] According to the CDC, not all children with MIS-C exhibit the same symptoms. […] Most children recover from MIS-C after being hospitalized and treated with a variety of anti-inflammatory interventions (usually a combination of intravenous corticosteroids, intravenous immunoglobulins and/or medications called biologics that are usually utilized for such disorders as juvenile arthritis). […] The symptoms of MIS-C mirror many characteristics of Kawasaki disease including high fever, rash on the chest, back and abdomen, red eyes, inflammation of the mouth, lips and throat, enlarged lymph glands in the neck, and redness and swelling of the hands and feet.

• #22 Multisystem inflammatory syndrome in children – Wikipedia

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

  Affected children always present with persistent fever. Other clinical features at presentation vary. In contrast to acute COVID-19, most children have gastrointestinal symptoms, such as diarrhoea, vomiting, and intense abdominal pain (sometimes severe enough to suggest appendicitis). Muscle pain and feelings of tiredness and general physical weakness are also very common. Some Kawasaki-like symptoms that may be present (especially in children under the age of 5) include mucosal changes around the mouth („strawberry tongue”, cracked lips, etc.), red eyes (conjunctivitis without pus), widespread rash (consistent with leukocytoclastic vasculitis), red or swollen hands and feet, and enlarged lymph nodes. Chest or neck pain may also be present. Severe headache and altered mental state have been reported, along with various neurological disturbances. Features of meningitis have been reported as well as septic encephalopathy, stroke, and Guillain-Barre Syndrome. Some patients present with very low blood pressure and shock, and they may require urgent admission to a paediatric intensive care unit.

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

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

  The burden of disease caused by the new SARS-CoV-2 coronavirus is focused on adults. In children, this infection manifests as a mild and even asymptomatic acute respiratory illness. Reports in April 2020 described a multisystem inflammatory syndrome in children (MIS-C) occurring 2 to 6 weeks after SARS-CoV-2 wave peak. Clinical manifestations included fever, gastrointestinal symptoms, Kawasaki Disease criteria, hypercoagulability, and laboratory parameters within severe inflammatory range. The disease can be life threatening, frequently presented as rapid-onset severe organ failure and need for pediatric critical care support. Cardiovascular dysfunction and coronary involvement are the most serious complications. The clinical and laboratory features of MIS-C indicate that the inflammation is exceptionally high; thus, empirical immunomodulation is the current therapy, leading to good clinical results. Once vaccination against SARS-CoV-2 began, a drop in the incidence of MIS-C happened. 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. The syndrome occurred with severity in a small group of children, even requiring critical care support and connection to mechanical ventilation. We know now that MIS-C is rare and has low mortality. Although critical care is required in a small group of pediatric patients, the evolution is favorable if the diagnosis and immunomodulatory treatment is instituted in time, with complete recovery of organ involvement in most affected children. The fall in the incidence of COVID-19, as well as the lower severity and decrease in mortality, was the consequence of the massive vaccination in both adults and children. The emergence of SARS-COV2 variants has had an impact on the current occurrence of MIS-C. The Omicron wave is described as less severe in adults and with a lower incidence of MIS-C, which was reported worldwide. The spectrum of the disease ranges from mild to severe as described above. MIS-C is new, so the factors that cause a child to evolve from mild-to-severe disease with cardiovascular involvement are still unknown. It is likely that laboratory tests that show a greater range of general inflammation are more frequently present in cases that are going to evolve to severe; however, the severity of the disease is determined by cardiovascular involvement and presence of shock rather than by the results of laboratory tests. The average duration is between 4 and 6 days. The early gastrointestinal symptoms are frequent to find, the series describe it in more than 60%. These include diffuse abdominal pain, vomiting, and diarrhea. Many of the children consult emergency services even with clinic suggestive of acute abdomen. The involvement of skin is also frequent, and it is described between 45 and 75% of cases. It includes rash which is usually non-specific and generalized and swelling of the palms and hands with edema. Another frequent clinical finding is the involvement of mucous membranes, which can vary between 30 and 75%, which includes inflammation of the labial mucosa presenting with edematous and reddened lips, and inflammation of lingual mucosa with a strawberry tongue, that resembles a Kawasaki Disease. Ocular involvement can vary from 30 to 80% of cases, usually presenting as bilateral no purulent conjunctivitis. The major problem is the group of patients who develops cardiovascular involvement. It is this involvement that reflects the severity of multisystemic inflammation and poses a potential life-threatening risk to affected pediatric population. These group of patient will need a pediatric critical care unit. It usually presents as shock, meeting most of the surviving sepsis campaign criteria, being difficult to differentiate it initially from a sepsis or a toxic shock since MIS-C usually is accompanied by cutaneous manifestations. Many children may show cardiovascular involvement due to cardiac dysfunction with or without coronary involvement. Coronary disease seems to be present more frequently than in Kawasaki Disease. The dysfunction of other organs is less frequent, but as it is generalized inflammatory multisystemic disease, there may be diffuse inflammation. This inflammation may present as serositis like pleurisy, pericardial effusion, and/or ascites. The liver can also be affected. There may be an increase in transaminases or even hepatitis. This condition is rare and fluctuates between 5 and 20% of cases. The disease may present with encephalopathy, meningeal inflammation, and seizures. The criteria can be modified over time as there is more knowledge of the syndrome. 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.

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

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

  Specific features of MIS-C may include: Rash, bloodshot eyes, swollen or red hands and feet, inflamed mucous membranes in the mouth, cracked lips, and a swollen tongue that looks like a strawberry. […] Symptoms and signs of shock or heart problems, such as cold, clammy skin, very low blood pressure, difficulty breathing, severe shortness of breath with exertion, dizziness or light headedness, and a very high heart rate or irregular heartbeat. […] Gastrointestinal symptoms: diarrhea, vomiting, or abdominal pain. […] Respiratory symptoms such as cough and shortness of breath. […] New neurologic symptoms, such as headache, neck pain, confusion, numbness/tingling in the hands and feet, or seizures.

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

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

  Neck pain has also been described, sometimes with development of phlegmon on radiographic imaging. […] Children with MIS-C can also have neurologic involvement which is usually transient and presents as headache or altered mental status. […] Other severe neurologic manifestations may include encephalopathy, stroke, demyelination, and fulminant cerebral edema, although this is rare. […] Not all children will have the same signs and symptoms, and some children may have symptoms not listed here.

• #26 Multisystem inflammatory syndrome in children – Wikipedia

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

  Affected children always present with persistent fever. Other clinical features at presentation vary. In contrast to acute COVID-19, most children have gastrointestinal symptoms, such as diarrhoea, vomiting, and intense abdominal pain (sometimes severe enough to suggest appendicitis). Muscle pain and feelings of tiredness and general physical weakness are also very common. Some Kawasaki-like symptoms that may be present (especially in children under the age of 5) include mucosal changes around the mouth („strawberry tongue”, cracked lips, etc.), red eyes (conjunctivitis without pus), widespread rash (consistent with leukocytoclastic vasculitis), red or swollen hands and feet, and enlarged lymph nodes. Chest or neck pain may also be present. Severe headache and altered mental state have been reported, along with various neurological disturbances. Features of meningitis have been reported as well as septic encephalopathy, stroke, and Guillain-Barre Syndrome. Some patients present with very low blood pressure and shock, and they may require urgent admission to a paediatric intensive care unit.

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

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

  A rare but serious condition that can occur in children diagnosed with COVID-19. Symptoms include a high fever for at least 24 hours and low blood pressure. […] 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. It can affect the heart, blood vessels, gastrointestinal organs, lungs and other respiratory organs, kidneys, skin, eyes, and nervous system, and it can lead to shock, impaired organ function, and even organ failure. In most cases, though, children experience inflammation in only a few of these organs. […] In nearly all known cases, children with MIS-C have had a fever of 100.4F or higher for at least 24 hours. In most cases, the fever persists for 4 to 7 days. Other symptoms associated with MIS-C may include but are not limited to: diarrhea, vomiting, or stomach pain; skin rash; red eyes (conjunctival hyperemia); cough; respiratory problems, including feeling short of breath or having an increased rate of breathing; chest pain or discomfort; swollen hands or feet; swollen lymph nodes in the neck; red, cracked lips; swollen red tongue with bumps that resembles a strawberry (known as strawberry tongue); headache; confusion; fatigue; sore throat; myalgia (muscle pain). […] Symptoms of MIS-C usually begin 2 to 5 weeks after infection with the novel coronavirus.

• #28 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. […] Symptoms of MIS-C may occur two or more weeks after acute COVID-19 illness. Should your child develop any of the following symptoms following COVID-19 illness, you should seek immediate care for your child from your childs healthcare provider: Fever, Bloodshot eyes, Skin Rash, Inflammation of oral mucosa, Stomach Pain, Diarrhea, Vomiting, Difficulty feeding (infants) or is too sick to drink fluids. […] Should your child develop any of the following severe symptoms, you should seek emergency medical care when the child has: Change in skin color – becoming pale, patchy and/or blue, Trouble breathing or is breathing very quickly, Racing heart or chest pain, Decreased amount or frequency of urine, Confusion, not acting right, or wont wake up or stay awake. […] Early recognition by pediatricians and referral to a specialist including to critical care are essential.

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

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

  The burden of disease caused by the new SARS-CoV-2 coronavirus is focused on adults. In children, this infection manifests as a mild and even asymptomatic acute respiratory illness. Reports in April 2020 described a multisystem inflammatory syndrome in children (MIS-C) occurring 2 to 6 weeks after SARS-CoV-2 wave peak. Clinical manifestations included fever, gastrointestinal symptoms, Kawasaki Disease criteria, hypercoagulability, and laboratory parameters within severe inflammatory range. The disease can be life threatening, frequently presented as rapid-onset severe organ failure and need for pediatric critical care support. Cardiovascular dysfunction and coronary involvement are the most serious complications. The clinical and laboratory features of MIS-C indicate that the inflammation is exceptionally high; thus, empirical immunomodulation is the current therapy, leading to good clinical results. Once vaccination against SARS-CoV-2 began, a drop in the incidence of MIS-C happened. 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. The syndrome occurred with severity in a small group of children, even requiring critical care support and connection to mechanical ventilation. We know now that MIS-C is rare and has low mortality. Although critical care is required in a small group of pediatric patients, the evolution is favorable if the diagnosis and immunomodulatory treatment is instituted in time, with complete recovery of organ involvement in most affected children. The fall in the incidence of COVID-19, as well as the lower severity and decrease in mortality, was the consequence of the massive vaccination in both adults and children. The emergence of SARS-COV2 variants has had an impact on the current occurrence of MIS-C. The Omicron wave is described as less severe in adults and with a lower incidence of MIS-C, which was reported worldwide. The spectrum of the disease ranges from mild to severe as described above. MIS-C is new, so the factors that cause a child to evolve from mild-to-severe disease with cardiovascular involvement are still unknown. It is likely that laboratory tests that show a greater range of general inflammation are more frequently present in cases that are going to evolve to severe; however, the severity of the disease is determined by cardiovascular involvement and presence of shock rather than by the results of laboratory tests. The average duration is between 4 and 6 days. The early gastrointestinal symptoms are frequent to find, the series describe it in more than 60%. These include diffuse abdominal pain, vomiting, and diarrhea. Many of the children consult emergency services even with clinic suggestive of acute abdomen. The involvement of skin is also frequent, and it is described between 45 and 75% of cases. It includes rash which is usually non-specific and generalized and swelling of the palms and hands with edema. Another frequent clinical finding is the involvement of mucous membranes, which can vary between 30 and 75%, which includes inflammation of the labial mucosa presenting with edematous and reddened lips, and inflammation of lingual mucosa with a strawberry tongue, that resembles a Kawasaki Disease. Ocular involvement can vary from 30 to 80% of cases, usually presenting as bilateral no purulent conjunctivitis. The major problem is the group of patients who develops cardiovascular involvement. It is this involvement that reflects the severity of multisystemic inflammation and poses a potential life-threatening risk to affected pediatric population. These group of patient will need a pediatric critical care unit. It usually presents as shock, meeting most of the surviving sepsis campaign criteria, being difficult to differentiate it initially from a sepsis or a toxic shock since MIS-C usually is accompanied by cutaneous manifestations. Many children may show cardiovascular involvement due to cardiac dysfunction with or without coronary involvement. Coronary disease seems to be present more frequently than in Kawasaki Disease. The dysfunction of other organs is less frequent, but as it is generalized inflammatory multisystemic disease, there may be diffuse inflammation. This inflammation may present as serositis like pleurisy, pericardial effusion, and/or ascites. The liver can also be affected. There may be an increase in transaminases or even hepatitis. This condition is rare and fluctuates between 5 and 20% of cases. The disease may present with encephalopathy, meningeal inflammation, and seizures. The criteria can be modified over time as there is more knowledge of the syndrome. 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.

• #30 Multisystem inflammatory syndrome in children – Wikipedia

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

  Clinical course tends to be more severe than with Kawasaki disease. A child’s condition can deteriorate rapidly, even in the presence of reassuring laboratory findings. Many children develop shock and heart failure. Most require paediatric intensive care. Supplemental oxygen is often needed, and mechanical ventilation is sometimes used. Most children who receive expert multidisciplinary care survive. In addition to respiratory distress, major complications that may need aggressive supportive care can include myocardial damage, acute kidney injury, and coagulopathy (thrombophilia). In some cases, sustained cardiac arrhythmias have led to haemodynamic collapse and need for extracorporeal membrane oxygenation (ECMO). Deaths have been recorded in a small minority (under 2%) of the cases reported.

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

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

  More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. Hypotension may result from myocardial dysfunction or preload reduction due to inflammation-associated vasodilation. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. High ferritin and high fibrinogen levels are also frequent findings. Myocardial injury and hypotension are predominant features of MIS-C, over half of patients has elevated troponin and/or pro-brain natriuretic peptide (proBNP) level. […] 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. Progression of coronary artery abnormalities may occur after discharge, suggesting possible long-term complications. A 6-month follow-up study showed a significant proportion of patients has emotional difficulty, exercise intolerance and mild impairment of neurological functions.

• #32 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 diagnosed with MIS-C were previously healthy or had mild conditions like mild asthma or allergies. Many children did not show signs of COVID-19 at the time of infection, but later developed MIS-C. MIS-C can occur 2-6 weeks after infection. […] MIS-C signs and symptoms can include: Fever of 102° F or higher for longer than 24 hours, Abdominal pain, Diarrhea or vomiting, Dizziness or lightheadedness, Fatigue, Loss of appetite, Rash, Bloodshot eyes, Pale appearance, Fast or labored breathing. […] 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). The immune system creates the inflammation that affects your child’s organs. […] There is no cure for MIS-C, but the experts at Children’s Health have developed a comprehensive approach to treating it. Multiple specialists collaborate to provide all the care your child needs. Your child will receive care that helps support the damaged organs. Usually, children need to be in the intensive care unit (ICU). Without this care, MIS-C can be life-threatening. […] 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. Fortunately, most children bounce back quickly after treatment. However, they may need to limit physical activity until a heart doctor clears them.

• #33 MIS-C Review Finds Severe Symptoms, Low Fatality Rate

  https://www.contagionlive.com/view/mis-c-review-finds-severe-symptoms-low-fatality-rate

  A review of approximately 1000 children with multisystem inflammatory syndrome (MIS-C) from SARS-Cov-2 finds low fatality with aggressive treatment. […] A systematic review of reports comprising almost 1,000 children affected with multisystem inflammatory syndrome (MIS-C) subsequent to SARS-CoV-2 infection details its presentations and finds that aggressive treatment has kept the fatality rate low. […] The principle presentations of MIS-C were fever (99.4%), gastrointestinal (85.6%), cardiocirculatory manifestations (79.3%) and increased inflammatory biomarkers. […] Although MIS-C is not associated with the pulmonary manifestations typical of COVID-19, the reviewers also found respiratory symptoms in 50.3% of these children. […] While the condition is relatively rare, the severity is reflected in over half of patients (56.3%) presenting with shock and most (73.3%) requiring intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%.

• #34 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/MIS-C.aspx

  While many of these symptoms are typical of other common pediatric illness, children with MIS-C will eventually become more severely ill. If you or your child develops these worsening symptoms you seek emergency medical care immediately: Trouble breathing, Pain or pressure in the chest that does not go away, Confusion or unusual behavior, Severe abdominal pain, Inability to wake or stay awake, Pale, gray, or blue-colored skin, lips, or nail beds (depending on skin tone).

• #35

  https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/covid_inflammatory_condition.aspx

  Children with MIS-C usually develop the condition 2 to 6 weeks after being infected with COVID. […] MIS-C can make children very ill. Thankfully, most children who have been diagnosed with MIS-C have recovered after getting medical care. […] Children with MIS-C are very ill with a fever for 24 hours or more, have inflammation in their bodies and problems with many organs (multisystem), such as the intestines, heart, lungs, skin and blood. […] Contact your child’s pediatrician right away if you are concerned that your child is showing symptoms of MIS-C, including ongoing fever plus more than one of the following: stomach pain, bloodshot eyes, diarrhea, dizziness or lightheadedness that are signs of low blood pressure, skin rash, vomiting. […] Seek immediate emergency medical care if your child has any of the following: Trouble breathing or shortness of breath, Pain or pressure in the chest that doesn’t go away, Starts to become confused, Unable to wake up or stay awake, Pale, gray or bluish-colored skin, lips or nail beds, depending on skin tone.

• #36 MIS-C | Department of Health | Commonwealth of Pennsylvania

  https://www.pa.gov/agencies/health/diseases-conditions/infectious-disease/respiratory-viruses/covid-19/mis-c.html

  Most children diagnosed with MIS-C have gotten better with medical care. […] Contact a healthcare provider if your child is showing symptoms of MIS-C. Children, adolescents, or young adults should see a healthcare provider if they had COVID-19 within the last 6 weeks, have been in close contact with someone who had COVID-19 and now have ongoing fever PLUS more than one of the following: stomach pain, bloodshot eyes, diarrhea, vomiting, dizziness or lightheadedness, skin rash. […] Seek emergency medical care immediately if your child is showing any serious MIS-C warning signs such as: trouble breathing, pain or pressure in the chest that does not go away, confusion or unusual behavior, severe abdominal pain, inability to wake or stay awake, pale, gray, or blue-colored skin, lips, or nail beds (depending on skin tone).

• #37

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

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

  More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. Hypotension may result from myocardial dysfunction or preload reduction due to inflammation-associated vasodilation. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. High ferritin and high fibrinogen levels are also frequent findings. Myocardial injury and hypotension are predominant features of MIS-C, over half of patients has elevated troponin and/or pro-brain natriuretic peptide (proBNP) level. […] 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. Progression of coronary artery abnormalities may occur after discharge, suggesting possible long-term complications. A 6-month follow-up study showed a significant proportion of patients has emotional difficulty, exercise intolerance and mild impairment of neurological functions.

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

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

  MIS-C may begin weeks after a child is infected with SARS-CoV-2. […] 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. […] 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). […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm. […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.

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

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

  Treatment for MIS-C may include: Receiving fluids from an IV, Taking medications to reduce inflammation, Antiviral therapy to treat COVID-19 if your child has an active infection, Receiving oxygen from an assisted breathing device. […] Most children diagnosed with MIS-C make a complete recovery. It can be life-threatening and severe in rare cases. […] Your child may be ill with MIS-C for up to two weeks. This varies based on the severity of your child’s diagnosis. Treatment can improve your child’s outcome and recovery time. […] If your child has symptoms of MIS-C, even if they have no history of COVID-19 infection, contact your child’s healthcare provider. They’ll let you know whether you need to visit the emergency room.

• #41 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

  One of the most dangerous features of this condition is involvement of the heart. Nearly all parts of the heart may be affected, with coronary artery dilation and aneurysm, pericarditis, myocarditis, valvulitis, and abnormal electrical conductivity all being common. […] A cascade of inflammatory markers consistent with a cytokine storm and hyperinflammation are commonly present, with elevation of interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, and ferritin. […] MIS-C is a serious condition and requires prompt, and often aggressive treatment and support of organ systems. […] Despite the seriousness, most children do make a full recovery from the condition and the prognosis is good. […] Most children have demonstrable reduction of inflammation within 1-4 weeks of the onset of MIS-C symptoms. […] The mortality rate from MIS-C is between 1%-3% which is higher than other systemic hyperinflammatory conditions like Kawasaki Disease.

• #42 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

  One of the most dangerous features of this condition is involvement of the heart. Nearly all parts of the heart may be affected, with coronary artery dilation and aneurysm, pericarditis, myocarditis, valvulitis, and abnormal electrical conductivity all being common. […] A cascade of inflammatory markers consistent with a cytokine storm and hyperinflammation are commonly present, with elevation of interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, and ferritin. […] MIS-C is a serious condition and requires prompt, and often aggressive treatment and support of organ systems. […] Despite the seriousness, most children do make a full recovery from the condition and the prognosis is good. […] Most children have demonstrable reduction of inflammation within 1-4 weeks of the onset of MIS-C symptoms. […] The mortality rate from MIS-C is between 1%-3% which is higher than other systemic hyperinflammatory conditions like Kawasaki Disease.

• #43 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.

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

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

  More than half of MIS-C patients are associated with hypotension and shock that frequently require intensive care. Hypotension may result from myocardial dysfunction or preload reduction due to inflammation-associated vasodilation. […] Elevated inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin, can be detected in most patients with MIS-C. High ferritin and high fibrinogen levels are also frequent findings. Myocardial injury and hypotension are predominant features of MIS-C, over half of patients has elevated troponin and/or pro-brain natriuretic peptide (proBNP) level. […] 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. Progression of coronary artery abnormalities may occur after discharge, suggesting possible long-term complications. A 6-month follow-up study showed a significant proportion of patients has emotional difficulty, exercise intolerance and mild impairment of neurological functions.

• #45 COVID-19 Resource Center

  https://www.healio.com/news/pediatrics/20250122/severity-of-misc-fell-over-time-and-most-children-recovered-within-6-months

  By 2 weeks after discharge, 86.3% of patients reported returning to 90% or more of their baseline health. That proportion rose to 95.1% by 6 months. […] Most patients were critically ill during the acute phase, but 6-month cardiovascular and overall health outcomes were excellent, Truong and colleagues wrote. Results suggest that cardiovascular and noncardiovascular morbidities were rare by 6 months after hospital discharge.

• #46

  https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/covid_inflammatory_condition.aspx

  If your child is diagnosed with MIS-C, depending on your child’s symptoms and test results, treatment may include: Intravenous immune globulin (IVIG), a „biologic” medicine that contains immune system antibodies, Steroids to help treat swelling or inflammation, Heart medicines or low-dose aspirin, Fluids given through a vein. […] Children who become ill with MIS-C need to be treated in the hospital, according to the Centers for Disease Control and Prevention. Some will need to receive care in the pediatric intensive care unit. […] MIS-C can cause the wall of the heart to be inflamed (myocarditis). Patients with myocarditis will be restricted from activities like exercise or sports for a period of time. […] Yes, all children who are eligible should receive the recommended dose or doses of COVID vaccine. COVID vaccine should be delayed for at least 90 days after MIS-C was diagnosed and the doctor has made sure that your child is fully recovered. […] The best way to prevent MIS-C is for all eligible children age 6 months and up to get the updated COVID vaccine.

• #47 COVID-19 Resource Center

  https://www.healio.com/news/pediatrics/20250122/severity-of-misc-fell-over-time-and-most-children-recovered-within-6-months

  MIS-C severity decreased over time, but symptoms were more severe for older children. […] The severity of multisystem inflammatory syndrome in children decreased as the COVID-19 pandemic went on, and most children recovered to their preinfection health within 6 months, according to two recent studies. […] Newly reported data from cases in Germany and Austria showed that symptom severity decreased from 2020 to 2023, and a North American study reported that almost all children recovered without serious morbidity by 6 months after hospital discharge. […] Lohrmann and colleagues reported that the severity of MIS-C symptoms decreased over time. […] However, the researchers also found that older children were at risk for more severe symptoms than younger children. […] Most children with severe cases of MIS-C recovered within 2 weeks, and almost all returned to their pre-infection health by 6 months, Truong and colleagues wrote in JAMA Pediatrics.

• #48 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/

  The MIS-C cases were classified into three distinct clusters of clinical phenotypes: inflammatory/MIS-C phenotype (characterized by a cytokine storm, with greater organ involvement shock, gastrointestinal symptoms, elevated inflammatory markers, and cardiovascular compromise), a predominantly respiratory phenotype, and a Kawasaki-like phenotype.

• #49 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

  Although COVID-19 was relatively mild in most children, multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) subsequently evolved as a post-infectious inflammatory condition associated with abnormal immune function, left ventricular cardiac dysfunction, coronary artery aneurysms, atrioventricular block and clinical deterioration with multiorgan involvement. […] The commonly affected age group is children 5-13 years of age, and initially, no cases were described in the early neonatal period. […] However more recently this syndrome has been increasingly recognized in neonates. […] The phenotype of MIS-C appears to vary with the age of the patient with mucocutaneous and gastrointestinal findings more common in younger children and respiratory presentation more common among adolescents.

• #50 COVID-19 Resource Center

  https://www.healio.com/news/pediatrics/20250122/severity-of-misc-fell-over-time-and-most-children-recovered-within-6-months

  MIS-C severity decreased over time, but symptoms were more severe for older children. […] The severity of multisystem inflammatory syndrome in children decreased as the COVID-19 pandemic went on, and most children recovered to their preinfection health within 6 months, according to two recent studies. […] Newly reported data from cases in Germany and Austria showed that symptom severity decreased from 2020 to 2023, and a North American study reported that almost all children recovered without serious morbidity by 6 months after hospital discharge. […] Lohrmann and colleagues reported that the severity of MIS-C symptoms decreased over time. […] However, the researchers also found that older children were at risk for more severe symptoms than younger children. […] Most children with severe cases of MIS-C recovered within 2 weeks, and almost all returned to their pre-infection health by 6 months, Truong and colleagues wrote in JAMA Pediatrics.

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

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

  The differential diagnosis of MIS-C includes KD, adenovirus infection, sepsis, toxic shock syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis, autoimmune disorders, drug reaction with eosinophilia and systemic clinical manifestations. Among them, KD is the most important differential diagnosis for MIS-C. Many of their clinical features overlap with each other, and 15%50% of patients with MIS-C meet the full diagnostic criteria for KD.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8938222/

  Gastrointestinal symptoms are a predominant clinical manifestation in MIS-C patients, and include abdominal pain, vomiting, and diarrhea. […] The exact pathophysiology of MIS-C remains unknown. However, post-infectious immune dysregulation, particularly involving the innate immune system is implicated given that the majority of patients improve drastically with immunomodulatory agents. […] MIS-C is a rare, recently recognized pediatric hyperinflammatory disorder affecting patients several weeks after infection with, or exposure to SARS-CoV-2 (COVID-19). Many patients present with features that overlap with Kawasaki disease, a pediatric vasculitis mainly affecting the coronary arteries, and shock. Significant differences in patients with MIS-C compared to those with Kawasaki disease include older age at onset, severe myocardial involvement, severe inflammation, and higher incidence among Blacks and Hispanics.

• #53

  https://link.springer.com/article/10.1007/s11882-022-01031-4

  The novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has developed into a pandemic. A unique challenge of this pandemic has been the emergence of multisystem inflammatory syndrome in children (MIS-C), a rare post-infectious hyperinflammatory disorder associated with SARS-CoV-2. This syndrome is characterized by overwhelming systemic inflammation, fever, hypotension, and cardiac dysfunction. This disorder may also have features overlapping with Kawasaki disease (KD), macrophage activation syndrome (MAS), and toxic shock syndrome (TSS). […] Patients with MIS-C present with characteristics that fall within a wide clinical spectrum. Main features include fever, gastrointestinal symptoms such as abdominal pain and diarrhea, and cardiac complications such as myocarditis and coronary artery aneurysms, although various other features have been reported. Younger children may present with features of Kawasaki-like disease, and older children are often admitted to the intensive care unit with cardiogenic shock. […] Understanding of this disorder continues to evolve, and prompt diagnosis and treatment allow for the best possible outcome for patients with MIS-C.

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

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

  The differential diagnosis of MIS-C includes KD, adenovirus infection, sepsis, toxic shock syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis, autoimmune disorders, drug reaction with eosinophilia and systemic clinical manifestations. Among them, KD is the most important differential diagnosis for MIS-C. Many of their clinical features overlap with each other, and 15%50% of patients with MIS-C meet the full diagnostic criteria for KD.

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

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

  MIS-C may begin weeks after a child is infected with SARS-CoV-2. […] 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. […] 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). […] Some patients develop cardiac dysfunction (e.g., decreased left ventricular function) and coronary artery dilatation or aneurysm. […] Gastrointestinal inflammation can manifest as abdominal pain, vomiting, and diarrhea; children may have signs and symptoms similar to those of acute appendicitis.

• #56 Department of Health | Communicable Disease Service | Multisystem Inflammatory Syndrome (MIS)

  https://www.nj.gov/health/cd/topics/mis.shtml

  Multisystem inflammatory syndrome (MIS) can affect children (MIS-C) and adults (MIS-A). […] Patients with MIS-C may present with a persistent fever and various symptoms, including abdominal pain, vomiting, diarrhea, skin rash, mucocutaneous lesions and, in severe cases, with hypotension and shock. […] MIS-C may begin weeks after a child is infected with SARS-CoV-2. […] Like children, adults who have been infected with the virus that causes COVID-19 can develop symptoms of Multisystem Inflammatory Syndrome in Adults (MIS-A) days to weeks after getting sick. […] Currently, there have been no studies comparing clinical efficacy of various treatment options.

• #57 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. […] Only some cells were activated, which suggests that these cells are mistakenly directing the immune system to attack blood vessels in the body that had been damaged by the virus, says Winchester. […] MIS-C also appears to drive patients natural killer cellsanother type of immune cellto exhaustion. […] Notably, interleukin-27, an inflammatory molecule, was very highly upregulated in patients with MIS-C but not in other febrile children. […] Perhapsand this is highly speculativewhat is unique to children is the ability to handle the initial viral infection more efficiently, and then a month or so later they develop MIS-C. In contrast, adults are not able to suppress the initial viral infection. And then secondarily, in severe cases, a serious MIS-C-like immune response develops. In both adults and children, however, this second phase immune signature appears quite similar.

• #58 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. […] Clinical features include fever, abdominal pain, diarrhea, headache, conjunctivitis, rash, sore throat, cardiac dysfunction, shock, and acute kidney injury. […] Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C. […] Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.

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