Multi-System Inflammatory Syndrome in Children (MIS-C) — another element of COVID-19

Over the past month, as we saw the number of COVID-19 casualties increase in Barbados, one of the saddest cases involved that of a nine-year-old girl who succumbed to the pandemic. Her case was unique in that it was attributed to a new aspect of COVID-19 which has surfaced over the past year, namely Multi-System Inflammatory Syndrome in Children, or MIS-C.

President of the Barbados Association of Medical Practitioners (BAMP), Dr Lynda Williams, stated that the condition was first detected a year ago and was similar to another phenomenon called Kawasaki’s disease. “In April 2020, doctors in the United Kingdom first started seeing symptoms of a condition called Kawasaki’s disease in some children that had either tested positive for COVID-19 three or four weeks previously or were currently dealing with it.

Now, Kawasaki’s disease, named after the Japanese physician who first discovered it in Japan in the 1960s, is a post-viral syndrome that normally occurs three or four weeks after a number of viral diseases, where, owing to dysregulation within their immune system, children develop intense inflammation throughout the body, particularly in large and mid-size vessels.”

However, the doctors realised that these cases were somewhat different from Kawasaki’s disease, in that this new condition was affecting children between the ages of 8 and 11 who had been infected with COVID-19 three or four weeks previously or who still had it, so that is why it was given a new name. So far, cases have been seen in the United Kingdom, Europe, South Africa, and some countries in the Far East.”

The Mayo Clinic website noted that in the United States, there has been a high prevalence among Black and Latino children, and while most patients are between the ages of three and twelve, some cases have also occurred among babies and older children. Another cause for concern is that while most children are asymptomatic when they experience COVID-19, even these children can develop MIS-C later on.

What are some of the symptoms? 

Dr. Williams said, “A fever lasting four to six days, on average five days, that does not respond to antibiotics; conjunctivitis or red eyes; the mouth is sore, and skin may be peeling on the inside as well as swollen lips; they may develop a rash; and lymph nodes or as we call them in Barbados, “Watson’s kernels”, leading to swelling in the armpits, legs or groin over 1.5 centimeters. Other complications beyond this can lead to heart problems. Shortness of breath without a cough is a particularly bad sign, and it can lead to heart failure, kidney failure or respiratory failure.”

Most children who experience this must be treated in a hospital, or a Paediatric Intensive Care Unit in the most severe cases. Supportive care may include fluids if the levels are too low; oxygen to help with breathing; a ventilator if necessary, and blood pressure medications to normalise low blood pressure relating to shock or to help with the heart function. Treatment to reduce swelling and inflammation may include antibiotics, steroid therapy, intravenous immunoglobin, that is, a blood product made up of antibodies, as well as targeted therapies aimed at reducing high levels of proteins called cytokines, which cause inflammation.

When visiting a doctor, parents and guardians are asked to make a list of any symptoms the child may be experiencing, including when they started, disclose key personal information such as recent life events, major stresses, and family medical history, list all medications and vitamin supplements the child is taking, including dosages, and whether he or she has been exposed to any group activities in recent times and note the dates on which those events took place.

Dr Williams noted that to her knowledge, we have only had one case here in Barbados, however, “Every case is extremely significant as MIS-C, and the way it presents itself is being monitored worldwide. We need to be aware of it and look out for it.”

 She advised, “Any child with a fever, red eyes, headaches, a poor appetite, and swollen lips should not be kept at home but taken to the doctor to be evaluated. These children are very sick and their condition will deteriorate gradually. I hope we do not see any more of these cases, but we should let doctors and others know that this is a very real complication of COVID-19 and they should look out for it.”

This article appears in the March 8 edition of COVID Weekly. Read the full publication here.