WHAT IS MIS-C?

1. A condition seen in children who have been previously infected with the SAR-CoV-2, where some may not even know that they have been infected, recovered from it, then later, which can be up to 6 weeks after being infected, present with an Immune response that results in significant inflammation in different organs
2. Inflammation can spread into the blood vessels, causing, Inflammation of the blood vessels (Vasculitis)
3. If left untreated, the inflammation can cause:
   • Tissue damage
   • Organ failure
   • Death
4. Symptoms can also overlap with other rare conditions like:
   • Kawasaki (KD) – this is a self-limited inflammation of the blood vessels, where patients may present with a persistently raised fever, rashes, inflammation of vessels of the heart
   • Toxic Shock Syndrome – life threatening clinical illness that occurs usually as a result of bacterial toxins, arising in rapid fevers, a rash, low blood pressure, and multi-organ involvement
   • Macrophage Activation Syndrome – is also life-threatening complication of viral infections or as complications associated with Kawasaki disease, where patients will present with previously mentioned symptoms, including fever, enlarged lymph nodes, liver and spleen, plus an overall system inflammation, involving multi-organs

When does MIS-C present?

• Usually anything from 2 – 6 weeks after COVID-19 exposure

How is it presented?

• Children can show a wide range of symptoms namely:
  • a rash
  • abdominal pain
  • diarrhoea
  • vomiting
  • headaches
  • shortness of breath
  • sore throat
  • swollen hands and feet
  • re “strawberry tongue”
  • red eyes (conjunctivitis)
  • enlarged lymph nodes
  • Heart failures also a common, together with acute kidney injuries
  • Persistently high fever for more than 24 hours
• NOTE: most of these children were not very ill, nor did they have any obvious symptoms at the time of infection with the Coronavirus.

How is MIS-C diagnosed?

• Currently, there is no specific test that will tell you if a child definitely has the Coronavirus.
• A combination of blood tests and other tests, including a cardiac echo, may be done by the Doctor.
• On most occasions blood tests will reveal high inflammatory markers. The ARS-CoV-2 PCR test may be positive or negative.
• We now have the antibody testing available, and if these are positive, this may indicate previous exposure to the virus and hence may assist with the diagnosis.

How can MIS-C be treated?

• Prompt referral to a paediatrician is necessary, as most patients will require admission
• Each patient’s condition must be discussed immediately with the Paediatric Intensive Care team, together with the Rheumatology, Infectious Diseases, Immunology and Cardiology teams, without delay

• Management involves a multidisciplinary team effort. The aim of treatment is to reduce the on-going inflammation as soon as possible, by using immunomodulatory medication, for example, intravenous immunoglobulin, steroids, as well as other medication, in order to avoid long term damage to the patients. All parents as well as child health professionals should be vigilant and have low threshold to recognise MIS-C, and promptly refer these patients as soon as possible to the appropriate medical facilities to get immediate treatment.