Yet another side effect of COVID 19?

The attack of the COVID 19 virus, initiated more than two years ago, caused much devastation and dysfunction at an unexpected time, to the point that scientists are still uncovering and exploring the associated morbidities of COVID 19. MISC or Multisystem inflammatory syndrome in children, is a relatively new condition that is associated with COVID infection, mostly found amongst pediatric population, which can be life threatening if recognized and treated early.

In today’s article, we’ll discuss about MISC, identification and treatment. Joining us in our discussion is Dr. Kavinda Dayasiri, Consultant Paediatrician and Senior Lecturer, Faculty of Medicine, University of Kelaniya.

What is MISC? 
Although most children and teenagers do not become seriously ill with COVID-19, a minor percentage of children who contracted COVID-19 are found to subsequently develop symptoms of a newly recognised,and unusual condition called MIS-C (Multisystem Inflammatory Syndrome in Children). In this condition, different body parts can become inflamed including heart, lung, kidney, brain, eyes, skin and gastrointestinal organs. It is important that parents be aware about this condition as MIS-C can be serious and even deadly, if not identified and treated early. However, most children who had MIS-C had gotten better with medical treatment. 

How does a child acquire MIS-C?
Children acquire MIS-C only if they had previous history of COVID-19 infection. However, since COVID-19 is mostly a less serious illness in children and children can be asymptomatic, some parents of children with MIS-C will recall no history of recent COVID-19 infection. 

MIS-C is believed to be caused by an overactive immune system in response to exposure or illness with COVID-19. This overactive immune response results in widespread inflammation throughout the body.

 In some children, immune system can make errors while making protective antibodies and this inappropriate inflammatory response to recent COVID-19 infection can also lead to MIS-C. 
Although it is known that children with certain health conditions such as diabetes and immunocompromised status are at higher risk for having severe COVID-19 infection, the same has not been seen for MIS-C. What factors will predispose some children to develop overactive immune response and, hence MIS-C over other children who may not develop MIS-C following COVID-19 infection is not clear. 

What happens to the body in MIS-C?
As the name itself indicates, MIS-C leads to widespread inflammation of body organs in children. What is more concerning is the inflammation of heart and blood vessels that can lead to low blood pressure and inflammation of heart muscles (myocarditis). These complications, in rare instances, can lead to death. Other body organs which are affected by widespread inflammation include brain, lung, kidney, eyes, skin and gastrointestinal organs

Signs and symptoms
Most children with MIS-C present with one or more of symptoms such as stomach pain, vomiting, red eyes, dizziness, diarrhoea, skin rash together with fever. Sometimes, the child may complain of having muscle aches, or have poor drinking or eating. As the child becomes more ill, or has heart involvement, he or she may experience chest pain or trouble breathing.
However, some children can present just with fever and with no other symptoms to explain the cause of fever. If your child becomes continuously unwell and feverish with no obvious explanation for ongoing fever, it is very important that your child is seen by a doctor to look for the possibility of MIS-C.  

Advice should specially be sought from a doctor if your child recently had COVID-19, or have been in close contactwith someone who had COVID-19, within the past 6 weeks and now have developed these symptoms. You need to seek advice immediately from a doctor if your child has one or more symptoms of trouble breathing, chest pain, unusual behaviour or confusion, excessive sleepiness and severe stomach pain as they may indicate severe MIS-C. 

Investigations and management
The doctor will perform several tests to look into the presence or absence of inflamed organs in your child’s body. These tests include Full blood count and C-reactive protein, and kidney and liver function tests. Echocardiogram and ECG are helpful in looking at the heart.  Abdominal ultrasound and chest x–ray are helpful in identifying ongoing inflammation in gastrointestinal organs and lungs, respectively. Whether or not your child recently had COVID-19 infection can be identified by a blood test called COVI9-19 specific antibodies.  

Most children with MIS-C need treatment in a hospital. Unlike COVID-19 infection, MIS-C is not contagious. Therefore, sick children can be kept together with other non-infected children with no fear of spreading COVID-19.  Some of these children with MISC can become seriously ill needing treatment in an Intensive Care Unit.

 Medical treatment of MIS-C is mainly targeted at mitigating widespread inflammation in your child’s body. For this, children can be treated with one or combination of drugs that have anti-inflammatory properties including immunoglobulin, methylprednisolone and aspirin. 

Sometimes, special medications may be needed to keep the child’s blood pressure within normal limits. As children can be quite unwell and drinking poorly at the beginning, they may also need fluids given through a cannula and medications to control pain and vomiting.

Prevention
Much is left to be learnt about MIS-C in children.  It is not clear why some children become seriously ill with MIS-C whilst other children do not. Also it is not known whether having certain health conditions can predispose to severe symptoms of MIS-C although the association of these heath conditions with severe COVID-19 infection is well known. Therefore, prevention of MIS-C lies with prevention of your family getting infected with COVID-19. It is, therefore, very important that you comply with national COVID-19 vaccination program and get the vaccine without delay. Social distancing, wearing face masks in public, and avoiding crowded places and gatherings are important in reducing the chance of your child acquiring COVID-19 infection from others. 

Children may not have similar symptoms when they become ill with MIS-C. Therefore, it is important that parents be vigilant of emergency warning signs, and seek medical care for their children without delay.