Novel disease: MIS-C in children after corona infectionCorona infections in children are harmless in most cases. Since April 2020, however, experts have been increasingly reporting a rare clinical picture that occurs in connection with infection by Sars-CoV-2 in children and adolescents.
We talk to Prof. Dr. Chief Physician of the Clinic for Children-. Adolescent Medicine at the Helios Klinikum Erfurt and Prof. Dr. Tim Niehues, Chief Physician of the Center for Pediatric and Adolescent Medicine at Helios Klinikum Krefeld on the inflammatory disease MIS-C.
MIS-C – what's behind it?
MIS-C is a disease that affects children and adolescents after an infection with Sars-CoV-2 can occur. The Abbreviation MIS-C derives from the English disease name "Multisystem Inflammatory Syndrome in Children. Internationally, the clinical picture is known by the acronyms MIS-C or PIMS (Pediatric Inflammatory Multisystem Syndrome) known to. MIS-C is characterized by Inflammation in organs such as skin, heart, gastrointestinal tract, mucous membranes, lungs, liver and kidneys from.
The first cases associated with Corona virus were observed in April 2020 in children from France, Italy and the United Kingdom.
At first, it was suspected that the children had Kawasaki syndrome. However, after a few months it became clear that it is a disease in its own right.
First symptoms of MIS-C appear not be cared for directly after a corona infection but about two to six weeks later. Usually, no corona viruses are found in the body after this period – rather, corona antibodies can be detected as a response of the Immune Response prove. It is not known why the syndrome develops in isolated children and adolescents. Corona virus overreacts. Sets off an acute inflammatory process. "So far, there is no precise information about the frequency of the disease. In large clinics, cases are estimated to be about between ten and twenty. Seen nationwide, this accumulation is considerable," explains Prof. Dr. Niehues. Boys and girls are also affected by the disease to the same extent, he says. Figures on MIS-C are currently collected by the German Society for Pediatric Infectiology (DGPI).
Symptoms and course of MIS-C
MIS-C disease is accompanied by characteristic symptoms, some of which are reminiscent of the Kawasaki syndrome. In contrast to Kawaski syndrome, however, it is not a vascular inflammation (vasculitis), but rather a Inflammatory disease, who has the whole body system concerns. So in addition to the vessels organ functions. Studies show that mostly four or more organs of the children are affected. The course of the disease is reminiscent of a severe sepsis (sepsis). Prof. Dr. Sauerbrey says, "Approximately one quarter of the children must intensive care be cared for".
These symptoms are typical:
– Skin rashes – Swelling of the lymph nodes – Fever – Changes in the mucous membranes and conjunctivae – Severe abdominal pain – Inflamed organs and resulting elevated levels of inflammation – Heart muscle inflammation (myocarditis) – Cardiac arrhythmias – Effusions in the pericardial sacs – Heart valve dysfunction – Kidney failure – Circulatory failure
Diagnosis of MIS-C – differentiation from Kawasaki syndrome
Children and adolescents with MIS-C are on average older as Kawasaki's disease. Studies also show that in MIS-C disease, the cytokines interleukin 17 and interferon gamma are strongly elevated in the blood. Cytokines are proteins that regulate the growth and differentiation of cells. Cytokines are also elevated in Kawasaki syndrome, although current evidence does not clearly differentiate between them.
The World Health Organization (WHO) has Criteria Developed in support of a diagnosis of MIS-C.
The six criteria are:
– Age 0-19 years – fever for at least three days – signs of disease of at least two different organs (skin, mucous membranes, eyes, low blood prere or shock, heart disease, blood clotting disorders, acute gastrointestinal symptoms) – increased inflammation levels – no other explanation – evidence of infection with the Corona virus, either by detection, determination of antibodies or contact with an infected person
Furthermore, if MIS-C is suspected, other serious diseases that can cause similar symptoms must be ruled out – for example, a Blood poisoning, intestinal infection or severe heart or lung diseases. The children are therefore examined for possible viral and bacterial diseases thoroughly examined. In addition, mostly Ultrasound examinations of the heart and X-ray examinations of the lungs.
This is how the disease can be treated
Therapy for MIS-C is aimed at reducing the excessive reaction of the immune system slow down. Here, an administration of cortisone be helpful. In addition, children receive treatment similar to that used for Kawasaki syndrome: intravenous immunoglobulins as well as acetylsalicylic acid tablets to prevent damage to the heart and immunomodulatory drugs (steroids, cytokine antagonists, if appropriate) to target the responsible neutralize messenger substances and to treat the disease effectively. In addition, the child gets intravenous fluid supplied. About one in four young patients is intensive care. In rare cases, patients may need to be artificially ventilated.
Why are mainly children affected?
Experts cannot yet say exactly why MIS-C primarily affects children. Prof. Dr. Sauerbrey makes an amption:
The immune system of children is very reactive – more so than in adults. It is possible that this is why immune reactions are more pronounced in children in the case of MIS-C.
In pediatrics, several diseases are known in which a viral infection leads to Joint swelling, skin symptoms or problems with the organs comes. These immune system phenomena are common in children more frequent than in adults. So far, it is not clear why this disease occurs in isolated children after Covid-19 and in some it does not. Also Risk factors have not yet been identified.
prognosis and long-term sequelae
MIS-C is a relatively new phenomenon in pediatrics, which is why there are so far no statements about long-term consequences. The chances that the disease will be completely cured in children are good. In rare cases, the organs are so severely damaged that long-term damage is left behind.
A rare disease that still raises many questions
The childhood disease MIS-C is a novel clinical picture, reminiscent of Kawasaki syndrome, but clearly different in individual respects. Due to the severity of the disease serious taken and further research are. professional societies document the diseases on a regular basis (DGPI). It is important that as many clinics as possible take part in these surveys, so that clearer statements can be made in the future about rare childhood diseases such as MIS-C.
10 points for your safety
Safe in the hospital – despite the Corona pandemic. Helios has drawn up a 10-point safety concept whose measures protect patients, visitors and employees from corona. With the safety concept, we make your stay in the hospital as safe as possible: starting with an individual risk check, through the strict separation of infected and non-infected patients, to short hospital stays and video consultation hours.