• Ann Falco

COVID-19 Infection and Multisystem Inflammatory Syndrome in Children


Many people who have been diagnosed with COVID-19 have been faced with lingering heart problems associated with the virus. These heart problems can further complicate their recovery. The symptoms common in patients recovering from COVID-19 include palpitations (irregular/rapid heartbeat), dizziness, chest pain, and shortness of breath. In general, children who are diagnosed with COVID-19 do not have serious problems as often as adults do. However, health officials are seeing a very rare complication of COVID-19 called multisystem inflammatory syndrome in children (MIS-C), which can cause serious heart damage, cardiogenic shock, and even death.


As described by the Centers for Disease Control and Prevention (CDC), MIS-C is a condition in children where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Doctors do not yet know exactly what causes MIS-C; however, it is clear that many children with MIS-C had COVID-19 or had been around someone with COVID-19. This syndrome can be serious, even deadly, but most children who are diagnosed with this condition have recovered with medical care and treatment.


According to researchers at John Hopkins Medicine, many children that are diagnosed with MIS-C have prolonged health effects such as abnormal heart rhythms and stiffened heart muscles that prevent the heart from relaxing normally and beating properly. This syndrome was first identified in April 2020 by doctors at children’s hospitals in the United States and the United Kingdom. The illness occurs following a COVID-19 infection and usually affects school-aged children. Many doctors have also identified this condition as pediatric inflammatory multisystem syndrome (PIMS). The syndrome has characteristics in common with toxic shock syndrome and an illness called Kawasaki disease, both of which cause an inflammatory reaction throughout the body. Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria. Kawasaki disease primarily affects children and causes inflammation in the walls of medium-sized arteries throughout the body. The disease also affects the lymph nodes, skin, and mucous membranes inside the mouth, nose, and throat. The most common signs of Kawasaki disease are high fever and peeling skin. Since these illnesses have many of the same symptoms, doctors will perform diagnostic testing to exclude other diseases that cause similar signs.


Although available data suggest that MIS-C is an uncommon complication of COVID-19 in children and adolescents, an important question is why this syndrome develops in some patients in this age group and not in others. Some scientists believe that potential age-specific differences among patients with MIS-C could result from variations in COVID-19 infection related to the exposure or to differences in nasal expression of an enzyme called angiotensin-converting enzyme 2 (ACE2). This specific enzyme is the receptor used by the coronavirus for cell entry. There could be differences in the enzyme that is linked to exposure rates or susceptibility to MIS-C.


Pediatrician Anna Sick-Samuels of John Hopkins Medical says “the syndrome is an inflammatory reaction in the body about four weeks after infection with the SARS-CoV-2 virus. The initial symptoms often include fever, rashes, red eyes, diarrhea, and vomiting, and may get worse over a few days. The inflammation can affect the heart, blood vessels and other organs, which can make some children very ill and in need of urgent care.”


The CDC recommends watching for signs of MIS-C and urges parents to contact a health professional if their child has a fever and any of the following symptoms:

  • Significant or worsening abdominal (stomach) pain

  • Bloodshot (red) eyes

  • Chest tightness/pain

  • Diarrhea

  • Feeling extra tired, weak, or dizzy

  • Acting unusually sleepy or confused

  • Headache

  • Low blood pressure

  • Neck pain

  • Rash (red spots, blotches, or bumps)

  • Vomiting

The CDC is still learning about MIS-C and how it affects children. They are trying to understand the connection between COVID-19 and the syndrome and why some children have gotten sick with MIS-C while others have not. Even though researchers are still learning about this syndrome, it is apparent that MIS-C is a rare complication of COVID-19. The symptoms can overlap with infections and other illnesses. Children showing signs and symptoms should be seen by a doctor. This syndrome usually affects school-age children, most commonly 8- and 9-year-olds, but the syndrome also has been seen in infants and young adults. In addition, symptoms appear between two and six weeks (four weeks on average) after COVID-19 infection, and most children with MIS-C have antibodies to the SARS-CoV-2 virus. Fortunately, MIS-C is a treatable condition, and most children fully recover from this illness. With prompt medical attention, medicine and fluids can control the inflammatory response and help avoid lasting organ damage, especially involving the heart.

 

Speaking Plainly:

  • MIS-C is a condition in children where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.

  • Doctors do not yet know exactly what causes MIS-C; however, many children with MIS-C had a COVID-19 infection or had been around someone with COVID-19.

  • Many children that are diagnosed with MIS-C have prolonged health effects such as abnormal heart rhythms and stiffened heart muscles that prevent the heart from relaxing normally and beating properly.

  • This syndrome usually affects school-age children, most commonly 8- and 9-year-olds, but the syndrome also has been seen in infants and young adults. In addition, symptoms appear between two and six weeks (four weeks on average) after a COVID-19 infection.

  • MIS-C is a treatable condition, and most children fully recover from this illness. With prompt medical attention, medicine and fluids can control the inflammatory response and help avoid lasting organ damage, especially involving the heart.