Multisystem Inflammatory Syndrome in children (MISC-C) and COVID-19: What providers should know

While the majority of cases of COVID-19 in children result in no symptoms or mild symptoms, some hospitals have recently reported an increased  number of cases of children with a multisystemic inflammatory syndrome that shares many characteristics with Kawasaki disease, an inflammatory disease of childhood that can affect blood vessels. Once referred to as PIMS, this new syndrome has been named multisystem inflammatory syndrome in children, or MIS-C by the Centers for Disease Control.

While research on the apparent link between COVID-19 and MIS-C is limited, scientists around the country are working to learn more about the correlation. In this Q & A,  Dr. Negar Ashouri, pediatric infectious disease specialist at CHOC Children’s, shares information about MIS-C .

What is MISC-C?

MIS-C is a condition where different body parts – such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs – become inflamed. Many children with MIS-C have previously been diagnosed with COVID-19 or have been exposed to COVID-19.

Is MISC-C dangerous?

MIS-C can be serious, but most children have recovered. MIS-C, like Kawasaki disease, can be a very uncomfortable illness because it causes prolonged fever, irritation and inflammation in many tissues of the body. The main concern with MIS-C and Kawasaki disease is heart and blood vessel involvement.

Conditions that involve inflammation in the heart, such as MIS-C or Kawasaki disease, can affect the heart in different ways. They may cause the heart muscle to be irritated and inflamed, affecting the overall function of the heart.

Or, it can weaken the wall of one or more of the coronary arteries causing them to bulge or balloon out. Blood clots can form in the ballooned area and possibly block the blood flow through the coronary artery. When this happens, the heart muscle will no longer receive an adequate supply of oxygen-rich blood, and the heart muscle can be damaged.

Dr. Negar Ashouri, pediatric infectious disease specialist, CHOC Children’s

What are the symptoms of MIS-C?

Though not all children will have the same presentation, these are common symptoms:

  • A fever that won’t go away
  • Abdominal pain, diarrhea or vomiting
  • Bloodshot eyes
  • Rash or changes in skin color

Patients with the following symptoms ought to seek emergency care:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
  • Severe abdominal pain

How is MIS-C diagnosed?

In addition to exploring medical history and performing a physical exam, additional tests may include:

  • Blood tests
  • Echocardiogram 
  • Electrocardiogram
  • Chest X-ray
  • Abdominal ultrasound

How is MIS-C treated?

Kawasaki and MIS-C are best treated in the hospital by a qualified multidisciplinary group of pediatric specialists who will work to to reduce inflammation and minimize long-term heart damage. Treatment may include plasma transfusions to reduce inflammation, steroids, aspirin, antibiotics or supportive oxygen.

Is MIS-C contagious?

MIS-C is not contagious.

What are the long-term effects of MIS-C?

MIS-C is a new illness and medical professionals are actively studying it to learn more,. Children who have had serious cases of MIS-C should be followed by a multidisciplinary group of specialists who will watch oversee their care.

Learn more about the infectious disease team at CHOC Children’s.

Mental health resources to share with patients, families during COVID-19

For many providers, the COVID-19 pandemic has prompted a flurry of tough questions from patients and their families: How do I explain this to my children? How do I help my child understand why their birthday party is canceled? How do I maintain normalcy while my child is out of school and stuck at home?

If you’re also fielding these questions from worried caregivers, this compilation of resources from CHOC Children’s — with more to come — can help address these questions and more:

Helping kids cope with COVID-19 stress

How to teach kids resilience throughout COVID-19

How parents can cope with COVID-19 stress

Establishing structure and routine for kids during COVID-19

Activity ideas for kids during COVID-19

7 ways to help reduce Coronavirus (COVID-19) anxiety

How to talk to kids about disappointment during COVID-19

Kid-friendly mindfulness and meditation strategies to cope with
COVID-19

Find more information to share with patients and families about COVID-19 at choc.org/coronavirus.

Coronavirus (COVID-19): what providers should know

The spread of Coronavirus (COVID-19) is changing rapidly. Follows is a list of resources to help providers stay abreast of the situation – and support their patients and families.

Local, state and federal resources, information

Provider guidance

The most current data

  • COVID-19 global cases dashboard by Johns Hopkins CSSE

Resources to share with patients and families

  • Information from CHOC Children’s experts, including a COVID-19 FAQ, tips for coping with anxiety, tips for parents of immunocompromised children, and hand-washing tips.

Printable materials for practices

Leprosy antibiotic is safe treatment for M. abscessus infections, CHOC infectious disease team finds

An oral antibiotic used to treat leprosy is safe and well-tolerated in the treatment of children with challenging-to-treat mycobacterium abscessus infections, the CHOC Children’s infectious disease team has found.

In their study, clofazimine was given to 27 patients during an outbreak of odontogenic mycobacterial infections as part of a multidrug regimen. Though clofazimine performed well in test-tube experiments against M. abscessus, reports in children were previously limited.

This group of patients represents the highest number of children to receive clofazimine outside of leprosy treatment settings.

The study findings were published in the July 2019 Journal of the Pediatric Infectious Disease Society. Its authors are CHOC infectious disease specialists Dr. Felice Adler-Shohet; Dr. Jasjit Singh; Dr. Delma Nieves; Dr. Negar Ashouri; and Dr. Antonio Arrieta; as well as Cathy Flores, a CHOC clinical research nurse coordinator, and Tuan Tran, an infectious disease pharmacist at CHOC.

The patients who received the antibiotic were among a large group of children who underwent pulpotomy procedures at a dental practice with a contaminated water system.

CHOC’s team added clofazimine to its original first-line medication regimen after receiving special use approval from the Food and Drug Administration.

An additional benefit of use of clofazimine was the ability to stop use of an intravenous antibiotic given thrice daily that prompted many side effects, the team found.

Learn how to refer a patient to CHOC Children’s infectious disease specialists.

CHOC Becomes SCID Referral Center

CHOC Children’s is pleased to have recently become a referral center for severe combined immune deficiency (SCID), filling a regional gap that once required Orange County infants to go outside the county for care.

Led by Drs. David Buchbinder, Wan-yin Chan, Diane Nugent and Jasjit Singh, the immunodeficiency program is a multidisciplinary effort crossing multiple specialties at CHOC including allergy and immunology, hematology and infectious disease

Though they appear healthy at birth, infants with this primary immunodeficiency disease lack T lymphocytes, one of the white blood cells that help fight infections. 

Babies with SCID cannot fight even the most innocuous infections and often die. The condition is considered by the medical community as a pediatric emergency.

“Prior to development of SCID newborn screening, the diagnosis would be delayed,” Dr. Chan says. “Often times these patients would not get sick until after 6 months of age. No one would know they were affected until the antibodies from their mother would wane. They end up with life threatening infections with serious complications often resulting in death.”

However, studies show that early bone marrow or stem cell transplants can improve outcomes significantly, Dr. Chan says.

Survival rates increase to 94 percent if administered to an affected infant by age 3 ½ months. However, if transplants occur after that age, survival rates increase to only 70 percent, underscoring the importance of early detection and intervention. 

To that end, California became one of the first states to add SCID to its list of recommended newborn screenings in 2010. In the years since, all states have followed suit. 

Under CHOC’s program, immunodeficiency team physicians review each case of Orange County babies who test positive in newborn screenings for SCID and ask parents to immediately seek a confirmatory blood test for the infant, Dr. Chan says.

If the additional tests confirm the diagnosis, patients are urgently admitted to CHOC for workup and treatment, Dr. Chan says.

Since CHOC’s center was formed in August, more than 20 patients have been flagged in the surrounding communities and each individual case has been reviewed by the immunodeficiency team in collaboration with local pediatricians.

Those urgent blood tests confirmed the presence of SCID or a SCID-like disorder in more than 25 percent of cases thus far.