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Year : 2021  |  Volume : 8  |  Issue : 6  |  Page : 266-267

Multisystem inflammatory syndrome associated with coronavirus disease 2019: MIS-C-concepts and MIS-concepts

Senior Consultant, Department of Pediatrics, Shree Aggarasain International Hospital, Shree Aggarsain International Hospital, New Delhi, India

Date of Submission15-Oct-2021
Date of Acceptance22-Oct-2021
Date of Web Publication19-Nov-2021

Correspondence Address:
Dr. Pradeep Kumar Sharma
Shree Aggarsain International Hospital, Sector 22, Rohini, New Delhi - 110 086
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcc.jpcc_90_21

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How to cite this article:
Sharma PK. Multisystem inflammatory syndrome associated with coronavirus disease 2019: MIS-C-concepts and MIS-concepts. J Pediatr Crit Care 2021;8:266-7

How to cite this URL:
Sharma PK. Multisystem inflammatory syndrome associated with coronavirus disease 2019: MIS-C-concepts and MIS-concepts. J Pediatr Crit Care [serial online] 2021 [cited 2022 Aug 16];8:266-7. Available from: http://www.jpcc.org.in/text.asp?2021/8/6/266/330736

The year 2019 brought the world to standstill with a catastrophic disease caused by novel coronavirus 2019. This is one of the largest pandemics which is still going on. The coronavirus disease 2019 (COVID-19) is mainly an adult disease with relative sparing of children.[1] Severe lung involvement with acute respiratory failure is the most common complication in adults with COVID-19. Children with COVID-19 infection usually have milder symptoms than adults. In April 2020, a cluster of eight previously healthy children presenting with cardiovascular shock, fever, and hyperinflammation was reported from the United Kingdom.[2] Subsequently, there have been reports of similarly affected children from most parts of the world. The condition has been termed multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.[3] This is a new disease and our understanding continue to evolve about this condition. This is usually a serious condition and majority of patients require inpatient care for management. Early recognition and timely supportive care and immunomodulatory therapy are lifesaving. Patients with MIS-C usually present with persistent fever, abdominal pain, vomiting, diarrhea, skin rash, mucocutaneous lesions and, in severe cases, with hypotension and shock. They have elevated laboratory markers of inflammation (e.g. C-reactive protein, ferritin), and in a majority of patients, laboratory markers of damage to the heart (e.g. troponin; B-type natriuretic peptide [BNP] or pro-BNP). Some patients develop myocarditis, cardiac dysfunction, and acute kidney injury.[3],[4]

The clinical features mimic symptoms of Kawasaki's disease (KD) and toxic shock syndrome and at time are indistinguishable. MIS-C being a new entity and probability of cases coming in cluster along with rapidly deteriorating clinical condition in children puts a lot of emphasis in education and imparting knowledge about MIS-C among pediatricians. The outcome of MIS-C patients depends on the correct diagnosis and early immunomodulatory treatment. There is a need to rapidly educate physician about this condition. In this era of social media, the information dissemination is very fast, however, the downside is that there is possibility of dissemination of scientifically unproven or half knowledge to the masses. This can lead to misconceptions about the disease and can be catastrophic. A good step in planning an educational module on MIS-C is to know about the existing knowledge and practices among the pediatricians. In this current issue of the Journal of Pediatric critical care, Sahu SK et al.[5] published the knowledge, attitude, and practices among the pediatricians in Eastern India. This is a good attempt by the authors. They found that majority of pediatricians (≥95%) are aware about the terminology MIS-C, it's clinical features, presence of raised inflammatory markers, its treatment, and follow-up. Fever as a mandatory criterion for diagnosis was known to 62.6%. Majority (75%) agreed that positivity of any of the tests (reverse transcription-polymerase chain reaction, antigen, or antibody) or history of contact with COVID is necessary for diagnosis. KD and toxic shock syndrome as common differential diagnosis of MIS-C were agreed upon by 86%. As expected, pediatricians working in COVID hospital were more confident in managing MIS-C than who are not working (72.8% vs. 38.6%). This study again highlights the importance of continuous educational program such as continuing medical educations (CMEs), interactive sessions with expert to increase the confidence of practicing physicians. Social media campaign as suggested by authors are double-edged sword as there is always probability of disseminating half-cooked knowledge or scientifically unproven therapies. A common error by practicing physician these days is that every febrile child is diagnosed as MIS-C and is invariably started on steroids or immunoglobulins. In the height of pandemic, everyone seems to forget about common diseases such as typhoid, pneumonia, sepsis, or tuberculosis, and there is little effort to diagnose these. In fact, the definition of MIS-C always mentions to rule other possible cause of hyperinflammation before labeling a child MIS-C, however, this is often overlooked as experienced by the editor himself in his personal practice.

In conclusion, in any new disease, there is a learning curve and with time, we understand disease better. There is always a scope for increasing knowledge and improving practices. The MIS-C terminology is well known to pediatricians, however, a lot is still needed to increase the knowledge and confidence of practicing physicians. The best way to achieve this is continuous medical education by means of CMEs or interactive sessions and timely guidelines by local pediatric societies.

  References Top

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607-8.  Back to cited text no. 2
Multisystem Inflammatory Syndrome in Children and Adolescents with COVID-19. Scientific Brief: World Health Organisation. Available from: https://www.who.int/publications-detail /multisysteminflammatory-syndrome-in-children- andadolescents- with-COVID-19. [Last accessed on 2021 Oct 17].  Back to cited text no. 3
World Health Organization. Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID-19. Available from: https://www.who.-int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents -with-covid-19. [Last accessed on 2021 Oct 17].  Back to cited text no. 4
Sahu SK, Patnaik S, Behera JR, Jain MK, Pathak M. Knowledge, attitudes, and practice toward multisystem inflammatory syndrome in children among pediatrician in Eastern India: An online cross-sectional survey. J Pediatr Crit Care. 2021;8:278-82.  Back to cited text no. 5


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