New England Journal of Medicine July 23, 2020 pp393-395. “Childhood Multisystem Inflammatory Syndrome-A New Challenge in the Pandemic.” Editorial by Michael Levin.
This entity now named multisystem inflammatory syndrome in children (MIS-C) is about 160-fold less frequent that Covid-19 infection in children at 2/100,000 children. About 1,000 cases have been reported worldwide (WW). This Editorial summarizes WW data and two papers published ibid 334-346 and 347-358.
What’s emerging?
· Occurs 2-4 weeks after infection with SARS-CoV-2
· Most patients have anti-SARS-CoV-2 antibodies with fewer being positive for the virus from NP swabs etc.
· A relatively higher proportion have occurred among “black, Hispanic, or South Asian persons”
· Critical illness leading to ICU “develops in some patients, with prominent cardiac involvement and coronary-artery aneurysms in 10-20%. These patients also have high levels of cardiac biomarkers troponin and BNP.
· Most patients have elevations in CRP, ferritin, LDH, D-Dimer and neutrophils. “Anemia, lymphopenia, hypoalbuminemia and abnormal coagulation indexes are also common.
· “Most patients recover with intensive care support and after treatment with a range of immunomodulatory agents” namely ivIgG, glucocorticoids, anti-TNF, and IL-1 or IL-6 inhibitors
Potential mechanism?
· Anti-SARS-CoV-2 antibodies may enhance disease severity by “triggering inflammation for mediating organ damage." “Furthermore, genetics studies hint that children carrying variants in genes that regulate T- and B-cell response or the clearance of immune complexes are at higher for Kawasaki’s disease”-a related but thought distinct from MIS-C.
Concerns
· Are there similar disease undetected processes in pediatric patients that don’t exactly fit MIS-c?
· Could these relatively rare complications “have implications for the development of a safe vaccine against SARS-CoV-2
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