Rare coronavirus-related syndrome targets kids.
Doctors urge parents to be on the lookout for symptoms of new coronavirus-triggered illness
While pediatricians around the world breathed a collective sigh of relief at the understanding that coronavirus would spare children, the recent emergence of multisystem inflammatory syndrome in children, or MIS-C, is giving doctors pause. While the diagnosis is rare, the effects can be life-threatening.
Symptoms include fever, abdominal pain, vomiting, diarrhea, rash, bloodshot eyes, fatigue and neck pain, according to the Centers for Disease Control and Prevention, which issued emergency warning signs, including trouble breathing, pain or pressure in the chest, confusion, extreme exhaustion, severe stomach pain and bluish lips or face.
Not all children have the same symptoms, said Dr. Michael Chang, infectious disease specialist at Children’s Memorial Hermann Hospital and UT Health.
He recommends parents be on alert for a combination of indicators — and seek medical attention early.
“You want to look at a constellation of symptoms,” Chang said. “It’s fever without a cause, something that’s not within a context you’re familiar with. If that fever persists, and you can’t come up with a reason or you don’t see improvement, seek medical attention.”
The sooner, the better, according to Dr. Keith Jensen, regional medical director of pediatric emergency medicine with HCA Houston Healthcare.
“They’re trying to catch it early,” he said. “It usually responds pretty well to our treatments. That’s why we try to catch it sooner rather than later. It does come on quickly.”
At HCA Houston Healthcare facilities, he said doctors start blood work, which is the only way to diagnose MIS-C, on the second or third day of a fever.
Symptoms are tied to an overactive response by the immune system — and usually occur a couple of weeks after the child is exposed to the coronavirus. Blood work shows whether a child has antibodies to the virus — even if the patient was asymptomatic.
Once diagnosed, pediatricians must keep a close watch on the patient’s heart, abdomen and chest, monitoring and treating symptoms separately.
“Because this is so new, we are still trying to find the best way to treat it,” Jensen said. “We’re trying to learn as much as we can — and then share that information.”
For now, intravenous medicines to treat general inflammation appear to be effective, as do steroids and immunomodulators.
At first, doctors thought MIS-C was Kawasaki disease, which also causes rash and fever, Chang explained.
“The difference is that with Kawasaki disease, we never found a trigger, and we still don’t know,” he said. “But with multisystem inflammatory syndrome, it appears to be COVID-19-related. Most infectious disease specialists feel this is a separate syndrome. It’s something on its own.”
Jensen added that Kawasaki disease normally affects children ages 6 months to 5 years. MIS-C patients are older, from 6 months to 18 years. In addition, MIS-C has an earlier, more significant effect on the heart, Jensen said.
Chang said that not all MIS-C patients test positive for COVID-19, but that could simply be related to tests producing false negatives.
Pediatricians initially hoped their young patients would not be infected by the coronavirus. “Kids just don’t seem to get this infection as easily as adults,” said Chang. “And the ones that do, have fewer symptoms. Fewer kids require hospitalization.”
Then, in late April, clinicians in the UK released a report documenting an increased number of children presenting symptoms for what seemed to be Kawasaki disease. All of the cases occurred in children who had recently tested positive for the coronavirus. That article put physicians around the world on alert, Chang said.
“Pediatricians escaped without having a lot of sick kids,” he said. “Then this report came out. Health care providers all around the globe were notified of this.”
By early May, reports of children with MIS-C began showing up in New York. Both Chang and Jensen said cases have since appeared in Houston. “A couple ended up in ICU to be monitored,” Jensen said.
Still, Jensen said physicians had success treating their young patients.
While the condition is rare, Jensen asked parents to stay informed about recommendations and keep a close watch on fevers. “If your child has a fever, get them in to see the doctor,” he said. “We need parents to know this is out there and that they should feel safe coming to the emergency room.”
Much about the syndrome is still unknown, including lasting effects and whether adults may be at risk.
Opening up activities for children can also mean more transmission of the coronavirus, which could then lead to greater incidence of MIS-C.
Socially distancing, wearing masks and handwashing are still the best precautions to take, Jensen said.
“Just because we have done fairly well so far does not mean it’s time to forget all the lessons that we’ve learned the last couple of months,” he said. “There’s honestly no way to prevent multisystem inflammatory syndrome. The best precaution is to keep kids from getting coronavirus in the first place.”
Being aware that the syndrome exists can be lifesaving, Chang said. “It is important for parents to be able to recognize symptoms and seek medical attention immediately,” he said. “And just because you don’t think your child had COVID-19, doesn’t mean they can’t develop this.”
He recommends that parents take proactive measures to ensure their children stay healthy, including paying attention to diet, exercise and sleep, and seeing pediatricians for regular checkups and vaccines, to minimize risk.
“Because this is so new, we are still trying to find the best way to treat it.”
Dr. Keith Jensen, regional medical director of pediatric emergency medicine with HCA Houston Healthcare