The World Health Organization (WHO) has recently provided new guidelines for the treatment of children experiencing Multisystem Inflammatory Syndrome (MIS-C) due to exposure to the Covid-19 infection. This article explores the complexities of the syndrome, its causes, symptoms and the newly suggested treatment methodologies.
Multisystem Inflammatory Syndrome Defined
MIS-C is a condition characterized by inflammation affecting various organs in the body, leading to potential heart complications, which could determine the subsequent line of treatment. It emerges as a rare but severe hyperinflammatory condition in children and adolescents, typically occurring 2-6 weeks after a Covid-19 infection. The syndrome can potentially be fatal as it can cause inflammation in different parts of the body such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
Children diagnosed with MIS-C usually have a fever alongside symptoms like abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or excessive fatigue.
MIS-C and Neurological Complications
Recent studies have discovered neurological problems among young patients with MIS-C. These can be life-threatening, including strokes or severe encephalopathy – any brain disease that alters brain function or structure. Other neurological symptoms might include hallucinations, confusion, speech impairments, and coordination or balance issues.
These findings contribute towards the theory that MIS-C is related to a surge of inflammation triggered by an immune response to the virus.
Potential Causes of MIS-C
Research on MIS-C is still in progress, which means there are varying theories as to what triggers it. Some researchers conceive that MIS-C arises from a delayed response to coronavirus, causing significant inflammation in the body and damaging organs. Other theories suggest that it could result from the child’s immune system creating antibodies against the virus. The disease’s genetic component is also being considered, as not every child develop MIS-C and the exhibited symptoms vary greatly.
WHO’s Recommendations for Treatment
The WHO advises the use of corticosteroids in addition to the standard care for Kawasaki disease (conditional recommendation, very low certainty) in hospitalized children aged 0-18 years. These drugs, commonly known as steroids, are anti-inflammatory. Combining corticosteroids with supportive care contributes to a more reliable treatment than either intravenous immunoglobulin plus supportive care or supportive care alone. The treatment also works effectively against Kawasaki disease linked to Covid-19. However, the guidelines strongly advise against using corticosteroids for non-severe Covid-19 patients, as it yields no benefits and can even be detrimental.
Kawasaki Disease
Kawasaki disease is an acute inflammatory disorder of the blood vessels that usually affects children under five years old. The inflammation in the coronary arteries responsible for supplying blood to the heart can result in enlargement or aneurysm formation (swelling of the artery wall), precipitating heart attacks. Symptoms typically include fever, rashes, corneal redness, red and cracked lips, a red tongue, and lymph node enlargement in the neck.