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What do we know so far about Multisystem Inflammatory Syndrome in children?

In other alarming news for the year 2021, a new illness by the name Multisystem Inflammatory Syndrome in Children (MIS-C) is observed at a rising trend in children with or without Covid-19 status. 

Brunch spoke to a few pediatricians to learn more about this subject. 

 

Dr.Nalin Kithulwatta

What is MIS-C?

MIS-C is a serious condition that appears to be linked to Covid-19. Most children who become infected with the Covid-19 virus have only a mild illness. But in children who go on to develop MIS-C, some organs and tissues – such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin, or eyes – become severely inflamed. Signs and symptoms depend on which areas of the body are affected. MIS-C is considered a syndrome – a group of signs and symptoms, not a disease – because much is unknown about it, including its cause and risk factors.

We spoke to Lady Ridgeway Hospital (LRH) Consultant Paediatric Intensivist Dr. Nalin Kithulwatta to learn more about the syndrome. He informed us that there have been 15 recorded cases of the disease in the country since last year and that it is identified in a child two to six weeks after they recover from Covid-19. Currently, LRH has seen over 16 cases of this illness in the country, and Dr. Kithulwatta added that although it can occur up to the age of 20, it is most commonly found in children between the ages of 8-15. 

Describing where it got its name from, Dr. Kithulwatta commented that the term “multisystems” means that this disease affects many systems in the body, including the heart, kidneys, liver, skin, and eyes. “The most serious case is when it affects the heart, which could cause the blood pressure to reduce, leading to even death. While there have been recorded deaths in other countries, Sri Lanka has not seen any deaths so far, although cases could have possibly gone undetected.” He stated that despite being fatal, the disease can be treated effectively with an expensive drug that government hospitals inject for free, Intravenous Immunoglobulin (IVIG), adding that out of all the patients he’s received, only four are still under recovery.

“There are also guidelines from the UK and US on how to handle and treat this illness, and some paediatricians got together and are also currently preparing our own guidelines for Sri Lanka.”

 

Treatment 

On the same note, Dr. Kithulwatta commented that early detection of the disease is the best path to treatment, explaining that the detection of this illness is not easy, as the PCR test, the rapid antigen test, or the antibody test used to identify Covid-19 may give negative results, which could lead to conviction that the child is not infected with MIS-C. He stated that most children that have Covid are asymptomatic, so if a child shows symptoms like fever that lasts 24 hours or longer, vomiting, diarrhoea, pain in the stomach, skin rash, feeling unusually tired, fast heartbeat, rapid breathing, red eyes, redness or swelling of the lips and tongue, redness or swelling of the hands or feet, headache, dizziness or feeling lightheaded, and in more serious cases, enlarged lymph nodes, severe stomach pain, difficulty in breathing, pale, gray, or blue-coloured skin, a change in the colour of lips or nails depending on the skin tone, confusion, or the inability to wake up or stay awake, he advised them to come to the hospital immediately. Researchers also say that children with MIS-C usually have symptoms resembling toxic shock syndrome or Kawasaki disease, in which the coronary arteries enlarge or form aneurysms. Most children recover to an excellent state of health with careful observation and treatment.

 

Prevention

According to the Sri Lanka College of Paediatricians, the exact mechanism of disease pathophysiology is not well understood but it is suggested to result from a dysregulated immune response leading to a massive cytokine storm like Kawasaki disease or Macrophage Activation Syndrome. Therefore, a preventive measure is not exactly known, but as it seems to be linked or potentially caused by Covid, doctors advise children to strongly follow the Covid health guidelines. 

Some preventive measures given by the foreign guidelines on how to handle MIS-C include keeping hands clean, avoiding people who are coughing, sneezing, or showing other signs that indicate that they might be sick and contagious, practise social distancing, wearing cloth-based facemasks in public settings when in indoor public places or outdoors if the children are at least two years old, avoiding touching one’s nose, eyes, and mouth, and covering one’s mouth with a tissue or elbow when sneezing or coughing, cleaning, and disinfecting highly touched surfaces every day, and washing clothing and other items as needed. 

 

Dr. Lakkumar Fernando

Linked to Covid?

When asked if this illness has any possible relations to Covid,  Dr. Kithulwatta stated: “This is definitely linked to Covid and if not treated it could be fatal. Since the symptoms are common and can be linked to other diseases, it is important that children be careful, and report to the doctor if they are showing any signs.”  

We spoke to Association of Medical Specialists (AMS) President Dr. Lakkumar Fernando, who is a Senior Consultant Paediatrician and Past President of the Sri Lanka College of Paediatricians, for his opinion on MIS-C. “MIS-C is believed to be a very rare consequence of Covid; in some patients, evidence of Covid through positive tests confirming usually past or concurrent infection is seen and in others it may only be a contact history of having Covid in the family or close associate only.” He also added that the ICU at the Lady Ridgeway Hospital is a place where a lot of patients are collected from all over the country, and as a result, it seems like there is an increase of patients with MIS-C. 

The number of patients at a certain hospital does not reflect the overall number suffering from the syndrome either, he noted, adding that LRH is well known for its excellent paediatric care, so it comes as no surprise that many patients have gathered at this hospital, making it seem like the number of patients are high, when in reality, the number of patients relative to the cases around the country is not high. “If the cases of Covid are high and prevalent in a country, there seems to be a higher number of relatively rare MIS-C cases too in those countries. When the UK and US had more Covid cases, they reported more MIS-C, and when case numbers were controlled, MIS-C followed the trend and became less. For it to go up, maybe we have a large number of asymptomatic Covid-infected children already in the country.” 

He also stated that we need to increase testing for Covid, taking into consideration that there is already an over 20% rate of PCR positivity in the country, whereas in an ideal situation, the rate should be about 5%.