First Corona, then MIS-C: More and more children end up in the hospital with a dangerous inflammatory disease. Researchers see a connection to Covid-19. You should watch out for these warning signs.
In children, Covid-19 is usually very mild or symptom-free. That makes it different Coronavirus clear of the flu and other respiratory diseases that are often particularly risky for them.
Worldwide, however, a serious secondary disease has been observed that occurs after surviving corona infection and is believed to be related to it: The multi-system inflammatory syndrome – MIS-C for short – can take a life-threatening course and complaints in children and adolescents for weeks after the infection cause. What’s behind it?
The abbreviation MIS-C comes from the English name of the disease “Multisystem Inflammatory Syndrome in Children”. In Europe, MIS-C is also known under the name PIMS (Pediatric Inflammatory Multisystem Syndrome).
One of the most common symptoms is high level feverthat can last up to three days. In addition, according to the World Health Organization (WHO), there are always at least two other complaints. Including:
- acute rash on the hands, feet or in the mouth
- conjunctivitis on both sides
- swollen lymph nodes
- Gastrointestinal problems such as diarrhea, vomiting, and abdominal pain
- Pain behind the breastbone, for example from a dysfunction of the heart muscle, inflammation of the pericardium or the heart valves
- severe drop in blood pressure
According to the WHO, the symptoms usually appear two to four weeks after the corona infection. Doctors and researchers believe that the body’s immune system reacts to the coronavirus SARS-CoV-2 overreacts and sets off violent inflammatory reactions throughout the body. In severe cases, the syndrome can affect the heart, so the children must be hospitalized and treated in the intensive care unit.
MIS-C appeared in the first corona wave
The re were then similar case reports in countries with high numbers of infections such as the USA. Children and adolescents under the age of 21 were affected. Many of them were previously healthy and had a symptom-free corona course.
The re are still very few cases – compared to the total number of people infected with corona. But the numbers are currently increasing again and severe courses are becoming more frequent.
The Guardian” recently reported, the second corona wave in Great Britain led to a significant increase in MIS-C cases. Since the beginning of January 2021, between 12 and 15 children have been suffering from the novel post-viral syndrome every day.
In addition, more children now have to be treated in hospital because of MIS-C. Up to 100 children suspected of having MIS-C would be admitted each week in the UK. In April 2020 there were only about 30 patients per week. This strong increase is presumably due to the higher number of cases due to the coronavirus variant B.1.1.7.
Post-viral syndrome: more cases reported in Germany
In Germany, too, the number of MIS-C cases has increased compared to the first wave of the pandemic. This is shown by data from the German Society for Pediatric Infectious Diseases (DGPI), which has set up a reporting tool for MIS-C / PIMS.
The previous high was reached at the beginning of December 2020 with 18 cases of illness. For comparison: In spring 2020, during the first corona wave, the maximum value was still five cases. According to the DGPI, 60 percent of the children had to be treated in the intensive care unit.
The re are no reports of deaths in connection with the childhood disease in Germany.
“Since PIMS occurs at a certain time interval after an acute SARS-CoV-2 infection, these numbers will also increase somewhat in the next few weeks,” said Jakob Armann from the Clinic for Pediatric and Adolescent Medicine at the Dresden University Hospital of the editorial network Germany (RND). Nevertheless, PIMS remains a relatively rare disease that can also be treated well in the vast majority of cases, according to Armann.
The pediatrician rules out that the virus variant B.1.1.7 that has appeared could exacerbate the situation in Germany: “So far there are no reliable data that the British mutation B.1.1.7 leads to more severe courses or to more frequent triggering of PIMS in children leads.”
Hospital: Those suffering from MIS-C often have to be treated in the intensive care unit. (Icon image) (Source: Bavorndej / Getty Images)
Many research questions still unanswered
The question of whether the increasing number of corona infections actually increases complications in children cannot therefore be answered. In general, it has not been conclusively clarified that an infection with SARS-CoV-2 is the trigger for the disease. A connection seems plausible, according to the European health authority ECDC. However, it is a rare disease whose connection to Covid-19 is not yet well understood.
The Society for the Intensive Care of Minors (PICS) urged doctors to pay close attention to symptoms in children that resembled toxic shock.
The authors of the study warn that the disease must be recognized and treated early on.
Previous studies showed an increase in ethnic groups
In June 2020, scientists examined the MISC syndrome and found one particular abnormality: around 75 percent of the children severely affected in Great Britain were dark-skinned, of Asian origin or belonged to an ethnic minority.
The results were published in the English-language journal “New England Journal of Medicine”.
The US health authority CDC also reported at the time that around 70 percent of reported cases in the US affected children of Hispanic / Latin American origin or dark-skinned, non-Hispanic-American children. It has not yet been clarified why some population groups are more likely to become ill than others.
Similarities Between MIS-C and Kawasaki Syndrome?
In the first cases of the syndrome at the start of the pandemic, medical professionals assumed that the symptoms the children were showing were Kawasaki disease. It shows a clinical picture similar to MIS-C, but was known long before the corona pandemic.
The re are more than 6,000 cases per year worldwide.
The Kawasaki syndrome and the multisystem inflammation syndrome differed mainly in degrees. With MIS-C, the inflammatory reactions are more severe and it can affect more organs, while Kawasaki attacks the cardiovascular system in most severe cases.
Another difference: Babies and toddlers up to five years of age suffer from Kawasaki disease in particular. MIS-C, on the other hand, affects children and adolescents up to about 21 years of age. Much research is still needed on both diseases.