MIS-C in children: secondary illness after Covid-19


Novel childhood disease: In several European countries, unusual symptoms were found in children weeks after a corona infection. The “multi-system inflammation syndrome” (MIS-C), the symptoms of which are similar to the “Kawasaki syndrome”, is responsible for this.

A connection with a corona infection is considered likely, said Reinhard Berner from the Dresden University Hospital German press agency. “It is entirely conceivable,” he added.

Update from March 4th, 2020: MIS-C mainly affects children of primary school age

At the beginning of the year there were increasing reports in Great Britain of an increased incidence of the inflammatory disease MIS-C. “Since the beginning of January, between twelve and 15 children have been diagnosed with it every day,” wrote the British news portal The Guardian on February 5th. It is considered likely that this is a sequela of Covid-19, which is observed primarily in children of primary school age.

In most cases, however, the symptoms do not appear until two to six weeks after a Covid 19 illness, explains the scientific journal BMJ. Is particularly typical high fever, that lasts for at least 24 hours. Also Rash as well as a Conjunctivitis are signs of the “multisystemic inflammatory syndrome” and should be examined by a doctor.
If MIS-C is suspected, it is important to conduct laboratory tests to determine possible inflammation and organ dysfunction. Although the secondary disease occurs relatively rarely, the signs should be taken very seriously. If it is diagnosed, medical treatment “with intravenous immunoglobin and steroids can reduce the inflammatory reactions and improve the outcome,” writes BMJ.

Update from July 2nd, 2020: US studies confirm the connection between childhood illness and corona infection

American researchers have looked at the novel disease that occurs in connection with coronavirus infections. It refers to MIS-C (multisystem inflammatory syndrome in children).

In the professional world, the disease is sometimes called PIMS (Paediatric inflammatory multisystem syndrome) oder PMIS (Paediatric multisystem inflammatory syndrome) bezeichnet.

In two studies published on Monday (June 29, 2020) in the New England Journal of Medicine, dhe scientists have the medical records of nearly 300 Children and young people under 21 years of age evaluated, which were treated between March and May in the USA. What they have in common: All of them had been found to be infected with the coronavirus or at least there was an urgent suspicion of an infection.

MIS-C (PIMS / PMIS): These are the symptoms of the new childhood disease

The results of the study at a glance:

  • The syndrome is just starting a few weeks after a coronavirus infection on: In one study there were 25 days between the outbreak of the disease and the peak of the pandemic, in the other over a month.
  • Most common symptoms are Gastrointestinal complaints such as abdominal pain, nausea and vomiting, and diarrhea. 80 percent of MIS-C patients suffered from this.
  • All patients had fever, often for more than four or five days.
  • 80 percent of those affected occurred Cardiovascular problems on, eight to nine percent of children developed an aneurysm on the heart arteries, a potentially dangerous widening of the arteries.
  • In 80 percent of the cases examined, treatment was carried out in the intensive care unit, 20 percent of the patients were ventilated. The Death rate was two percent.
  • Black children and children of Hispanic or Indian roots were more likely to be affected than white children.

According to Express be wAround 1000 cases of the syndrome have been registered worldwide, as Michael Levin of London’s Imperial College wrote in a commentary on the US studies. The European Center for Disease Prevention and Control had until May 15th 230 cases in Europe reported. One child each in France and Great Britain is therefore on MIS-C died.

The UK warned of the syndrome in children in connection with Sars-CoV-2 at the end of April, and the US health authority CDC also joined the warning in May, reports the Express. The new US studies confirmed that there were similarities between MIS-C and Kawasaki. However, older children usually suffered from MIS-C and the inflammatory reactions are more severe. The cause of MIS-C has not yet been conclusively clarified. It is believed that this is an overreaction of the immune system.

Update from May 29th, 2020: New childhood disease discovered in Germany

In addition to the “Kawasaki syndrome”, another disease has now been discovered: In a children’s hospital in Lower Saxony, several cases of an autoimmune disease have been detected for the first time since mid-April. The so-called “Pediatric Inflammatory Multisystem Syndrome (PIMS)” shows symptoms similar to “Kawasaki Syndrome”, for example high fever or a rash. That reports the Daily mirror.

So far there have been four confirmed cases of the “PIMS” disease in Germany. The children were between three months and 13 years old. The treatment went largely smoothly, so that none of the children had to stay in hospital for more than twelve days. Especially interesting: Antibodies to the coronavirus were found in all four children.

It is not yet clear whether there is a direct connection to the corona virus. By mid-May, 230 children worldwide had contracted the autoimmune disease. Some of them tested positive for the Sars-CoV-2 pathogen.

Immune reaction to infection with the coronavirus?

In the University Hospital of Geneva, three children have been treated with such severe inflammations since the beginning of the corona epidemic. A child has recovered and been discharged, one is in the normal and one in the intensive care unit, said a spokeswoman on Thursday. She couldn’t tell the age of the children.

According to the Swiss Corona Commissioner Daniel Koch, it is likely an immune reaction to an infection with the corona virus. “The virus triggers an inflammatory storm, an overreaction of the immune system,” said the Geneva canton doctor Jacques-André Romand.

Cases have also been reported from Italy and Spain. In the UK, the National Health Service (NHS) has alerted hospitals to around two dozen seriously ill children. Many, but not all, have tested positive for the new Sars-CoV-2 virus. The Society for Intensive Care of Minors (PICS) advised doctors to pay particular attention to symptoms in children that resembled toxic shock.

Some children develop severe disease

The World Health Organization (WHO) has already dealt with the issue, as the Covid-19 commissioner Maria van Kerkhove said on Wednesday evening. “We know that children tend to have less severe illnesses, but some develop serious illnesses and some have died,” she said. “We have called on our global network of doctors to be vigilant.”

WHO Emergency Relief Coordinator Michael Ryan added: “This shows that the virus is attacking not only the lungs but other tissues as well.” However, Ryan reassured concerned parents: “The vast majority of children who contract the virus have a mild infection and recover completely.”

The president of the professional association of paediatricians (BVKJ), Thomas Fischbach, also warned of panic. “There is no evidence of a connection between Covid-19 and the Kawasaki syndrome,” he told the “Neue Osnabrücker Zeitung”. Kawasaki syndrome has been around for a long time and it is very rare. An increase in the disease since the beginning of the Covid 19 pandemic has not been seen.

So far, no connection between Kawasaki and the corona virus has been proven

“The reports from other countries of children with a Kawasaki syndrome-like course at this point in time only show a severe inflammatory reaction that could not only be explained by the coronavirus alone. It is often referred to as incomplete Kawasaki syndrome,” explains André Jakob, head of the pediatric cardiological outpatient department at Dr. von Haunersche Children’s Hospital in Munich opposite the Bavarian Broadcasting Corporation (BR).
The normal case is that children who contract Covid-19 hardly have any symptoms.

To this day, doctors do not know what causes Kawasaki syndrome. It mostly affects young children.

You can find all information about the Corona crisis in our constantly updated news ticker.

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