Transfer to a referral center should be arranged. Severely ill-appearing patients and those in compensated shock or shock should be evaluated and treated in the emergency department/critical care setting. Evaluation of severely ill appearing or hemodynamically fragile patients Note that none of these laboratory studies is specific for the diagnosis of MIS-C, so even if there is evidence of significant systemic inflammation, alternative diagnoses must still be considered (eg, pyelonephritis, appendicitis). Laboratory screening for systemic inflammation may be considered and initial lab screenings may include complete blood cell count (CBC) with differential, urine analysis, ESR, and CRP, with the addition of ferritin, LDH, comprehensive metabolic panel, pro-BNP, troponin and fibrinogen depending on initial clinical suspicion and/or evidence of inflammation on initial lab screening. Early consultation and coordination with the nearest pediatric infectious disease and rheumatology specialist and pediatric referral center for optimal testing and management should be considered. Initial evaluation should include measurement of vital signs, assessment of perfusion and oxygen saturation. When should I perform testing for MIS-C and what sort of testing should I start with in the outpatient or emergency department setting?Įvaluate a child with persistent fever (≥3 days) who is moderately to severely ill with clinical signs of organ dysfunction (eg, gastrointestinal, respiratory, cardiac, mucocutaneous or hematologic). These children should be followed and cared for in a hospital with tertiary pediatric/cardiac intensive care units whenever possible. Some children clinically progress rapidly and may develop hemodynamic compromise. Any fever that is accompanied by symptoms concerning in their severity or coincident with recent exposure to a person with COVID-19 should raise suspicions. Persistent fever without a clear clinical source is the first clue. Any child with suspected MIS-C should also be evaluated for infectious and noninfectious etiologies. MIS-C is a rare complication temporally associated with COVID-19. When should you suspect MIS-C as part of your differential diagnosis? Elevated B-type natriuretic peptide (BNP) or NT-proBNP (pro-BNP), hyponatremia, elevated D-dimers.Lymphopenia An abnormal level of inflammatory markers in the blood, including elevated erythrocyte sedimentation rate (ESR)/CRP and ferritin, lactic acid dehydrogenase (LDH).Respiratory symptoms typically reported in adults with COVID-19 may or may not be present in pediatric patients with MIS-C.Ĭommon laboratory findings in case reports have included:.Shortness of breath suggestive of congestive heart failure or pulmonary embolism.Cytokine storm/macrophage activation or hyperinflammatory features.Toxic shock syndrome-like features with hemodynamic instability and poor heart function.Gastrointestinal symptoms such as abdominal pain, diarrhea, nausea/vomiting (patients have presented with colitis, hepatitis and questionable appendicitis).Some children presenting with Kawasaki disease-like syndrome have been noted to have a broader age range and presentation with more gastrointestinal (abdominal pain or diarrhea) and neurologic (headaches/meningitis) manifestations. In some children, coronary artery enlargement and/or aneurysms have been described. Kawasaki disease-like features: conjunctivitis, red eyes red or swollen hands and feet rash red cracked lips, swollen glands.Signs and symptoms include persistent fever, inflammation (based on laboratory test results) and evidence of organ dysfunction or shock.Īlthough different presentations have been described, common symptoms include: What are the common signs and symptoms of MIS-C? Detection of SARS-CoV-2 nucleic acid/antigen up to 60 days prior to or during hospitalization or in a postmortem specimen, OR detection of antibody associated with current illness, OR close contact with a confirmed/probable COVID-19 case in the 60 days prior to hospitalization.Hematologic: platelet count Gastrointestinal: abdominal pain, vomiting or diarrhea.Mucocutaneous: rash, oral mucosal inflammation, conjunctivitis/conjunctival injection or extremity findings (erythema, edema). Cardiac: coronary artery dilatation/aneurysm, left ventricular ejection fraction New onset manifestations of >2 of the following categories:.Clinical severity requiring hospitalization or resulting in death.The Council of State and Territorial Epidemiologists (CSTE) and Centers for Disease Control and Prevention (CDC) developed a new standardized surveillance case definition for MIS-C in December 2022 as follows: What is the case definition of multisystem inflammatory syndrome in children (MIS-C)?
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