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COVID-19-related illness among children: What we know so far

Multisystem Inflammatory Syndrome in Children is rare, but developing
mother sitting on couch, on the phone, reading the temperature of a child who is covered with a blanket
Children across Europe and the United States have been presenting with a wide variety of symptoms, which doctors are calling Multisystem Inflammatory Syndrome in Children (MIS-C). It is thought to be related to COVID-19 because it is occurring primarily in cities where the prevalence of COVID-19 is high. (Getty Images)

Across Europe and the United States, otherwise healthy children are presenting with symptoms that can also be associated with Kawasaki disease and Toxic Shock Syndrome. These symptoms include high fever, rash, red eyes and red, dry lips. In addition, these children experience stomach ache, vomiting and diarrhea.

Judy Guzman-Cottrill, D.O.
Judy Guzman-Cottrill, D.O.

“The worrisome part of this new syndrome is that they also have severe multi-organ disease, meaning they can have problems including severe inflammation of their liver or acute kidney dysfunction,” said Judy Guzman-Cottrill, D.O., a pediatric infectious disease specialist at OHSU Doernbecher Children’s Hospital and a professor of pediatrics (infectious diseases) in the OHSU School of Medicine. “There are also cardiovascular implications, including low blood pressure, poor heart function and sometimes inflammation of the coronary arteries.”

The syndrome, dubbed Multisystem Inflammatory Syndrome in Children (MIS-C), is thought to be related to COVID-19 because it is occurring primarily in cities where the prevalence of COVID-19 is high. However, some patients with the syndrome are testing negative for COVID-19. This might be because the syndrome is thought to be an immune response after a child has recovered from COVID-19 infection. This immune response leads to significant inflammation in organ systems.

“Prior to becoming sick with the syndrome, many of these children did not have an obvious illness when they were infected with the novel coronavirus. It’s a really mixed picture,” Guzman-Cottrill said. “I think it’s too soon to know exactly what’s happening in these kids – temporally, it appears to be related to recent COVID-19 infection. If this syndrome is proved to be a consequence of COVID-19, I suspect the main driver of disease is the child’s robust immune response to the virus.”

Although OHSU Doernbecher Children’s Hospital has not had any patient cases that fit this clinical picture, care teams are prepared to diagnose and treat children.

“Our general pediatricians, infectious disease specialists, cardiologists and critical care physicians have all been discussing this,” Guzman-Cottrill said. “We’re following the literature closely, and learning from our colleagues across the country and the world who are caring for children with this syndrome.”

And although this development is new, it’s not entirely surprising to Guzman-Cottrill.

“The one thing we’ve learned is that this novel coronavirus has very different characteristics than past coronaviruses,” she said. “It’s surprising to see this new syndrome arise in kids, and we’re still learning something new about the virus every day.”

In terms of protecting kids from the syndrome, the same prevention tips for COVID-19 apply. Simple things like good handwashing and minimized interactions with others are still important. Staying home will definitely decrease children’s risk of contracting COVID-19 and being at risk for this syndrome.

If a child becomes sick and has a high fever, rash, red eyes, stomach ache, diarrhea or vomiting, they should first call their primary care provider to discuss it over the phone. It’s always best to call first – even if going to the emergency room – so the health care team can take proper precautions and triage children appropriately.

If you are a physician and have questions about managing patients with this syndrome, please contact the OHSU Doernbecher Physician Advice and Referral Service.


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