Multisystem Inflammatory Syndrome (MIS-C) in Children and COVID - What Nurses Should Know

Despite the ongoing increase in COVID-19 vaccinations among the general public, unfortunately, there is no approved vaccination for children under 16. Schools are reopening, youth sports leagues are resuming, and life is starting to move towards normalcy. Kids are at increased risk for contracting COVID and potential lifelong complications, more specifically related to MIS-C. 

According to the Centers for Disease Control and Prevention (CDC), MIS-C stands for Multisystem inflammatory syndrome in children (MIS-C). This is a potentially deadly condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. 

MIS-C is a rare but severe hyperinflammatory condition in children and adolescents that typically occurs 2–6 weeks after a COVID-19 infection. This disease is not new to healthcare but because of its rarity, it was not regularly studied. The coronavirus killed hundreds of thousands but the overwhelming majority were adults. The effects on children were long ignored, but it’s more important now to continue to shed light on the devastating and possibly deadly effects of COVID for children. 

What are the causes of MIS-C?

Some researchers believe that MIS-C is a delayed response to the coronavirus which in turn causes massive inflammation in the body and as a result damages organs. Others believe it is a result of the children’s immune response making antibodies against the virus. Still, others believe there may be a genetic component as not every child develops MIS-C and the presenting symptoms are so varied. 

In late April 2020, medical doctors in Europe and the United States saw a very small but increasing number of cases of children afflicted with a new multisystem inflammatory syndrome that appeared to be associated with COVID-19. At the time, the children were testing positive for the virus. However, due to the small percentage of children developing MIS-C symptoms, it was and continues to be difficult for doctors and researchers to study the disorder. 

MIS-C Facts

According to the CDC, as of March 1, 2021, there have been 2617 cases of MIS-C in the United States, which has resulted in 33 deaths. Cases were reported in 48 states as well as Puerto Rico and Washington, DC.

5 important facts reported by the CDC about MIS-C:

1. Most cases were in children and adolescents between the ages of 1 and 14 years, with a median age of 9 years
2. Cases have occurred in children and adolescents from <1 year old to 20 years old
3. 66% of reported cases have occurred in children who are Hispanic, Latino and/or Black
4. 99% of cases tested positive for SARS CoV-2, the virus that causes COVID-19. The remaining 1% were around someone with COVID-19.
5. 59% of reported cases were male.

What are the symptoms of MIS-C in children?

Sometimes it can be difficult to differentiate MIS-C from other diseases especially Kawasaki disease. It’s important to educate patients and their families about the signs and symptoms of MIS-C. Some of the more common symptoms include, 

• Abdominal pain
• Bloodshot eyes
• Diarrhea
• Feeling extra tired
• Fever
• Neck pain
• Rash or changes in skin color
• Red, cracked lips
• Red, swollen tongue
• Swollen or reddened hands and feet
• Trouble breathing
• Vomiting

How to Diagnosis MIS-C

Currently, there is no single test to diagnose MIS-C. It is based on symptoms as well as several blood tests to look for signs of inflammation in the body. The history of a positive COVID test or positive antibodies is not always a clear indicator of MIS-C. There have been numerous reports throughout the country of patients developing MIS-C but not knowing they were infected with COVID previously. Patients were asymptomatic at the time and were never tested for an active COVID-19 infection. 

Common lab tests and results used to diagnose MIS-C include, 

• Elevated ESR/CRP and ferritin, LDH
• Lymphopenia <1000, thrombocytopenia <150,000, neutrophilia
• Elevated B-type natriuretic peptide (BNP) or NT-proBNP (pro-BNP), hyponatremia, elevated D-dimers

Patients will also have a myriad of ultrasounds for kidney and liver, as well as an EKG and echo to evaluate heart function. 

MIS-C symptoms are very similar to other well-known inflammatory disorders, including Kawasaki disease and toxic shock syndrome. 

• Kawasaki disease is an inflammatory syndrome of unknown cause that mostly affects children, and is characterized by vasculitis, or inflammation of the blood vessels. It can cause fever, rash, red eyes, swollen hands and feet, swollen lymph nodes in the neck, and dry and red lips and tongue.
• Toxic shock syndrome is an inflammatory condition caused by a bacterial infection, most commonly in young females with tampon use,  that can result in low blood pressure, fever, and rash.

How to Treat MIS-C

Much like there is no single test to diagnose MIS-C, there is no singular treatment for MIS-C. Treatment involves managing the varying symptoms and correcting any abnormal lab findings. It is considered supportive care because MIS-C affects multiple systems. Other common treatment options include IV immunoglobulin and anti-inflammatory drugs such as corticosteroids. 

Patients can expect to need, 

• Supplemental oxygen
• IV hydration
• Antibiotics
• Ventilator assistance (if unable to breathe on their own)
• In very rare cases, extracorporeal membrane oxygenation (ECMO) using a machine that does the work of the heart and lungs

Due to the effect on multiple body systems, true healthcare collaboration is essential for treating patients with MIS-C. Oftentimes these patients will require ICU level care and have consultations from cardiology, infectious disease, ophthalmology, and nephrology. Other subspecialties may be involved in the care of the patient depending on the individual symptoms. 

MIS-C remains a rare but possible deadly medical condition as a direct result of a COVID-19 infection despite the decreasing number of coronavirus infections. It’s essential that nurses, healthcare providers, and the general public are aware of the signs and symptoms before there are long-term complications. Through supportive care and diligent lab work - MIS-C is something that the overwhelming majority will fully recover from.