In a new review study, researchers found multisystem inflammatory syndrome in children (MIS-C), believed to be linked to COVID-19, damages the heart to such an extent that some children will need lifelong monitoring and interventions.
Case studies also showed MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections.
According to previous findings, children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C.
Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body.
The research was conducted by a team at The University of Texas Health Science Center at San Antonio.
The team reviewed 662 MIS-C cases reported worldwide between Jan. 1 and July 25. Among the findings: 71% of the children were admitted to the intensive care unit (ICU), and 60% presented with shock.
The average length of stay in the hospital was 7.9 days, and 100% had a fever, 73.7% had abdominal pain or diarrhea, and 68.3% suffered vomiting.
90% had an echocardiogram (EKG) test and 54% of the results were abnormal, and 22.2% of the children required mechanical ventilation.
4.4% required extracorporeal membrane oxygenation (ECMO), and 11 children died.
The team says this is a new childhood disease that is believed to be associated with SARS-CoV-2. It can be lethal because it affects multiple organ systems.
Whether it be the heart and the lungs, the gastrointestinal system or the neurologic system, it has so many different faces that initially it was challenging for clinicians to understand.
The amount of inflammation in MIS-C surpasses two similar pediatric conditions, Kawasaki disease, and toxic shock syndrome.
The saving grace is that treating these patients with therapies commonly used for Kawasaki—immunoglobulin and glucocorticosteroids—has been effective.
Most of the 662 children suffered cardiac involvement as indicated by markers such as troponin, which is used with great accuracy in adults to diagnose heart attacks.
The damage included: Dilation of coronary blood vessels, a phenomenon is also seen in Kawasaki disease, and depressed ejection fraction, indicating a reduced ability for the heart to pump oxygenated blood to the tissues of the body.
Almost 10% of children had an aneurysm of a coronary vessel. This is a localized stretching or ballooning of the blood vessel that can be measured on an ultrasound of the heart
Children with an aneurysm are at the most risk of a future event. These are children who are going to require significant observation and follow-up with multiple ultrasounds to see if this is going to resolve or if this is something they will have for the rest of their lives.
Another finding from the case studies: Almost half of the patients who had MIS-C had an underlying medical condition, and of those, half of the individuals were obese or overweight.
Generally, in both adults and children, patients who are obese will have a worse outcome.
When compared to the initial COVID-19 infection, inflammatory markers in MIS-C were far more abnormal. For instance, troponin, the marker used in adults to diagnose heart attacks, was 50 times its normal level in children with MIS-C.
One author of the study is Alvaro Moreira, MD, MSc.
The study is published in EClinicalMedicine.
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