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. 2021 Jan;32(1):17-22.
doi: 10.1111/pai.13361. Epub 2020 Oct 13.

The potential threat of multisystem inflammatory syndrome in children during the COVID-19 pandemic

Hussin A Rothan  1 , Siddappa N Byrareddy  2   3   4
Affiliations

The potential threat of multisystem inflammatory syndrome in children during the COVID-19 pandemic

Hussin A Rothan et al. Pediatr Allergy Immunol. 2021 Jan.

Abstract

Multisystem inflammatory syndrome in children (MIS-C) during the COVID-19 pandemic raised a global alert from the Centers for Disease Control and Prevention's Health Alert Network. The main manifestations of MIS-C (also known as pediatric MIS (PMIS)) in the setting of a severe inflammatory state include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes. In some cases, these symptoms progressed to multi-organ failure. The low percentage of children with asymptomatic cases compared with mild illness and moderate illness could be correlated with the rare cases of MIS-C. One potential explanation for the progression to severe MIS-C disease despite the presence of readily detectable anti-SARS-CoV-2 antibodies could be due to the potential role of antibody-dependent enhancement (ADE). We reason that the incidence of the ADE phenomenon whereby the pathogen-specific antibodies can promote pathology should be considered in vaccine development against SARS-CoV-2.

Keywords: COVID-19; Kawasaki syndrome; SARS-CoV-2; antibody-dependent enhancement; multisystem inflammatory syndrome.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that no conflict of interest exists.

Figures

FIGURE 1
FIGURE 1
The MIS-C cases could increase through the SARS-CoV-2 waves of infection. (A) The number of new COVID-19 cases reported by CDC each day in the United States since the beginning of the outbreak shows wave-like patterns. (B) The hypothetical scheme shows that the susceptibility of children to re-infection with SARS-CoV-2 via ACE2-independent pathway will increase when the accumulated number of children with asymptomatic disease is increasing in the population during the waves of SARS-CoV-2 pandemic
FIGURE 2
FIGURE 2
The ACE2-independent pathway of virus entry depends on the expression of Fc receptors on the cellular membrane of the immune cells. Binding of virus-antibody complex to Fc receptors induces cellular endocytosis resulting in immune cell activation and subsequent acute inflammation
See this image and copyright information in PMC

References

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