The Present State of Understanding of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection - A Comprehensive Review of the Current Literature

Abstract

The coronavirus disease-2019 (COVID-19) has (as of Oct. 14, 2020) infected approximately 38 million people worldwide. The most feared sequelae of COVID-19 in adults are severe, often fatal, lung disease, venous thromboembolic disease, cerebrovascular disease, and multiple organ system failure. Fortunately, unlike adults, most children who contract COVID-19 have a mild respiratory illness or asymptomatic. It is now evident that a small percentage of children develop a critical and novel illness with persistent fever , prominent GI symptoms , single or multi-organ dysfunction including shock and laboratory evidence of profound inflammation which has been termed multisystem inflammatory syndrome in children (MIS-C) by the CDC. Some of the reported cases share features with well-known inflammatory syndromes such as Kawasaki disease, macrophage activation syndrome/hemophagocytic lymphohistiocytosis and toxic shock syndrome. The temporal relationship of MIS-C and COVID-19 suggests a post-infectious immune dysregulation. Patients with MIS-C, especially those with cardiac dysfunction and/or shock, should preferably be managed in pediatric intensive care. We will discuss the epidemiology of MIS-C, similarities with known inflammatory syndromes in children, clinical presentation, and present management options.