Understanding SARS-CoV-2-related multisystem inflammatory sy
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When the COVID-19 pandemic was first reported in Asia and initially spread throughout the globe, paediatricians were grateful that children seemed to be only mildly symptomatic with the infection in most cases. Then, an alarming warning came from the National Health Service in England in April 2020 about cases of older school-aged children and adolescents presenting with fever, hypotension, severe abdominal pain and cardiac dysfunction who tested positive for SARS-CoV-2 infection either by nasopharyngeal RT-PCR assay or by antibody testing.

These children had laboratory findings of cytokine storm, including high serum IL-6 levels, and generally required inotropic support to increase cardiac output with rare need for extracorporeal membrane oxygenation. Almost all of these children no longer required intensive care after only a few days and completely recovered, although rare deaths resulted from complications of extracorporeal membrane oxygenation.

Case series of children presenting with this condition have now been reported from the UK, Italy, Spain, France and Switzerland, and the United States. The CDC has developed a case definition for use in the United States and has termed the condition multisystem inflammatory syndrome in children (MIS-C).

KD is presently of unknown aetiology, although substantial recent progress supports a presently unidentified ubiquitous virus as the cause. Patients with MIS-C may have some of the clinical features of KD, including fever, dilation of conjunctival blood vessels, rash and redness of the oropharynx. However, these clinical signs can be observed in many infectious diseases in childhood and are not specific for any one diagnosis. The question has therefore arisen as to whether MIS-C and KD are the same entity.

This article discusses the similarities and differences between MIS-C and Kawasaki disease, focusing on their epidemiology, aetiology and pathophysiological mechanisms.

Source: https://www.nature.com/articles/s41577-020-0367-5
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