Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Multisystem inflammatory syndrome in children

Neil Chanchlani, Emily Chesshyre and James W. Hart
CMAJ July 11, 2022 194 (26) E909; DOI: https://doi.org/10.1503/cmaj.220384
Neil Chanchlani
Royal Devon University Healthcare NHS Foundation Trust (Chanchlani, Chesshyre, Hart); MRC Centre for Medical Mycology (Chesshyre), University of Exeter, Exeter, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Emily Chesshyre
Royal Devon University Healthcare NHS Foundation Trust (Chanchlani, Chesshyre, Hart); MRC Centre for Medical Mycology (Chesshyre), University of Exeter, Exeter, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
James W. Hart
Royal Devon University Healthcare NHS Foundation Trust (Chanchlani, Chesshyre, Hart); MRC Centre for Medical Mycology (Chesshyre), University of Exeter, Exeter, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with a history of SARS-CoV-2 infection

From March 2020 to May 2021, 406 cases were reported in Canada.1 As of January 2022, the United States reported 1 MIS-C case per 3200 SARS-CoV-2 infections, and 59 deaths.2 Patients usually present within 6 weeks after SARS-CoV-2 infection, and most are positive for SARS-CoV-2 antibodies.3–5

Diagnostic criteria include fever and multiorgan involvement

Most patients are school-aged children (median age 8 yr). Risk factors include male sex; obesity; and Black, Hispanic or South Asian ethnicity. 2,3,5 Although case definitions vary worldwide, diagnostic criteria include fever for at least 24 hours, multisystem involvement and evidence of inflammation.2–4 Cardiovascular shock is common. Older children usually present with gastrointestinal involvement (abdominal pain, diarrhea and vomiting), whereas younger children present with rash, conjunctivitis, strawberry tongue or swollen extremities, similar to Kawasaki disease.3–5 Differential diagnoses include bacterial sepsis, appendicitis and toxic shock syndrome.

Suspected or confirmed MIS-C should prompt hospitalization

Initial symptoms may be mild; however, children can deteriorate quickly and may require intensive care support. Most patients have elevated inflammatory markers (C-reactive protein, ferritin), lymphopenia, elevated cardiac enzymes (troponin, B-type natriuretic peptide) and evidence of coagulopathy, including elevated D-dimer.3–5 Initial treatment with broad-spectrum, intravenous (IV) antibiotics is essential as clinical features overlap with sepsis.1,4,5 Immunomodulation with IV immunoglobulin, with or without methylprednisolone, is the first-line treatment, and should be guided by specialists.2,4,5

Two-thirds of patients will have cardiac involvement

Electrocardiography and echocardiography should be performed in all patients, and may identify features of myocarditis, pericarditis, valvulitis and pathological changes in coronary arteries.2–5 Treatment includes fluid resuscitation, inotropic support and antiplatelet therapy.

Most patients recover fully from the hyperinflammatory state

Response to immunomodulation is usually excellent. Patients should be reviewed by a cardiologist to check resolution of cardiac dysfunction and development of aneurysms of the coronary arteries. Follow-up data are limited; however, in a cohort of 46 children, most (98%) were able to resume full-time education by 6 months, although some continued to report reduced exercise capacity and emotional dysregulation.6

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • Disclaimer: Neil Chanchlani is an associate editor for CMAJ and was not involved in the editorial decision-making process for this article.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    1. El Tal T,
    2. Morin M-P,
    3. Morris SK,
    4. et al
    . Epidemiology and role of SARS-CoV-2 linkage in paediatric inflammatory multisystem syndrome (PIMS): a Canadian Paediatric Surveillance Program national prospective study. medRxiv 2022 May 27. doi: 10.1101/2022.05.27.22275613.
    OpenUrlCrossRef
  2. ↵
    COVID-19 updates: what clinicians need to know about multisystem inflammatory syndrome in children [webinar]. Atlanta: Centers for Disease Control and Prevention; 2022 Feb. 10. Available: https://emergency.cdc.gov/coca/calls/2022/callinfo_021022.asp (accessed 2022 June 1).
  3. ↵
    1. Laverty M,
    2. Salvadori M,
    3. Squires SG,
    4. et al
    . Multisystem inflammatory syndrome in children in Canada. Can Commun Dis Rep 2021;47:461–5.
    OpenUrl
  4. ↵
    1. Berard RA,
    2. Tam H,
    3. Scuccimarri R,
    4. et al
    . Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (spring 2021 update). Ottawa; Canadian Paediatric Society; 2020, updated 2021 May 3. Available: https://cps.ca/en/documents/position/pims (accessed 2022 June 1).
  5. ↵
    1. Merckx J,
    2. Cooke S,
    3. el Tal T,
    4. et al.
    Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC). Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multi-centre cohort study. CMAJ 2022;194:E513–23.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Penner J,
    2. Abdel-Mannan O,
    3. Grant K,
    4. et al.
    GOSH PIMS-TS MDT Group. 6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital: a retrospective cohort study. Lancet Child Adolesc Health 2021; 5:473–82.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 194 (26)
CMAJ
Vol. 194, Issue 26
11 Jul 2022
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Multisystem inflammatory syndrome in children
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Multisystem inflammatory syndrome in children
Neil Chanchlani, Emily Chesshyre, James W. Hart
CMAJ Jul 2022, 194 (26) E909; DOI: 10.1503/cmaj.220384

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Multisystem inflammatory syndrome in children
Neil Chanchlani, Emily Chesshyre, James W. Hart
CMAJ Jul 2022, 194 (26) E909; DOI: 10.1503/cmaj.220384
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with a history of SARS-CoV-2 infection
    • Diagnostic criteria include fever and multiorgan involvement
    • Suspected or confirmed MIS-C should prompt hospitalization
    • Two-thirds of patients will have cardiac involvement
    • Most patients recover fully from the hyperinflammatory state
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Methemoglobinemia in a 28-year-old woman treated with dapsone
  • Methemoglobinemia caused by sodium nitrite overdose
  • Fixed drug eruption
Show more Practice

Similar Articles

Collections

  • Article Types
    • Five Things to Know About
  • Topics
    • Cardiovascular medicine
    • Infectious diseases: COVID-19
    • Internal medicine
    • Pediatrics

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire