Study highlights overlapping symptoms of MIS-C, other illnesses

ByKen Downey Jr.

A study presented at IDWeek underscored the need to identify clinical and laboratory features that distinguish multisystem inflammatory syndrome in children from other similar illnesses, researchers said.

Perspective from David Cennimo, MD

Multisystem inflammatory syndrome in children (MIS-C) is a newly reported condition that has been associated with COVID-19.

In a study that included 39 children aged between 2 and 12 years who were being evaluated for MIS-C, Jeffrey Campbell, MD, a clinical pediatric infectious diseases fellow at Boston Children’s Hospital, and colleagues reported that 19 were diagnosed with MIS-C per the Massachusetts Department of Public Health’s case definition, which includes symptoms that overlap with other childhood infections, including fever and elevated inflammatory markers.

Jeffrey Campell

“While most MIS-C case definitions require clinicians to exclude ‘plausible’ alternative infectious diagnoses, these definitions aren’t uniformly clear about what constitutes a ‘plausible’ alternative diagnosis,” Campbell told Healio.

Seven of the 39 patients received a diagnosis of a non-SARS-CoV-2 infection. Of those seven, five had bacterial infections, one had a viral infection and the other a viral and bacterial coinfection.

Two of the patients diagnosed with MIS-C also had a non-SARS-CoV-2 infection.

“We don’t yet know why some patients develop MIS-C, nor do we know how it affects their immune systems or susceptibility to infections. Hopefully, additional research will shed light on these questions,” Campbell said.

Five of the 19 patients who were diagnosed with MIS-C (26%) received a positive PCR test for SARS-CoV-2 infection. Of these five patients, four were treated with remdesivir.

Of the 39 patients being evaluated for MIS-C, 17 (44%) received IV immune globulin, 14 (36%) received aspirin, four (10%) anakinra and 14 (36%) methylprednisolone. More than half of the patients (n = 21; 54%) received antibacterial therapy and five (13%) received antiviral therapies.

“Clinicians should be aware that symptoms and findings of MIS-C can overlap with symptoms and findings of non-SARS-CoV-2 infections,” Campbell said. “Clinicians should maintain a broad differential diagnosis when evaluating patients with features of MIS-C since non-SARS-CoV-2 infections may either explain these features or occur at the same time as MIS-C.”

Perspective

David Cennimo, MD

David Cennimo

This is an interesting and informative description of children suspected of having MIS-C. It very importantly illustrates the need to keep an open mind when evaluating patients and generating a differential diagnosis. Although we certainly do not want to miss cases of MIS-C, it is imperative that we do not overlook other diagnoses, particularly those that are treatable. Fifty-one percent of the patients investigated were not diagnosed with MIS-C, indicating a high index of suspicion initially. Given the overlapping symptoms, I am struck by the one case of staphylococcal toxic shock as a reminder of this rare but severe infection. Since the current treatments attempted for MIS-C usually include immune modulation (steroids, anakinra, etc.) we must be aware of the potential to worsen active infections and investigate accordingly.

David Cennimo, MD

Clinician and assistant professor of adult infectious diseases

Rutgers New Jersey Medical School

Newark, New Jersey

Disclosures: Cennimo reports no relevant financial disclosures.

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Sources/Disclosures

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Source:

Campbell J, et al. Abstract 82. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).

Disclosures: The authors report no relevant financial disclosures.

IDWeek

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Study highlights overlapping symptoms of MIS-C, other illnesses

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