Published in:
01-01-2021 | SARS-CoV-2 | Understanding the Disease
Paediatric Inflammatory Multisystem Syndrome Temporally-Associated with SARS-CoV-2 Infection: An Overview
Published in: Intensive Care Medicine | Issue 1/2021
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In spring 2020 paediatricians working across Europe and the USA [1] alerted colleagues to clusters of previously healthy children presenting with unremitting fever, multisystem inflammation and pancarditis. This syndrome, initially termed Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMS-TS), or by its US variation Multisystem Inflammatory Syndrome in Children (MIS-C; Table 1), appears to be a rare complication of (largely) asymptomatic SARS-CoV-2 infection in children [8]. However, the overlap with other paediatric inflammatory syndromes such as Kawasaki disease (KD) and optimum treatments remain unknown. We provide a narrative overview of PIMS-TS and highlight important knowledge gaps.
Table 1
Abbreviate case definitions from the UK Royal College of Paediatrics and Child Health (RCPCH) for PIMS-TS, the US Centre for Disease Control and Prevention (CDC) for MIS-C, and the World Health Organization (WHO) for multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19
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Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS; RCPCH 2020)
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Multisystem Inflammatory Syndrome in Children (MIS-C; CDC 2020)
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Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 (WHO 2020)
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A child presenting with persistent fever, inflammation and evidence of single or multi-organ dysfunction
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An individual aged < 21 years presenting with fever, inflammation, and severe illness requiring hospitalization, with multisystem (> 2) organ involvement
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Children and adolescents 0–19 years of age with fever > 3 days
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This may include children meeting full or partial criteria for Kawasaki disease
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No alternative plausible diagnoses
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AND two of the following:
- Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs
. Hypotension or shock
. Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities
. Evidence of coagulopathy
. Acute gastrointestinal problems
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Exclusion of any other microbial cause
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Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms
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AND
Elevated markers of inflammation
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SARS-CoV-2 PCR testing may be positive or negative
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Some individuals may fulfil full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
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AND
No other obvious microbial cause of inflammation
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Consider MIS-C in any paediatric death with evidence of SARS-CoV-2 infection
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AND
Evidence of COVID-19, or likely contact with patients with COVID-19
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