Mystery illness in kids is linked to COVID-19

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A Riley infectious disease physician answers questions about multisystem inflammatory syndrome and what symptoms parents should watch for in their children.


By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

A mysterious new illness that is attacking children in the wake of the COVID-19 pandemic has scientists and physicians around the world seeking answers.

That includes doctors at Riley Hospital for Children at IU Health.

Dr. James Wood, pediatric infectious disease specialist at Riley, addresses questions about Multisystem Inflammatory Syndrome in Children (MIS-C), which has been reported in at least 16 states (including Indiana) and six European countries, and what symptoms parents should watch for in their children.

What is multisystem inflammatory syndrome?

According to the Centers for Disease Control and Prevention, MIS-C is a condition in which different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. The cause is unknown, but there appears to be a link to COVID-19.

“The whole medical community has been watching closely to see the medical effects of COVID-19 in kids. Thankfully for the most part, most kids seem to have mild infections,” Dr. Wood said. “However, about a month ago, there started to be cases of this inflammatory syndrome popping up in our country and around the world. Kids were coming in with a disease that seemed similar to Kawasaki disease (a condition that causes inflammation in the walls of blood vessels in the body).

“We know Kawasaki disease; it’s been around for a long time. Nobody knows exactly what triggers it, but it seems to affect kids who have some type of predisposing genetic condition for this inflammatory syndrome. It usually occurs in kids under 10 who develop a robust inflammatory response – fever for five or more days, rash over much of the body, redness in the eyes, swollen lymph nodes, swollen hands and feet, cracked and swollen lips – those are typical Kawasaki symptoms,” he said.

The challenge, he said, is distinguishing it from the new syndrome, which causes similar symptoms in addition to abdominal pain. Riley sees several cases of Kawasaki disease each year, but they don’t come in large clusters, as seems to be happening with the multisystem inflammatory syndrome in other hospitals.

“The hard part of Kawasaki is that it can look like a lot of different things and it can have some abdominal pain symptoms, but certainly with this new syndrome, abdominal pain is one of the major complaints, so that may be a distinguishing feature.”

In addition, Dr. Wood said, reports from other hospitals indicate the heart is often affected in patients with the new syndrome. Inflammation in the coronary arteries has been reported, leading to the heart not pumping as well as it should. Patients are coming in with low blood pressure and other signs of shock, which can lead to organ failure.

New York leads the nation in reports of the mystery syndrome, though Indiana has a small number of confirmed cases as of Friday. This week, Dr. Wood and his colleagues in infectious disease, cardiology, critical care and other specialties met virtually to discuss ways to better track kids with symptoms and reach consensus on how to treat children with the illness.

How is this new syndrome related to COVID-19?

“Most people think it is likely related to COVID, mainly because kids who’ve been reported as coming down with it have either had exposure to someone with COVID or have tested positive for an antibody. So most kids with this do have that link, but at this point we don’t have any definitive tests to say that this is 100 percent related to COVID.”

While most children recover from the mystery illness, the long-term impact is unknown at this point. The CDC issued a health advisory about MIS-C on May 14.

What advice do you have for parents at this time?

“The main thing they should know is that this remains a rare illness, but we do want them to recognize the symptoms – anytime a child has a prolonged fever (more than three or four days), especially now if it’s associated with other signs like rash, red eyes, or if they are just not acting themselves,” he said.

“We want parents to be educated on those symptoms and to get in contact with their doctor. I know right now can be a scary time to be going into the doctor’s office, but we do want people to know that talking to their doctor and not being scared to seek medical attention is appropriate. The most important thing I want to stress is we want parents to know what to look out for but not to panic. It is still very rare.”

The CDC advises parents seek emergency care for their child if they are having trouble breathing, experiencing pain or pressure in the chest, appear confused, are having trouble staying awake, have bluish lips or are suffering severe abdominal pain.

In the midst of COVID-19, how do you mentally prepare for another anomaly in healthcare?

“The key is that although there have been lots of unknowns, this pandemic has really brought our medical community, especially here at Riley and IU Health, closer together in terms of the way we share information and the way we are all working together,” Dr. Wood said.

“Our critical care doctors and everybody at Riley are really good at taking care of kids who are very sick. Although this is new, the things that are involved with this syndrome are not new – our ICU folks know how to take care of kids who have low blood pressure, how to help them breathe if they need help.

“One thing about this pandemic is the communication between our groups has been amazing the last several months. We’ve been able to really talk openly, and we’re able to share and reach out to colleagues across the country to develop guidelines for tracking and treating patients.”

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