MIS-C treatment guidelines by WHO - for Children

Multisystem Inflammatory Syndrome (MIS-C) needs special care - an update

MIS-C treatment guidelines by WHO - for Children

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• The stoey: The World Health Organization (WHO) has released fresh guidelines for treating children who develop Multisystem Inflammatory Syndrome (MIS-C) after being exposed to Covid-19 infection.
• What is it: The MIS-C is a condition where various organs of the body are affected by inflammation. The patient develops heart problems, the severity of which may determine the line of treatment.

1. It is a rare but severe hyperinflammatory condition in children and adolescents that typically occurs 2-6 weeks after a Covid-19 infection.
2. It is a potentially deadly condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
3. Children with MIS-C may have a fever and various symptoms, including abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired.

• MIS-C with neurological complications: In a study, young people with the MIS-C syndrome have shown neurological issues which were life-threatening such as strokes or severe encephalopathy (any brain disease that alters brain function or structure). Neurological symptoms include hallucinations, confusion, speech impairments, and problems with balance and coordination. The new findings strengthen the theory that the syndrome is related to a surge of inflammation triggered by an immune response to the virus.
• Causes: As the Syndrome is less researched, there are varied theories as to what causes MIS-C. While some researchers believe that MIS-C is a delayed response to the coronavirus which in turn causes massive inflammation in the body and as a result damages organs. Others believe that it can also be a result of the children’s immune response making antibodies against the virus. There may be a genetic component as not every child develops MIS-C and the presenting symptoms are so varied.
• WHO Guidelines for treatment: It is suggested to use corticosteroids in addition to the standard of care for Kawasaki disease (conditional recommendation, very low certainty) in hospitalised children (0-18 years of age). Commonly referred to as steroids, corticosteroids are a type of anti-inflammatory drug. Corticosteroids along with supportive care resulted in a more effective treatment than either intravenous immunoglobulin plus supportive care or supportive care alone. The treatment was also found to be effective in treating children with Kawasaki disease in association to Covid-19. Not to use corticosteroids in the treatment of patients with non-severe Covid-19 as the treatment brought no benefits, and could even prove harmful.
• Kawasaki disease: It is an acute inflammatory disease of the blood vessels and usually occurs in children below the age of five. The inflammation in the coronary arteries that are responsible for supplying blood to the heart results in enlargement or in the formation of aneurysms (swelling of the wall of an artery), leading to heart attacks. Symptoms: Fever, rashes, redness of the cornea, red and cracked lips, a red tongue and lymph node enlargement of the neck.
• EXAM QUESTIONS: (1) Explain the various aspects of the "Multisystem Inflammatory Syndrome (MIS-C)" linked to Covid-19 infections. (2) What are the WHO's stated precautions for MIS-C disease treatment? Explain.

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