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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

The association between pediatric hyperinflammatory condition and SARS-CoV-2 has been termed pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome (in children) (MIS (-C)) . PIMS-TS / MIS (-C) is a serious and heterogeneous disease that particularly affects males, adolescents, racial and ethnic minorities. However, the death rate is low and the short-term outcome is favorable. Long-term follow-up of chronic complications and additional clinical research to elucidate the underlying pathogenesis is crucial.

What is known:

• a new pediatric inflammatory syndrome with multisystem involvement has been described in association with SARS-CoV-2

• to date, case reporting and the use of different case definitions provide insufficient view of the full spectrum clinical, epidemiological and immunological characteristics and prognosis.

What’s new:

• This systematic review illustrates the heterogeneous spectrum of PIMS-TS / MIS (-C)

• Despite its severe presentation, the overall short-term results are good

• The WHO MIS definition is preferable in the more precise, while including most of the cases.

February 8, 2021. Ital J Pediatr. Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): a diagnostic and treatment guidance from the Rheumatology Study Group of the Italian Society of Pediatrics

The authors propose a diagnostic algorithm, to help define cases and support the therapeutic approach.

Misc italia algorithm

MIS-C is a relatively rare syndrome, affecting only 0.6% of children who have come into contact with SARS-CoV2 and usually occurs 3-6 weeks after acute infection. Affected children often require pediatric hospitalization and multi-specialist assessments, sometimes requiring intensive care.

Unlike Covid-19, in which the severity of the clinical presentation is associated with comorbidities and immuno-compromise of the patient, MIS-C appears to affect subjects with no particular comorbidities, except for obesity, and is often complicated by multiorgan dysfunction. .

MIS-C shares some features with other pediatric inflammatory syndromes, but differs with Kawasaki disease, staph and streptococcal toxic shock syndromes, bacterial sepsis, macrophage activation syndrome, and myocarditis. Read the document Multidisciplinary Approach to Multisystem Inflammatory Syndrome Covid-19

Misc italia algorithmEmerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection: a Systematic Review with Meta-analysis

This systematic review with meta-analysis aims to analyze the clinical features, pathogenesis and current treatment options for effective management of children with multisystem inflammatory syndrome. It is crucial for the physician to recognize the disease, differentiate it from other inflammatory conditions, and start treatment early. Further studies are needed for the long-term prognosis, especially in relation to cardiac complications of SARS-CoV-2 associated multisystem inflammatory syndrome.


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