The Covid pandemic has brought with it a whole can of worms, and believe me those worms are all over the show. For the past 18 months it has felt like we are back in Med School, and I have not “studied” and read this much about a single subject for many years.

Although Paediatrics has been spared the brunt of this pandemic, we have seen many children with Covid-19 and luckily most of these cases have been mild, with only flu-like symptoms.

Unfortunately we are also seeing a few cases of Multi Inflammatory Syndrome in Children (MIS-C) or PIMS (Paediatric Multisystem Inflammatory Syndrome) and these are not so innocent. More of these cases were diagnosed in hospitals around Gauteng during the recent third wave with the Delta variant as the prominent strain. Worldwide the incidence of MIS-C seems to be 2 per 100 000 of all children who are diagnosed with Covid-19 infection. A pink canary indeed.

Despite it being so rare it is important that we create awareness around this potentially, life threatening complication of Covid-19 disease. Early and timeous diagnosis of this syndrome can save lives.

What is MIS-C?.
• MIS-C is a rare but extremely serious complication that causes significant inflammation in multiple organs of the body. It can affect the heart, kidneys, brain, skin, eyes or the GIT system. Signs and symptoms may differ depending which organ system is affected.
• It happens post 2-6 weeks post Covid infection. This is very important note, as few people make the association so long after the acute symptoms of Covid has passed. Many children, as many as 50%, will be asymptomatic when they have Covid and it is important that parents and care-givers keep this diagnosis in mind if anyone in the house has had Covid, even if the children were not sick at the time.

How does MIS-C present?
• High fever (usually more than 39º Celsius), that continues for more than three days, 2-6 weeks after there was a history of Covid in the house.

•   One or more of the following symptoms needs to be present.
⁃   Abdominal pain. This pain is a common sign and  is usually severe and relentless.
⁃   Red, bloodshot eyes.
⁃   Swollen red lips and gums . 
⁃   Swollen hand and feet.
⁃   Can have a red rash, or small spots of bruising under the skin, over parts of the body.
⁃   Rapid heart rate, difficulty in breathing.
⁃   May be pale or 
⁃    Cough, tight chest or chest pain.
⁃   Headache and neck pain.
⁃   Drowsiness or confusion.
⁃   Achy and/or swollen joints.
⁃   Diarroea and/or vomiting.
⁃   Extreme lethargy and tiredness.

•   There is usually an indication that the child had Covid or was in close contact with someone who had Covid-19. This can include a positive PCR, rapid antigen test or antibody test.

Why does this happen?
We don’t really have all the answers at the moment, but it seems the acquired immunity after acute Covid infection may set the ball rolling and cause immune dysregulation, leading to development of high levels of inflammatory cells, that may attack the different organs.

How is MIS-C diagnosed?
• Other causes of serious bacterial infections are ruled out by the attending Dr.
• Blood tests to check, heart, kidney and liver functions, as well as markers of serious inflammation in the body, will be requested.
• Assessment by Paediatric Cardiologist to detect specific changes in the arteries that supply the heart muscle of blood.
• Sonars, CT scans and MRI’s of the abdomen, chest and brain might be necessary to evaluate the function of these organs and to detect if blood clots ( very common in MIS-C ) may have formed in there.

Who is at risk to develop MIS-C?
• This syndrome seems to occur more in the age group of 3-12 years, with a median age of 8 years.
• Children who have co-morbid conditions are generally more at risk to contract serious acute Covid-19 symptoms. Although a few cases have been diagnosed in children with underlying heart, lung and neurological conditions, it seems that MIC-C is more prevalent in previously healthy individuals without definite co-morbid conditions. The most common co-morbidities that is seemingly linked to the development of MIS-C is serious asthma and obesity.

Can MIS-C be treated?
• Luckily the answer is yes. Using a combination of Intravenous antibodies, steroids and with supportive treatment of heart, brain and kidney function, most children make a complete recovery. Again, early diagnosis leads to early initiation of treatment and a better chance of recovery.
• Prevention is better than cure. Vaccines will not be available for our children for many months to come and the only way to protect them is to vaccinate ourselves and create a safety cocoon around our kids and other vulnerable individuals. Don’t delay! Please please vaccinate!

You may ask why do I talk about such a rare condition? I also asked myself this question and I have this to say; Covid has taken so much from us already. It has taken our loved ones, our friends, our freedom and our security. If I can can save even one child’s life by raising awareness of this illness, then it is totally worth it.

Sending healthy hugs
XOXO Dr Christa
@drchristas