COVID-19 NEWS
A Protocol for MIS-C
Can a standardized approach help quickly and accurately identify this rare disease ?
Multisystem inflammatory syndrome in children , or MIS-C , is associated with COVID-19 , but has a clinical presentation similar to that of Kawasaki disease , with symptoms like high fever and high inflammatory markers .
“ There are important laboratory and clinical differences that put MIS-C patients at risk for requiring admission to the intensive care unit ,” says Children ’ s Hospital Colorado critical care fellow Christina Osborne , MD .
In addition to being a critical care fellow , Dr . Osborne recently completed a pediatric infectious disease fellowship — coincidentally studying coronavirus prior to the global pandemic . Given her interest in both infectious disease and pediatric critical care , she offered to oversee the creation of a protocol at Children ’ s Colorado to help rule out or rule in patients with suspected MIS-C , allowing for early recognition . The design and implementation of the protocol was collaborative and multidisciplinary , with input from infectious disease , hospital medicine , critical care , cardiology , rheumatology and emergency medicine .
Like in most hospitals across the country , the protocol combines recommendations from the Centers for Disease Control and Prevention , World Health Organization and European Centre for Disease Prevention and Control . But there are several intentional differences .
A COMPREHENSIVE ECHO IS ESSENTIAL
“ When a patient has MIS-C , the body starts to respond in a typical way , developing anti-inflammatory cells to eradicate the coronavirus ,” says Children ’ s Colorado pediatric cardiologist Pei- Ni Jone , MD . “ But then the immune system goes hyperactive and a cytokine storm develops in which the
“ We are fortunate to have such a robust group of providers that have studied Kawasaki disease and management for quite some time , and I think that gave us an advantage in responding to this newly emerging disease .”
CHRISTINA OSBORNE , MD
immune cells starts to harm the normal cells in addition to the virus . So these patients get sicker and faster than those with Kawasaki disease .”
Heart inflammation will often cause damage to the
heart cells . And that sets off a marker called troponin , which can be elevated in patients with MIS-C . Additional tests reveal these patients have low lymphocyte counts , meaning that these cells are fighting the virus and depleting the lymphocytes . That ’ s what makes MIS-C a totally different entity from Kawasaki disease .
Those characteristics trigger steps in the protocol including a comprehensive echocardiogram with coronary imaging and a function assessment of the heart . It ’ s one of the most important steps the multidisciplinary team wrote , says Dr . Jone , and something that ’ s unique to Children ’ s Colorado .
“ It ’ s very sophisticated imaging . These are 1- or 2-millimeter measurements ,” she says . “ If you wait to do that
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