• LAC DPH Health Update: Multisystem Inflammatory Syndrome in Children (MIS-C) (7-18-20) LAHAN
• CDC Webinar Clinical Management of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: Slides  Recording 07-16-20.

Patients with MIS-C have presented with a persistent fever, fatigue, and a variety of signs and symptoms including multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic, neurologic) involvement, and elevated inflammatory markers.

Not all children will have the same signs and symptoms, and some children may have symptoms not listed here. A child under investigation for MIS-C should also be evaluated for other infectious (e.g. septic shock) and non-infectious (e.g., malignancy) etiologies that may explain the clinical presentation.

MIS-C may begin weeks after a child is infected with SARS-CoV-2. The child may have been infected from an asymptomatic contact and, in some cases, the child and their caregivers may not even know they had been infected.

Most children diagnosed with MIS-C have had laboratory evidence of either past or current COVID-19 infection and the majority have had no documented underlying medical conditions.

Information on laboratory evaluation, treatment, follow-up, and other clinical considerations for patients with suspected or diagnosed MIS-C have been provided by the CDC and a recently published guidance from the American College of Rheumatology which also compares and contrasts features of MIS-C and Kawasaki Disease as well as providing guidance evaluation and treatment.

• An individual aged <21 years presenting with feverⁱ, laboratory evidence of inflammationⁱⁱ, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
• No alternative plausible diagnoses; AND
• Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

 ⁱFever ≥38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
ⁱⁱIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin

NOTE:

• Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
• Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection
• Note that CDC and LAC DPH case definition for MIS-C differs from the case definition published by the World Health Organization (WHO).