One year ago, Dr. Audrey Odom John Chief of the Division of Infectious Diseases at Philadephia’s Children’s Hospital, treated a teenage patient for what seemed to be a new disease.
As reported in Science Magazine, several weeks later, Dr. John witnessed two newly admitted children with the same four symptoms which were shock, fever, rash, and inflammation. She also discovered that of the three patients, two had relatives who reported testing positive for the COVID-19 virus.
Dr. John’s suspicions that there may be a connection between the new disease and COVID became a realization after receiving an alert in April from the United Kingdom. The notice reported an increase in cases with pediatric patients showing symptoms similar to those observed by Dr. John. COVID-19 was also reported in some instances. It has now been identified and labeled MIS-C.
A New Disease And International Cooperation
Researchers across the globe are adopting various strategies to treat MIS-C.
The new disease has earned a name: Multisystem Inflammatory syndrome in children (MIS-C). Investigators have determined that MIS-C is unlike Kawasaki disease, a rare inflammatory disorder that affects children after they have had infections.
The two-pronged efforts of the international community began with its recognition of the immune system’s overactivity. As a result, effective treatments have been developed. Secondly, the more difficult task is to find out why the disease develops four to six weeks after being infected with COVID-19.
Reported Cases
The Centers for Disease Control in the U.S. reports over 2600 cases of MIS-C and thirty-three deaths. But the good news is that most children recover from the disease after one week of hospitalization.
Tracking MIS-C
Researchers in the University of Pennsylvania’s infectious disease unit compared samples of blood from fourteen children diagnosed with MIS-C against sixteen children and one hundred adults who had been hospitalized due to acute COVID-19.
Although results showed that both children and adults with acute COVID-19 had elevated immune activation, the levels in MIS-C patients were exceedingly high. This activity occurs when immune cells are activated to protect against potential harm.
An interesting occurrence is that despite the rapidly increasing inflammation in patients with MIS-C, they recovered quickly when treated with immune-suppressing therapies. Yet the inflammation lasted much longer in patients with COVID-19.
In the United States, intravenous immunoglobulin is generally used to treat children. However, the treatment is not usually available in underdeveloped countries.
Emerging Theories
There is no doubt that early discovery and treatment will improve outcomes. Right now investigators are living with suppositions.
If a child tests negative for SARS-CoV-2 using a nasal swab, can the virus still be hiding somewhere else in the body?
Do antibodies that are produced after an infection interact with the body’s tissues?
Does the immune system head into overdrive when it is hit with a second virus?
Why are teenagers seriously affected by MIS-C while those in their twenties are generally not affected?
Other Factors
Black children had a higher risk of needing treatment in the intensive care unit. Seventy-seven percent of children among 1,080 young children in a recent study were Hispanic or black.
One of the researchers describes the current approach as a hammer that squashes the immune system. The concern is that this approach has side effects such as a buildup of fluid in the lungs.
Looking Forward
The researchers hope to see advances in the area of precision immunology, rapid and accurate diagnostics, and targeted treatment.
