Clinical practice guidelines in multisystem inflammatory syndrome (MIS-C) related to COVID-19: a critical review and recommendations

Abstract

Background Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that develops from and is linked to coronavirus disease 2019. MIS-C is considered a multi-organ dysfunction involving cardiac, renal, respiratory, hematologic, gastrointestinal and neurological symptoms and groups of signs and symptoms such as rash or bilateral non-purulent conjunctivitis, hypotension or shock and acute gastrointestinal problems, which require immediate therapeutic intervention to prevent the aggravation of the patient’s health condition. MIS-C is relatively new in the field of evidence-based medicine; however, there are several clinical guidelines for good clinical practice. For every disorder, the guidelines have different suggestions. Hence, based on the current status of the evidence, recommendations have been combined to form a unified guideline for therapeutic management. Methods This paper compares and evaluates the current MIS-C-specific clinical practice guidelines (namely, American Academy of Pediatrics, American College of Rheumatology, Helen DeVos Children’s Hospital Foundation, Children’s Hospital of The King’s Daughters, and the Infectious Diseases Society of America). The compiled literature was then assessed by the authors separately, and an algorithm was proposed for each disorder, taking into consideration the various guidelines proposed for the management of the disorder. Results The features of MIS-C patients are unified; this is very helpful in managing its symptoms and decreasing mortality rates. In addition, recommendations for pharmacological treatment for MIS-C symptoms are formulated after cross-comparison across five different guidelines. Conclusions This study provides a general interpretation of the results in the context of other evidence and implications for future research. It proposes a unified guideline based on the current evidence, with the best potential to maintain suitable clinical standards in the Saudi Arabian Ministry of Health.

Severe Thrombocytopenic Purpura Associated with COVID-19 in a Pediatric Patient

“… 50 Even though our patient presented a history of low grade fever, elevated D-dimers, ferritin, C-reactive protein, hepatic transaminase, and creatinine, it should be noted that she maintained a clinically good condition throughout the admission period with no signs or symptoms of shock, viral pneumonia, gastrointestinal manifestations, organomegaly, or features of myocardial dysfunction, pericarditis, or coronary abnormalities. Given the WHO defining criteria for MIS-C and the degree of thrombocytopenia, peripheral blood smear, and lack of other physical examination findings, our patient presentation raised the concern for acute ITP rather than MIS-C. 51 According to a consensus report by Provan et al, bone marrow aspiration is not required to make a diagnosis of ITP, but the procedure was performed on our patient in order to assess platelet production and to rule out any lymphoproliferative disorders. 52 …”

Multisystem Inflammatory Syndrome in Children: A Case Report From Japan

“…The World Health Organization (WHO) named this clinical syndrome as multisystem inflammatory syndrome in children (MIS-C). According to the latest statistics updated by the Centers for Disease Control and Prevention in early 2021, the total number of MIS-C patients is only 1659 [ 4 ], and to the best of our knowledge, there have been no reports from Japan. Therefore, information regarding the recognition of MIS-C is needed.…”

Reversible Autoimmune Cardiomyopathy Secondary to a Vaccine-Induced Multisystem Inflammatory Syndrome

“…The management of MIS-V is based on the guides for the treatment of MIS-C and MIS-A; supportive measures and immunomodulatory treatment are crucial to the patient's outcome. Immunosuppressive therapy used is steroids and immunoglobulins [ 15 ]. The steroid is the first-line therapy to suppress the immune and inflammatory process; its mechanism is based on the affinity to a specific receptor on the membranes to modify transcription, affecting protein synthesis; this therapy also inhibits the phospholipase A2 [ 16 , 17 ].…”