Multisystem inflammatory syndrome (MIS): a multicentre retrospective review of adults and adolescents in South Africa

Abstract

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Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

“…The time to develop MIS-C after exposure to SARS-CoV-2 is reported to be within five weeks after infection [ 14 ]. The existing data regarding MIS-A suggest a similar convalescent response in adults [ 15 , 16 , 17 , 18 ]. Nevertheless, reports of a multisystem inflammatory syndrome after vaccination (MIS-V) in individuals who had received immunization after recovering from mild COVID-19, or perhaps non-neutralizing antibodies from other coronaviruses, suggest an alternative pathogenesis involving antibody enhancement that leads to the hyper-inflammatory syndrome [ 19 , 20 , 21 ].…”

Multisystem inflammatory syndrome in an adult (MIS-A) due to SARS-CoV-2 infection presenting to a South African hospital

“…Close to 3 million cases of COVID-19 have so far been diagnosed in South Africa, 32 yet only a few isolated reports of MIS-A in the country have been published to date. 7 15 One reason for this may simply be a lack of knowledge about the condition among adult clinicians, resulting in patients with seemingly disparate features of MIS-A not being considered as part of a single clinical entity and a potential for underdiagnosis. Another factor is the lack of appropriate national infrastructure which limits patients’ access to healthcare services.…”

“… 2–5 The condition typically presents at least 2 weeks after acute SARS-CoV-2 infection, although not all patients give a history of preceding symptomatic infection. 7 While not fully understood, the prevailing theory underpinning the pathophysiology is that of excessive post-infectious immune activation resulting in an aberrant inflammatory response, autoantigen recognition and subsequent tissue damage and end-organ dysfunction. 5 8–10 PCR for SARS-CoV-2 is frequently negative in such patients and positive serological testing suggests evidence of recent infection, 2 11 12 though persistent PCR positivity in these patients is well described.…”

“…The syndrome, later termed multisystem inflammatory syndrome in children (MIS-C), is characterised by fever, elevated inflammatory biomarkers and multiorgan involvement 2–5. The condition typically presents at least 2 weeks after acute SARS-CoV-2 infection, although not all patients give a history of preceding symptomatic infection 7. While not fully understood, the prevailing theory underpinning the pathophysiology is that of excessive post-infectious immune activation resulting in an aberrant inflammatory response, autoantigen recognition and subsequent tissue damage and end-organ dysfunction 5 8–10.…”

“…PCR for SARS-CoV-2 is frequently negative in such patients and positive serological testing suggests evidence of recent infection,2 11 12 though persistent PCR positivity in these patients is well described 3 8 9 13. A similar syndrome has subsequently been recognised in adults7 8 11 13–21 and a case definition for multisystem inflammatory syndrome in adults (MIS-A) was published by the Centers for Disease Control and Prevention (CDC) in May 2021 22. However, few cases of MIS-A have been reported in Africa, where unique challenges exist which may limit the recognition and prompt appropriate management of this life-threatening condition.…”