Reports distinguish MIS-C, Kawasaki disease and severe COVID-19 in children | Photo Credits: Canva
New Delhi: So much has changed since the time the COVID-19 outbreak happened at the end of the year, 2019. The viral outbreak not just changed our normal lives as we knew it, new information about the virus also brought to light some shocking revelations. For instance, the COVID-19 disease was initially thought to only be a respiratory illness, but recent findings suggest that it could have an impact on the kidneys and the liver, and a significant impact on the heart as well. Similarly, COVID-19 in children was believed to be not severe, or worrisome, but with time, doctors have found rare inflammatory diseases, similar to Kawasaki disease, in kids infected with the novel coronavirus.
In the month of May, the Centres for Disease Control and Prevention, USA, had named the new condition Multisystem Inflammatory Syndrome in Children (MIS-C).
According to a report by researchers from Children’s Hospital of Philadelphia (CHOP), data that differentiates MIS-C from severe COVID-19 in children and suggests that MIS-C is actually a by-product of the COVID-19 infection, and also different from Kawasaki disease, has come to light.
“This is the first report comparing, head-to-head, the distinct outcomes of SARS-CoV2 in children and provides novel information on disease biology, as well as clinical information that can help practitioners distinguish between the clinical syndromes,” said Edward M. Behrens, MD, Chief of the Division of Rheumatology at CHOP, member of the Immune Dysregulation Frontier Program, and co-senior author of the paper, reported TechnologyNetworks.
The clinical and laboratory measures we describe accurately distinguish between patients with MIS-C and severe COVID-19, which will help physicians provide better, more accurate treatment for their patients.”
The difference in cytokine profiles
The researchers for the study analysed 20 patients who had COVID-19. Nine of these patients had severe COVID-19, five had mild, and six had MIS-C. To differentiate these conditions biologically, the researchers looked at the cytokine levels of each group of patients. Cytokines are immune system response substances that send messages to the immune system and tell it what to do. Cytokine storm is when there are too many cytokines, which leads to severe inflammation and sometimes shock. Cytokine storm is reportedly one of the common reasons for COVID-19 deaths.
The researchers then found that patients with MIS-C had elevated levels of two cytokines – IL-10 and TNF-a – while patients with severe or mild COVID-19 had no minimally elevated levels of cytokines. This profile for MIS-C is distinct from previously reported cytokine profiles in KD, which tend to be associated with mild elevations of other cytokines and not IL-10.
Connection with COVID-19
It was also found that the so-called viral cycle threshold, defined by how many times a test sample must be multiplied and amplified before the virus is detected, also differed between the two conditions. Patients with severe COVID-19 had low cycle thresholds, while those with MIS-C had high cycle thresholds. This supports the theory that MIS-C is a post-viral hyperinflammatory reaction to SARS-CoV-2.
The difference between MIS-C and Kawasaki Disease
According to researchers, while there may be some similarity between the two conditions, it was found that the predominating symptoms do not overlap. Most patients with MIS-C has severe ventricular dysfunction, a symptom not typical in KD.
Patients with MIS-C also tended to have severe gastrointestinal inflammation, which combined with the cytokine data generated by the study, led the team to conclude that MIS-C is a distinct hyperinflammatory syndrome.
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