KOCHI: The pandemic has created a new world with many new challenges. It was generally believed that children cope well with Covid-19 and are largely asymptomatic or get by with a mild infection. However, since April this year, paediatricians have been alerted to a new disease related to the immune system’s reaction to Covid. Previously referred to as the Paediatric multisystem Inflammatory Syndrome(PIMS) or as Multisystem Inflammatory Disorder in Children (MIS-C), it is now found to be temporally associated with Covid-19.
The disease manifests after one recovers from Covid or sometimes parallel to an active infection. It is associated with a rapidly progressing state, where the child develops high fever and several systems in their body begin to function poorly. The child could have been totally asymptomatic to Covid, and in fact, may not even have been tested. MIS-C affects all ages. However, in western countries, children aged above 7 years have been mostly affected. In India, cases have been reported so far from places like Kolkata, suggesting that younger children are also significantly affected.
When treated early, children recover well. The condition is not contagious, unless they turn positive for RT-PCR or antigen test. Since MIS-C is considered an immunological reaction to past Covid infection, these children are commonly RT-PCR/antigen negative and will only be antibody positive.
In one-third of infected children, it can mimic another disease called Kawasaki Disease associated with inflammation of the blood vessels to the heart. While most children with MIS-C recover extremely well with no significant long term sequelae, a small proportion can develop complications related to the heart.
First of such cases were reported from the UK in April 2020 .
Ever since, this has been picked up in multiple parts of the world. In India , there are several cases being reported from Chennai, Kolkata, Bengaluru and Mumbai. In May 2020, the Paediatric Rheumatology Society of India, in association with the Indian Academy of Paediatrics issued a new disease alert about MIS-C across the country. With Kerala likely to experience Covid-19 backlash for a while now, we can expect MIS-C patients here too. Parents should be careful not to ignore symptoms in children and get them timely treatment.
The author is a professor & Paediatric Rheumatologist and HOD of the Department of Rheumatology & Clinical immunology, Amrita Institute of Medical Sciences, Kochi
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