key: cord-0808093-coe2pz6p
authors: Brodsky, Nina N.; Ramaswamy, Anjali; Lucas, Carrie L.
title: The mystery of MIS-C post-SARS-CoV-2 infection
date: 2020-10-14
journal: Trends Microbiol
DOI: 10.1016/j.tim.2020.10.004
sha: 19734720cd53ded2688a7711cf2b96f04e3b84ab
doc_id: 808093
cord_uid: coe2pz6p

Following emergence of the COVID-19 pandemic, a surge in the life-threatening illness now termed ‘multisystem inflammatory syndrome in children’ (MIS-C) has raised questions about the unique effects of SARS-CoV-2 in children and adolescents. Two important new studies by Consiglio, et al. and Gruber, et al. begin to shine light on the immune drivers of this enigmatic disease.

Early in the COVID-19 pandemic, epidemiological data offered reassuring evidence that children are largely spared of severe sequelae of SARS-CoV-2. Although that remains true, the severe MIS-C syndrome occurs in an estimated 2 per 100,000 children, based on New York State numbers 1 , and primarily affects school-aged children approximately 4-6 weeks after the peak of total COVID-19 cases in a given region. Since April 2020, over 1,000 cases of MIS-C have been confirmed by the Centers for Disease Control in the US alone, and the clinical features of disease are now well established. MIS-C is characterized by fever and multiorgan dysfunction (including gastrointestinal, cardiovascular, cutaneous, neurologic, respiratory, nephrological, hepatologic) with need for hospitalization in an intensive care unit in up to 80% of patients and a mortality rate of 2%. 2,3 Most children respond well to anti-inflammatory drugs (steroids, intravenous immunoglobulin, and various biologics) and supportive therapy, though a systematic evaluation of best treatments is currently lacking. To date, the pathophysiology of MIS-C remains enigmatic.

Due to a common presentation with rash, myocardial involvement, and coronary aneurisms, MIS-C has been compared extensively with Kawasaki Disease (KD). 3 . MIS-C occurs 4-6 weeks after SARS-CoV-2 infection in children and adolescents and is characterized by a cytokine storm involving innate and adaptive immune cells. The self-limiting acute inflammatory episode is characterized by tissue damage affecting blood vessels, heart, and other organ systems and is associated with potential extravasation of innate immune cells, activation of T cells, and presence of potential autoantibodies. Generated with Biorender.com.

J o u r n a l P r e -p r o o f

Multisystem Inflammatory Syndrome in Children in New York State

Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children

Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from

The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19

Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection

Mapping Systemic Inflammation and Antibody Responses in Multisystem Inflammatory Syndrome in Children (MIS-C)

Multisystem Inflammatory Syndrome in Children and COVID-19 are distinct presentations of SARS-CoV-2

Endothelial cell activation and high interleukin-1 secretion in the pathogenesis of acute Kawasaki disease