Cases of an inflammatory illness that’s associated with COVID-19 and affects children and young adults have been identified in Arizona.
Officials with Phoenix-based Banner Health confirmed they have already seen a few Arizona cases of multisystem inflammatory syndrome in children.
MIS-C illness is rare, said Dr. David Moromisato, chief medical officer for Banner Desert and Cardon Children’s medical centers in Mesa.
Still, it’s important for parents, children and their loved ones to know the signs, because when it does occur, MIS-C can be extremely serious and is potentially fatal, said Moromisato, a pediatric ICU physician.
“All of the pediatric centers around the state are on the lookout for anything that looks like this MIS-C,” he said.
The illness mostly tends to affect young children and teens, although the age range of patients is from about two to young adulthood, early evidence is showing.
Different body parts can become inflamed with MIS-C, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.
Cases in Phoenix, Tucson
The syndrome is believed to be related to COVID-19, the illness caused by the SARS-CoV-2 virus, although that association has not been proven.
“We cannot say at this point that we know at this point that it’s caused by COVID,” said Dr. Josh Koch, division chief of pediatric critical care medicine at Phoenix Children’s Hospital.
“I think right now there’s a strong association with COVID … We think all the markers are there and all the dots are going to line up, but we can’t say right now definitively.”
What researchers do know is that children who get the MIS-C illness may never have been sick with COVID-19, although the majority appear to have been infected with it at some point, and about 25% have active COVID-19 infection.
The MIS-C could be a post-infection inflammatory response. While kids appear to be good at fighting off COVID-19 illness, some of them may be having severe immune responses to the virus that makes them ill.
“We are seeing it from an epidemiological standpoint in areas where COVID hits hard, and then four to six weeks later we see this inflammatory syndrome show up in children,” Koch said.
“We do know for the most part pediatric patients aren’t severely affected by COVID. So it may be that they had this infection for a while and nobody noticed, and then they see the multisystem inflammatory syndrome and they test for COVID and they’ve got it.”
Moromisato had heard of no Arizona cases as of May 28. Since that time, cases have been identified in Phoenix and Tucson, officials with Banner Health confirmed.
“New York is seeing a fair number of cases. They have seen at least 100. But considering how many adults they saw, 100 is not a lot of children,” he said.
Citing patient privacy, Koch would not say whether Phoenix Children’s Hospital had seen any MIS-C cases.
Telltale signs of MIS-C
Evidence is showing that the PCR tests for active COVID-19 in children with MIS-C is mostly negative, but the serology tests for antibodies have been mostly positive, Moromisato said.
“It’s not 100% who have a COVID infection but most of them, like 90%, have had positive antibodies (to COVID). So they had some kind of infection, even if the symptoms were mild, or even asymptomatic, the vast majority have had positive serology,” Moromisato said.
“That’s why they are putting the whole thing together with COVID-19. Most of these kids are coming out positive for the antibody.”
Children will not have all the symptoms, but some telltale signs of MIS-C include:
- Abdominal pain.
- Neck pain.
- Bloodshot eyes.
- Feeling extra tired.
- Swollen hands and feet.
- Red tongue and cracked lips.
“They definitely need to seek care if they see these sorts of symptoms,” Koch said. “This disease can be very bad … The good thing is we are communicating across cities, across states, across countries on how to treat this illness. We do know what works and we know how to treat children with this disease.”
While the syndrome has some symptoms similar to Kawasaki disease, another illness that affects children, they are not the same thing, the U.S. Centers for Disease Control and Prevention says. Kawasaki disease causes blood vessels in young children to become inflamed.
The illness also can look similar to Toxic shock syndrome, caused by bacterial infections, but it’s not that, either, pediatric experts say.
“This seems to be a new disease,” Koch said.
“At first it was thought to be Kawasaki’s and some of the effects are similar because it is affecting the heart like Kawasaki’s does, but it is different. In Kawasaki’s they are uncomfortable, but they are not critically ill,” Moromisato said.
Treatment may include steroids
When children do have MIS-C, they can get very sick very quickly, Moromisato said.
“Quite often they just need supportive care, whether it’s just a little bit of oxygen or just a little bit of IV fluids,” Moromisato said. “We’ve been talking to our colleagues back East who have more experience with treating this in New York, and they are treating with steroids.”
Other possible treatments include IVIG, which is intravenous immunoglobulin. Some children may need medicine to help their heart, and they may need breathing support or machines to help their kidneys, Koch said.
“A lot of subspecialties go into treating these children because it’s a very complicated disease,” Koch said. “Experts in infectious disease, rheumatology, critical care, experts in cardiology, they are all coming together to take care of these children.”
If a child has a fever, red eyes, cracked lips, and they are having vomiting and diarrhea, parents should seek medical attention, Moromisato said. The earlier the intervention for MIS-C, the better, he said.
“Even though we feel that children are not affected (by COVID-19), I think that it’s still important for us to be appropriately socially distancing, not just adults and the elderly, but children,” he said.
“We should be considering when we go out not to be getting into crowds in which you are going to be exposed to a lot of people. Do it for your children as well.”
Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.
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