Yuma Regional Medical Center is alerting parents of an “autoimmune phenomenon” called MIS-C that is occurring in some children following a COVID-19 infection.
According to Dr. James Leiferman, YRMC’s lead pediatric hospitalist, recently detected multisystem inflammatory syndrome can affect any age group, but it’s primarily occurring in children between the ages of 7 and 13 – as was the case with two of the three cases YRMC reported to the Yuma County Public Health Services District in July.
While MIS-C was initially believed to be a very rare condition, Leiferman said he’s not convinced that’s the case.
“The American Academy of Pediatrics put out some information earlier in the year, when this disorder was first recognized after the outbreak (of COVID-19) in New York, and the message that was sent out to pediatricians was that this is an exceedingly rare complication of COVID,” he said. “Having seen three cases in just two weeks, this is not nearly as rare as we are being led to believe. And I think there are probably subtler cases that aren’t being recognized at all.”
According to Leiferman, YRMC’s pediatricians are looking to the Centers for Disease Control and Prevention (CDC) for the most current information on MIS-C. However, as MIS-C is still a relatively new finding, research on the condition is limited.
“Every day that goes by, there’s more information published about it,” said Leiferman. “Because it’s not all that well defined or described, we want to make people aware of it and get those kids in to see a doctor (if they are exhibiting symptoms). I have a feeling there are milder cases that are not getting recognized at all and just going away on their own, but that has yet to be reported or documented.”
The illness is not contagious, the doctor said, and its symptoms seem to generally last about five days, differing in severity case by case.
According to Leiferman, each of the three children diagnosed with MIS-C in Yuma were transferred to children’s hospitals in the Phoenix area. Two have since been discharged and recovered, while the other – who “got quite a bit sicker than the first two” – was admitted to the ICU and to Leiferman’s knowledge is still receiving treatment there.
Each of the children, according to Leiferman, tested negative for COVID-19 but tested positive for antibodies, indicating that they were previously infected but asymptomatic.
“In most children, COVID infections are silent or asymptomatic,” Leiferman said. “That was the case with all three of ours so far – nobody knew they had it, but they all had a family member who tested positive and was sick with COVID-19, and the parents believed that the child never caught it because the child never had any symptoms. Until they developed this syndrome several weeks later.”
While research on the syndrome is limited, the available data indicates that MIS-C is occurring two to four weeks after a COVID-19 infection.
“We don’t know why some children get it and others don’t,” said Leiferman. “If you think about the number of people in Yuma including children that have COVID right now, the number of children that get this MIS-C is very small. But it’s still not as rare as some of the initial reports made it sound. It’s really an autoimmune phenomenon, meaning basically the body’s immune system is reacting in such a way that it’s attacking its own body and causing these symptoms.”
According to Leiferman, there are some “hallmark symptoms” of MIS-C – stomach symptoms like nausea, diarrhea and abdominal pain, and a fever. There are also some additional symptoms like rashes, headaches, uncharacteristic fatigue and eye redness that is similar to conjunctivitis.
“These kids are getting red eyes but it’s not your standard conjunctivitis, or what parents know as pink eye, because the eyes don’t get crusty or goopy,” said Leiferman. “They’re just red. And that’s unusual for a child. So if (parents) have a child that has a fever and vomiting and red eyes, that should be a red flag to them that this is not your typical stomach flu.”
According to Leiferman, most children who contract the standard stomach flu – known as gastroenteritis – tend to experience symptoms for 24 to 48 hours, while children diagnosed with MIS-C are experiencing prolonged symptoms, though initially they are difficult to detect.
“The reason it’s hard to recognize is because when it starts, it’s not obvious,” said Leiferman. “It’s pretty subtle. But again, the key here is it doesn’t go away in a day or two like most viruses. It keeps hanging on. These kids are all having three, four, five, six days of fever by the time they’re diagnosed, so it’s quite prolonged. So if it seems like it’s not fitting the stereotype of what their kids have had in the past with a ‘stomach flu,’ that’s the time to get them in to see their pediatrician.”
MIS-C, according to Leiferman, bears “quite a few similarities” to Kawasaki disease, an auto-immune disorder believed to follow a viral infection – red eyes, a rash, prolonged fever and cardiac complications.
“Kids with Kawasaki disease develop inflammation of their coronary arteries, and we’re seeing that in probably 50% of patients with this MIS-C as well,” said Leiferman. “That’s why it’s important that it get recognized. There’s a treatment for this illness. It’s treated just like Kawasaki disease right now, and the treatment ideally prevents significant cardiac complications.”
If children begin exhibiting symptoms, Leiferman recommends monitoring them for 24 to 48 hours and if they aren’t “running their typical course,” paying a visit to the pediatrician’s office, which he recommends over the emergency room or an urgent care facility if possible.
“Ideally, you want to see the doctor that is familiar with your child,” said Leiferman.
Additional information on MIS-C can be found online at cdc.gov/mis-c.