The american english Academy of Pediatrics has published interim guidanceexternal icon on multisystem inflammatory syndrome in children ( MIS-C ) .
Case Definition for MIS-C
Reporting Multisystem Inflammatory Syndrome in Children ( MIS-C ) Report possible cases of MIS-C to your local, state, or territorial health department. Questions ? Contact CDC ’ s 24-hour Emergency Operations Center at 770-488-7100. Download and print the Reporting MIS-C fact sheet pdf icon [ 76 KB, 1 page ] to learn more .
As described in the CDC Health Advisory, “ Multisystem Inflammatory Syndrome in Children ( MIS-C ) Associated with Coronavirus Disease 2019 ( COVID-19 ), ” the case definition for MIS-C is :
- An individual aged <21 years presenting with fever*, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
- No alternative plausible diagnoses; AND
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.
*Fever > 38.0°C for ≥24 hours, or report of immanent fever lasting ≥24 hours
**Including, but not express to, one or more of the following : an elevated C-reactive protein ( CRP ), red blood cell deposit pace ( ESR ), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acerb dehydrogenase ( LDH ), or interleukin 6 ( IL-6 ), elevated neutrophils, reduced lymphocytes and low albumin
extra comments :
- Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C.
- Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.
Patients with MIS-C normally portray with haunting fever, abdominal trouble, vomit, diarrhea, skin rash, mucocutaneous lesions and, in dangerous cases, with hypotension and daze. They have elevated testing ground markers of inflammation ( for example, CRP, ferritin ), and in a majority of patients lab markers of wrong to the heart ( for example, troponin ; B-type natriuretic peptide ( BNP ) or proBNP ). Some patients develop myocardial inflammation, cardiac dysfunction, and acute kidney injury. not all children will have the same signs and symptoms, and some children may have symptoms not listed here. MIS-C may begin weeks after a child is infected with SARS-CoV-2. The child may have been infected from an asymptomatic contact and, in some cases, the child and their caregivers may not evening know they had been infected .
For more information on the clinical presentation of MIS-C, listen to the clinician Outreach and Communication Activity ( COCA ) Call, hosted by CDC on May 19, 2020. During this call, clinicians discussed clinical characteristics, how cases have been diagnosed and treated, and how to respond to recently reported cases associated with COVID-19 .
- Testing aimed at identifying laboratory evidence of inflammation as listed in the Case Definition section is warranted.
- Similarly, SARS-CoV-2 detection by RT-PCR or antigen test is indicated.
- Where feasible, SARS-CoV-2 serologic testing is suggested, even in the presence of positive results from RT-PCR or antigen testing. Any serologic testing should be performed prior to administering intravenous immunoglobulin (IVIG) or any other exogenous antibody treatments.
Given the frequent association of MIS-C with cardiac affair, many centers are performing [ 1-3 ] cardiac testing including, but not limited to :
- cardiac enzyme or troponin testing (per the center’s testing standards); and
- B-type natriuretic peptide (BNP) or NT-proBNP.
early testing to evaluate multisystem participation should be directed by patient signs or symptoms. additionally, testing to evaluate for early electric potential diagnoses should be directed by affected role signs or symptoms .
At this time, there have been no studies comparing clinical efficacy of assorted discussion options. Treatments have consisted primarily of supportive care and directed concern against the fundamental inflammatory process. supportive measures have included :
- fluid resuscitation;
- inotropic support;
- respiratory support; and
- in rare cases, extracorporeal membranous oxygenation (ECMO).
anti-inflammatory measures have included the frequent use of IVIG and steroids. The use of other anti-inflammatory medications and the use of anti-coagulation treatments have been variable star. Aspirin has normally been used due to concerns for coronary thrombosis artery affair, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. Thrombotic prophylaxis is often used given the hypercoagulable submit typically associated with MIS-C .
The american College of Rheumatology has developed clinical guidanceexternal icon for pediatric patients diagnosed with MIS-C associated with SARS-CoV-2.
New ICD-10-CM Diagnosis Code for MIS: M35.81 external icon
- Applicable to:
- Multisystem inflammatory syndrome in adults
- Multisystem inflammatory syndrome in children
- Pediatric inflammatory multisystem syndrome
- Use additional code, if applicable, for:
- Sequelae of COVID-19 (B94.8 external icon)
- Personal history of COVID-19 (Z86.16 external icon)
- Exposure to COVID-19 or SARS-CoV-2 infection (Z20.822 external icon)
- Code first, if applicable, COVID-19 (U07.1 external picture
- Code also any associated complications
Patients with a diagnosis of MIS-C should have finale outpatient follow-up, including pediatric cardiology follow-up starting 2 to 3 weeks after discharge .
For more information, see AAP Interim Guidance on Multisystem Inflammatory Syndrome in Children ( MIS-C ) external picture .
Healthcare providers should report suspected cases among patients younger than 21 years of age suffer MIS-C criteria described in the shell definition above to their local, department of state, or territorial health department. Clinicians can report by submitting either completed case report forms or medical records for review to their express, local, or territorial health department. After-hours phone numbers for health departments are available at the Council of State and Territorial Epidemiologists websiteexternal icon. For extra report questions, please contact CDC ’ s 24-hour Emergency Operations Center at 770-488-7100 .