Mis-C, the multi-systemic inflammatory syndrome that affects children and young people- time.news

by time news
from Ruggiero Corcella

It is a particular characteristic of manifestation of Sars-Cov-2; similar to Kawasaki disease, but more dangerous. In Italy, 239 cases have been registered so far

I boys between the ages of 12 and 18 get little sick from Covid and rarely have severe forms.

However, in Italy, 28 fatal cases of Covid have been reported in this age group and some adolescents ended up in intensive care due to a multi-systemic inflammation that affects the whole organism, as reiterated in the Corriere, professor Alberto Mantovani (here the article).

At the start of the pandemic, this inflammation affecting multiple organs was defined “Kawasaki-like”, due to the similarities with the rare inflammatory disease of small and medium caliber vessels of all parts of the organism, the cause of which is currently still unknown.

Ma Ormai we talk about Multisystem Inflammatory Syndrome (Mis-C, English acronym for Multisystem inflammatory syndrome – Covid) in pediatric age, even if the scientific community is still divided between those who recognize it a status of autonomy and those who still consider it a manifestation of the spectrum of Kawasaki disease.

Let’s try to understand better what it is with the help of professor Andrea Biondi, director of the Bicocca University Pediatric Clinic of Milan-Bicocca, MBBM Foundation / San Gerardo Hospital of Monza, and the professor Andrea Taddio, associate of Pediatrics at the University of Trieste and advisor to the Rheumatology Study Group of the Italian Society of Pediatrics.

Different definitions for a clinical picture that should make us suspect

What is multisystem inflammatory syndrome and why was it referred to as Kawasaki-like in the beginning?

«Because it evidently had some characteristics that could somehow recall Kawasaki’s disease – explains Andrea Biondi -. Differences from a clinical and pathogenetic point of view gradually emerged between these two forms. There are different definitions of disease which, however, are largely overlapping, and these different definitions are those produced by the World Health Organization, the Centers for disease control and prevention (CDC) of Atlanta USA and the Royal College of Paediatrics and Child Health in UK. A picture emerged that today allows in some way to identify differences between the two pathologies and to have suspicion from the beginning in front of a child or adolescent who presents with high fever, signs of systemic inflammation shown by laboratory tests (increase in neutrophils among leukocytes, elevated Pcr which is an index of inflammation, lymphopenia which obviously is typical of Covid), with signs and symptoms of organ involvement: the heart, lungs, kidneys ».

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Professor Taddio adds: “The important thing, however, is to know that there is an inflammatory form and that it must be treated promptly when it is recognized”.

Age, frequency and other differences

So what are the differences?

«Most of the diseases of Kawasaki occurs under 5 years. Characteristic of Mis-C are older children and 25% of the cases registered by the CDC as of May 2021 – which are 3,742 in the US – are in the 12-18 age range.

Second difference criterion: the Kawasaki is very common in Eastern countries, less from us. Furthermore in Mis-C there is no increase in lymph nodes while in Kawasaki the presence of lymphadenopathy is more common.

Then there are the cardiovascular complications, frequent at diagnosis in Mis-C. Myocardial dysfunction is present at diagnosis and these pictures are associated with severe myocarditis and pericarditis.

From a respiratory point of view, in addition to the non-specific pictures that are also typical of Kawasaki, ie nasal and mucous congestion, pharyngodynia, cough, in Mis-C chest pain and respiratory failure are much more common “, replies the Professor Biondi who, out of 90 pediatric Covid cases followed at San Gerardo between November and April, he had five diagnosed with Mis-C and all in the age group between 12 and 18 years.

Field therapies

How is Mis-C treated?

«The drugs that are used are essentially steroids and high-dose immunoglobulins, or the same therapy used in Kawasaki – replies the director of the pediatric clinic -. Immunoglobulins have an immunomodulatory effect which, associated with the immunosuppressive effect of cortisone, allows you to cure this disease in all cases. Even the thirteen year old boy who went into cardiogenic shock within 24 hours, hospitalized here, came out with this treatment ».

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But another weapon was added to the therapies: “We realized that probably in the most severe cases, add other drugs such as the inhibitor of an inflammatory cytokine called interleukin-1, it can be very effective », explains Andrea Taddio who, together with a group of colleagues, is writing a scientific paper on this very topic.

The cases registered in Italy so far

How many cases of Mis-C are there in Italy?

The rheumatology study group of the Italian Society of Pediatrics has created the first national register. From 10 February 2020 to today, they have been registered 239 .

“We are trying to merge these data into the European register managed by Printo (Pediatric Rheumatology International Trial Organization, the largest international network for the experimentation of new therapies in rheumatic diseases of the child based at the Uoc Clinica Pediatrica e Rheumatologia dell ‘ Giannina Gaslini Institute of Genoa, ed), in order to compare them with other European data in order to have a more robust register.

The cases collected so far come from all over Italy. We have disseminated our initiative through the Sip and many have responded, but iThe Register is on a voluntary basis and therefore it may be that not all Italian cases have been reported».

Serious but treatable disease if diagnosed and treated in time

What is the first evidence you have had from the recorded cases?

«In the first study on 53 children with multi-inflammatory syndrome systemic included in the national register, published on Pediatric Rheumatology (here the article), scientific journal of the European Society of Pediatric Rheumatology (with Professor Marco Cattalini of the University of Brescia, ed) we have confirmed that there is a correlation between SARS-CoV-2 and systemic multi-inflammatory syndrome and we have described its clinical and laboratory characteristics.

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Now we are writing a second scientific work, more focused on the therapeutic aspect: the most important thing is in fact the speed of recognition of the problem and the timeliness of treatment », says Taddio.

«The prognosis of these cases is good. Basically, the disease remains rare overall but there is now an attention to these cases, at least in the pediatric field, so if the therapy is timely, practically everyone heals. In our register unfortunately there was a death, ma all the others recovered without substantially leaving cardiac outcomes».

But vaccines remain fundamental

And the question of vaccines then?

“It’s true, fFortunately, Mis-C is a rare event but represents the most serious condition in Covid in pediatric age – underlines Professor Biondi -. As Professor Mantovani said, the vaccine in adolescence will function as a sort of safety belt, to protect against uncertainty. So the whole controversy over vaccines between 12 and 16 years it is a problem that does not arise for three reasons: first, it is wrong to put the issue in competition with the other groups most at risk, arguing that there are not enough vaccines. The second objection: we are not sure that the vaccine protects against this type of severe complication, but it is reasonable to think that it is because, for good or bad, it is the trigger for Covid. disimmune response in some susceptible individuals. Third, I think people feel that too the more the virus circulates, the more the risk of variants that can be created increases and young people from this point of view are much more intelligent than we think. Because even if vaccine does not mean free everyone, vaccine means extra protection tool. In other words, it will be added to the protections that, alas, we will have to maintain even if vaccinated: face masks, hand washing and spacing».

August 5, 2021 (change August 5, 2021 | 18:58)

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