A Comparative Insight- MIS-C, Kawasaki Disease and Covid-19!

Richismita Hazra, Amity University Kolkata

With the expansion of the ongoing pandemic, there have been increasing reports from Europe, North America, Asia and Latin America describing children and adolescents with COVID-19 associated multisystem inflammatory conditions. Pediatric inflammatory multisystem syndrome, also known as Multisystem inflammatory syndrome in children (MIS-C), is a rare but perilous complication which is associated with Covid-19 in a way that it sets in weeks after severe infection with SARS-CoV-19. It has been found that many children with MIS-C had the virus that causes COVID-19 or had been around someone with COVID-19 infection. 

MIS-C results in high fever, organ dis-functioning, inflammation of different body parts like heart, brain or various internal organs as well. Other symptoms like rashes, vomiting, nausea etc. occur in children. Although the pathogenesis of MIS-C is blurred, it has been found to have overlapping features with Kawasaki Disease, also called mucocutaneous lymph node syndrome. Kawasaki disease is an autoimmune vasculitis with the highest frequency among children under 5 years which causes inflammation in the walls of blood vessels in the body. 

In an attempt to draw a parallel, researchers applied systems-level analyses of blood immune cells, cytokines, and autoantibodies in healthy children, children with Kawasaki disease enrolled before COVID-19, children infected with SARS-CoV-2, and children presenting with MIS-C. 

Results showed that hyper inflammation during MIS-C differs from the cytokine storm of SARS-CoV-19. Though its shared traits with Kawasaki disease, differences were observed in the CD4+ T cells, interleukin (IL)-17A, and biomarkers associated with arterial damage. Additional plasma proteins distinguishing MIS-C from Kawasaki was identified by the researchers.

The rarity of this complication is a major limitation for the study of the same. Though this analysis could not shed light on the pathogenesis of MIS-C, it cautioned the application of therapeutic strategies for Kawasaki disease to treatment of MIS-C.

Source:  https://doi.org/10.1016/j.cell.2020.09.016

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