New post-COVID syndrome ‘MIS-C’ can cause lifelong damage to children’s hearts

SAN ANTONIO, Texas — A frightening new set of coronavirus research may lead some parents to think twice about in-person learning this school year. Although many people will never know if they had COVID-19, doctors say a frightening side-effect of the virus is being found in asymptomatic children. Researchers in Texas find a life-threatening inflammation of the heart, believed to be linked to coronavirus, can injure children so badly survivors may need lifelong care afterwards.

The devastating condition, known as Multisystem Inflammatory Syndrome in Children (MIS-C), can emerge in youngsters three to fours weeks after a COVID-19 infection. It’s also referred to as PIMS-TS, short for “pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” in some parts of the world.

Dr. Alvaro Moreira says this condition can strike without warning and affects kids who are healthy and asymptomatic during the pandemic.

“According to the literature, children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C, which is frightening,” the neonatologist from the University of Texas Health Science Center at San Antonio says in a release.

“Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body.”

How does MIS-C affect children?

Moreira and his team examine 662 MIS-C cases around the world from Jan. 1 to July 25, 2020. Just over 70 percent of those cases sent children into the intensive care unit.

All of the young patients had fevers, 73.7 percent experienced abdominal pain or diarrhea, and 68.3 percent were vomiting. Eleven of these children died from MIS-C.

“This is a new childhood disease that is believed to be associated with SARS-CoV-2,” Dr. Moreira explains. “It can be lethal because it affects multiple organ systems. Whether it be the heart and the lungs, the gastrointestinal system or the neurologic system, it has so many different faces that initially it was challenging for clinicians to understand.”

Devastating effects on the heart

Researchers are finding this hidden condition is also causing damage to a child’s heart usually seen in much older patients. Troponin, a marker found in heart attack patients, was discovered in most of the MIS-C cases.

“Almost 90% of the children (581) underwent an echocardiogram because they had such a significant cardiac manifestation of the disease,” Moreira details.

Out of those examinations, 54 percent of the results came back abnormal. These children are experiencing a dilation of coronary blood vessels, a symptom seen in the similar Kawasaki disease. Young patients also suffer depressed ejection fraction, suggesting the heart is struggling to pump oxygenated blood to the body’s tissues.

One in 10 kids with MIS-C had an aneurysm of a coronary vessel. Moreira warns these patients have the highest risk of suffering future heart and health issues.

“These are children who are going to require significant observation and follow-up with multiple ultrasounds to see if this is going to resolve or if this is something they will have for the rest of their lives,” the assistant professor of pediatrics adds.

Weight problems are a key factor

The study reveals children who are obese or overweight are particularly at risk for MIS-C if they have COVID-19. Nearly half the children in the report have an underlying medical condition. Half of those MIS-C patients are either overweight or obese.

When researchers compare this condition to COVID-19, they find MIS-C causes far more inflammation than coronavirus. Troponin markers are 50 times higher than normal in children affected by Multisystem Inflammatory Syndrome.

This incredible amount of inflammation surpasses that caused by two more common childhood conditions, Kawasaki disease and toxic shock syndrome. Luckily, study authors report the treatment for MIS-C seems to be the same.

“The saving grace is that treating these patients with therapies commonly used for Kawasaki – immunoglobulin and glucocorticosteroids – has been effective,” says Moreira.

The study appears in the journal EClinicalMedicine.

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