Written by First Physicians Group Pediatrician Jose Tavarez, MD
Kawasaki Disease started popping up in headlines and newsfeeds last month after clusters of children became sick with Kawasaki-like symptoms after having COVID-19 or being exposed to someone infected with COVID-19. The condition is now being called “Multisystem Inflammatory Syndrome in Children,” or sometimes “pediatric multisystem inflammatory syndrome.”
Similar in symptoms and behavior to Kawasaki Disease, the rare syndrome is linked to COVID-19 but is not thought to be contagious. It can cause different organs, arteries and blood vessels to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.
We continue to get questions about the syndrome from concerned patient families at First Physicians Group Pediatrics at Lakewood Ranch. As a pediatrician — and more importantly, as a parent — I understand these concerns, and I wanted to share this information to hopefully ease fears and to provide parents with the info they need to keep their families healthy.
Here’s what parents need to know about Kawasaki Disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C).
What is Kawasaki Disease?
Kawasaki Disease causes “vasculitis,” or “inflammation of the blood vessels,” when the immune system attacks the vascular system. It typically affects children age 5 and younger.
Although KD is a rare disease, it is well known to pediatricians, so we are comfortable identifying and treating it. A speedy diagnosis is critical as it may stop the vascular system inflammation from damaging the patient’s coronary arteries.
Once the disease is diagnosed, the patient should be admitted to the hospital, where he/she will be treated with intravenous (IV) immunoglobulins (antibodies to decrease the inflammation) and aspirin. (This is one of the few instances where it’s OK to give aspirin to a child.)
What are the Symptoms of Kawasaki Disease?
Children who present with Kawasaki Disease typically have a fever over 101 degrees that lasts more than 4 days, along with four or more of the following symptoms*:
- Rash (which could have a different presentation, could be localized or diffused, could be on hands or feet, etc.)
- Changes in extremities (usually edema or swelling and peeling which happens later on the disease)
- Strawberry tongue and/or cracked lips with mucus involvement
- Conjunctivitis in both eyes (red/pink, bloodshot and inflamed eyes)
- Swollen lymph nodes / Adenopathy (neck or cervical nodes)
- Cardiac complications (inflammation of the heart’s coronary arteries)
There is also a condition called “atypical Kawasaki.” It is similar to KD in that children will present with a persistent fever, but the child will have only 2 or 3 of the other symptoms. In these cases, the pediatrician may order blood tests or a sonogram of the heart to confirm there is involvement of the coronary arteries.
What is MIS-C?
Multi-system Inflammatory Syndrome in Children is presenting very similar to Kawasaki Disease, but not all children will have the same symptoms, and everything we know about MIS-C is based on managed reports from across the world.
We know that this is a post-viral syndrome striking the pediatric population and that in most cases, it’s happening 4 to 6 weeks after COVID-19 infection or exposure. While not all children with MIS-C have had COVID-19, most test positive for novel coronavirus.
We also know that MIS-C causes severe inflammation in multiple body systems and that most cases have been diagnosed in kids older than age 5 (unlike KD, which typically affects younger children) but can present in anyone younger than 21, according to the Centers for Disease Control and Prevention (CDC).
Treatment for MIS-C is typically the same as with KD: The child is treated in a hospital with IVIG (antibodies) to decrease inflammation; other treatments, such as steroids or medication to regulate the immune system (immunomodulators) may also be used, depending on the presentation.
The vast majority of MIS-C patients, even the sickest ones, reportedly respond very well to this treatment and recover. And much of the time, the symptoms resolve by themselves.
What are the Symptoms of MIS-C?
Similar to those with Kawasaki Disease, almost all children diagnosed with MIS-C have had persistent high fevers (over 101 degrees) and about 50% of them have a rash or swelling of the hands.
The organs of multiple systems are impacted by MIS-C, and symptoms often include*:
- Fever that lasts at least 1 day
- Severe abdominal pain, vomiting or diarrhea
- Bloodshot eyes (conjunctivitis, pinkeye, inflammation of the eyes)
- Skin rash
- Change in skin color (becoming pale, patchy or blue)
- Difficulty eating or too sick to drink
- Difficulty breathing or rapid breathing
- Cough, congestion, sore throat
- Chest pain or racing heart
- Confusion, irritability or lethargy
- Inflammation of heart lining and heart muscle (cardiovascular system involvement seems to be more severe than with KD)
To diagnose MIS-C, patients must have a fever, be younger than 21, have multi-system involvement and test COVID-19 positive for current or recent infection (or have a known exposure within 3 to 4 weeks prior to the onset of symptoms). Doctors also must rule out all other explanations for the symptoms.
What Should Parents Do?
Do not panic: Keep in mind that most of these symptoms can also be signs of other common viral illnesses. MIS-C is still a very rare condition, as is Kawasaki Disease. However, treatments for both have proven very effective when they are diagnosed in a timely manner.
Look for red flags: Watch for a persistent, high fever accompanied by the other symptoms, particularly gastrointestinal issues, which seem to be the most prevalent; swelling / redness in the hands and feet; redness or cracking in lips or tongue; swollen lymph nodes; or breathing difficulty.
Call your pediatrician: If your child shows signs of severe COVID-19, MIS-C or has a persistent fever plus any of the above symptoms, call your doctor’s office right away and let them know.
Keep kids healthy: Stick to the recommended schedule for your child’s well visits and vaccinations to support their health and immune system.
* Symptoms are based on information from the U.S. Centers for Disease Control and Prevention. This information was posted June 3, 2020. For the most up-to-date related info, please also visit the CDC website.
Board-certified pediatrician Jose Tavarez, MD, serves patients and families at the First Physicians Group Pediatrics office in Lakewood Ranch.