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Other reports arrived – a death in France, a group in Italy – and in the United States, the CDC gathered what had been observed of the unusual condition and asked doctors to report the corresponding cases to health services. of State. Establishing a case definition is the first step in monitoring what may be a new disease. With him, the CDC learned in mid-May that more than 100 American children had the disease, three of whom had died.
On August 7, the agency updated these figures. By the end of July, 570 American children had experienced this constellation of shock, heart problems and gastrointestinal problems; had blood tests showing inflammation in their body and were positive for Covid-19. Many of them were seriously ill: 364 required treatment in an intensive care unit and 10 died. In many of them, several organs – heart, lungs, kidneys and brain – were affected, giving the disorder its new agreed name of “multisystem inflammatory syndrome in children”. Almost one in five survivors had damage to the kidneys or weakened arteries and aneurysms for which they will need long-term drug treatment and monitoring.
Many of these cases have come from a research network overseen by Randolph, the Overcoming Covid Project, which collects case reports from 70 pediatric referral hospitals across the United States and collects blood and respiratory samples from patients for prepare to launch clinical studies in children with acute Covid-19 disease and with MIS-C. The network released its first report in June, revealing 186 children and adolescents in 26 states and confirming that the new syndrome was causing “serious and potentially fatal illness,” including four deaths. “I think people are very aware of this now,” says Randolph. “They also recognize less severe cases and define that there is a spectrum of disease.”
It seems clear at this point that MIS-C is not Kawasaki: Children affected by the new syndrome are of school age and adolescents, while Kawasaki mainly occurs in toddlers. And almost all of the children reported with MIS-C show evidence of having had a novel coronavirus infection, while the underlying cause of Kawasaki is unknown. But the similarities between the two are enough to illuminate the science of both.
“If you phrase the question like, ‘Are these two diseases the same?’ the answer to that is: clearly no, ”says Jane Burns, professor of pediatrics and director of the Kawasaki Disease Research Center at the University of California, San Diego. “If by the same you mean, ‘These immunological responses in specifically genetically sensitive children, did they arise as a result of exposure of these children, and then they have an unusual immune response to that exposure? So yes, they are exactly the same.
This could be a crucial idea, as it’s actually not uncommon for children to have inflammatory reactions to an infection and doctors never determine exactly what was causing it. Still, it may take a while for researchers to gather enough data to understand the immune processes that create MIS-C, even with the help of networks like Randolph’s.
“Learning what a genetic predisposition might be requires tons of samples, as it’s unlikely to be due to a single rare mutation,” says Burns, who has seen 10 MIS-C patients at his center. As with Kawasaki disease, she said, “it is probably a complex pathway” that allows for a range of responses, from very mild disease to the more severe versions that place children in ICUs. .
Finding a genetic link will be difficult because, seen simply by the numbers, MIS-C is rare, occurring in only about two in 100,000 children. Researchers are concerned, however, that it is not as unusual as these numbers. seem so, because the MIS-C case definition that requires a child to be counted requires proof of infection or exposure – and as has been observed on several occasions since the pandemic began, children can be carriers of the virus symptomless, so their cases are not routinely recognized or recorded.
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