Multisystem inflammatory syndrome (MIS) is a rare but severe condition linked to COVID-19, especially in children and adolescents. It is also known as multisystem inflammatory syndrome in children (MIS-C) or pediatric multisystem inflammatory syndrome (PMIS).
MIS is a type of hyperinflammatory response in which different organs in the body become inflamed. The symptoms of MIS can vary, but they typically include fever, rash, abdominal pain, vomiting, diarrhea, and inflammation in the eyes, mouth, and throat. MIS can lead to organ dysfunction, shock, and even death in more severe cases.
MIS appears to be a delayed immune response to COVID-19, occurring several weeks after the initial infection. The exact cause of MIS is not yet fully understood, but it is thought to be related to an overactive immune response triggered by the virus. Although MIS is rare, it is essential to be aware of the symptoms and seek medical attention immediately if they occur, particularly in children and adolescents who have had COVID-19 or been exposed to someone with COVID-19.
Epidemiology
Age and gender: MIS appear to be more common in children and adolescents, particularly those between the ages of 5 and 14. However, it can occur in young adults up to age 21. MIS also appears to affect boys and girls equally.
Timing: MIS typically occurs several weeks after a COVID-19 infection rather than during the acute phase of the illness. The exact timing can vary, but most cases have been reported 2-6 weeks after the initial infection.
Incidence: MIS is a rare complication of COVID-19. According to the Centers for Disease Control and Prevention (CDC), as of December 2021, approximately 8,000 cases of MIS were reported in the United States. However, the incidence may be higher since some cases go undiagnosed or unreported.
Geographic distribution: MIS has been reported in many countries worldwide, but the incidence varies by region. In the United States, for example, the highest rates of MIS have been reported in the Northeast and Southeast regions.
Anatomy
Pathophysiology
The pathophysiology of multisystem inflammatory syndrome (MIS) is not yet fully understood, but it is believed to be related to a dysregulated immune response to the SARS-CoV-2 virus, which causes COVID-19. The virus triggers an immune response that involves the production of cytokines and other inflammatory molecules, which help to fight off the infection. However, in some people with MIS, this immune response becomes overactive and causes widespread inflammation.
It is thought that MIS may be a type of delayed immune response occurring several weeks after the initial COVID-19 infection. A persistent viral antigen may trigger this delayed response, stimulating the immune system even after clearing the virus.
The inflammation associated with MIS can affect multiple organ systems, including the heart, lungs, kidneys, brain, and gastrointestinal tract. MIS can cause myocarditis in the heart, which is heart muscle inflammation. In the lungs, it can lead to acute respiratory distress syndrome (ARDS), a severe lung injury. In the kidneys, it can cause acute kidney injury, and in the brain, it can lead to encephalitis, which is inflammation of the brain tissue.
Etiology
MIS may be caused by a delayed immune response to SARS-CoV-2, which occurs weeks after the initial infection. This delayed response may be triggered by persistent viral antigens or the formation of autoantibodies that target host tissues. MIS may also be related to host factors, such as genetic predisposition to dysregulated immune responses or the presence of comorbidities.
MIS shares some similarities with other inflammatory conditions, such as Kawasaki disease and toxic shock syndrome, which may suggest a shared etiology.
The etiology of MIS is complex and likely involves multiple factors, including both viral and host factors.
Genetics
Prognostic Factors
The most important prognostic factor in MIS is the severity of illness at presentation. Patients with more severe symptoms, such as cardiovascular shock or respiratory failure, are at higher risk of adverse outcomes, including death. Other factors associated with worse outcomes include neurological symptoms, elevated inflammatory markers, and abnormal laboratory values, such as high levels of troponin or D-dimer.
Early recognition and treatment of MIS are also important prognostic factors. Patients who receive timely medical attention, including supportive care and immunomodulatory therapies, are more likely to recover without serious complications. In contrast, delays in diagnosis or treatment can lead to rapid deterioration and poor outcomes.
Clinical History
The clinical history of MIS typically begins with a prodromal phase, characterized by nonspecific symptoms such as fever, fatigue, and gastrointestinal symptoms.
This prodromal phase is usually followed by a hyperinflammatory phase, which is marked by the onset of more severe symptoms, such as:
High fever
Rash
Conjunctivitis
Mucocutaneous lesions (such as cracked lips)
Swollen lymph nodes
Abdominal pain
Vomiting and diarrhea
Respiratory symptoms (such as cough, shortness of breath, or chest pain)
Cardiac symptoms (such as chest pain or palpitations)
MIS can affect multiple organ systems, including the respiratory, gastrointestinal, cardiovascular, and nervous systems. Some patients may develop severe complications such as acute respiratory distress syndrome (ARDS), myocardial dysfunction, shock, and multiorgan failure.
Physical Examination
The severity and type of symptoms can vary from patient to patient, but some common findings on physical examination may include:
Fever: Patients with MIS typically have a high fever that may be persistent and difficult to control with antipyretic medications.
Rash: A rash may be present, which can vary in appearance from maculopapular to petechial or purpuric.
Conjunctivitis: Conjunctivitis, or eye inflammation, is common in patients with MIS.
Mucocutaneous lesions: Patients may develop mucocutaneous lesions, such as cracked lips or a strawberry tongue.
Lymphadenopathy: Swollen lymph nodes may be present, particularly in the neck region.
Abdominal findings: Abdominal examination may reveal tenderness, distension, or hepatosplenomegaly. Patients may also have diarrhea, vomiting, or other gastrointestinal symptoms.
Respiratory findings: Respiratory examination may reveal signs of respiratory distress, such as tachypnea, crackles, or wheezing.
Cardiac findings: Cardiac examination may reveal signs of myocardial dysfunction, such as tachycardia, gallop rhythm, or murmurs.
Neurological findings: Patients may develop neurological symptoms, such as altered mental status, seizures, or focal deficits.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Kawasaki disease: Kawasaki disease is a systemic vasculitis that can affect children under the age of 5 years. It shares many features with MIS, including fever, rash, conjunctivitis, and mucocutaneous lesions.
Toxic shock syndrome: Toxic shock syndrome is a rare but serious bacterial infection that can cause fever, rash, and multiorgan dysfunction.
Sepsis: It is a systemic inflammatory response to infection that can cause fever, hypotension, and organ dysfunction.
Viral infections: Other viral infections, such as adenovirus, enterovirus, and influenza, can cause fever, rash, and multiorgan dysfunction.
Autoimmune disorders: Autoimmune disorders, such as systemic lupus erythematosus (SLE), can cause fever, rash, and multiorgan dysfunction.
Drug reactions: Drug reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, can cause fever, rash, and mucocutaneous lesions.
Malignancy: Rarely, malignancies such as lymphoma can present with fever, lymphadenopathy, and multiorgan dysfunction.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treating multisystem inflammatory syndrome (MIS) typically involves a combination of supportive care and specific therapies to control inflammation and prevent organ damage.
Intravenous immunoglobulin (IVIG): IVIG is a blood product containing antibodies and other proteins that can help control inflammation. IVIG is typically given as a single infusion, and the dose depends on the patient’s weight and disease severity.
Corticosteroids: Corticosteroids are potent anti-inflammatory medications that can help control the systemic inflammation seen in MIS. The NIH guidelines recommend using high-dose methylprednisolone or dexamethasone for severe cases of MIS.
Biologic agents: Biologic agents, such as tocilizumab or anakinra, can help block specific inflammatory pathways that are thought to contribute to MIS. These medications are typically reserved for patients with severe or refractory disease.
Supportive care: Supportive care, such as intravenous fluids, respiratory, and hemodynamic support, may be necessary for patients with severe organ dysfunction.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK587347/
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Multisystem inflammatory syndrome (MIS) is a rare but severe condition linked to COVID-19, especially in children and adolescents. It is also known as multisystem inflammatory syndrome in children (MIS-C) or pediatric multisystem inflammatory syndrome (PMIS).
MIS is a type of hyperinflammatory response in which different organs in the body become inflamed. The symptoms of MIS can vary, but they typically include fever, rash, abdominal pain, vomiting, diarrhea, and inflammation in the eyes, mouth, and throat. MIS can lead to organ dysfunction, shock, and even death in more severe cases.
MIS appears to be a delayed immune response to COVID-19, occurring several weeks after the initial infection. The exact cause of MIS is not yet fully understood, but it is thought to be related to an overactive immune response triggered by the virus. Although MIS is rare, it is essential to be aware of the symptoms and seek medical attention immediately if they occur, particularly in children and adolescents who have had COVID-19 or been exposed to someone with COVID-19.
Age and gender: MIS appear to be more common in children and adolescents, particularly those between the ages of 5 and 14. However, it can occur in young adults up to age 21. MIS also appears to affect boys and girls equally.
Timing: MIS typically occurs several weeks after a COVID-19 infection rather than during the acute phase of the illness. The exact timing can vary, but most cases have been reported 2-6 weeks after the initial infection.
Incidence: MIS is a rare complication of COVID-19. According to the Centers for Disease Control and Prevention (CDC), as of December 2021, approximately 8,000 cases of MIS were reported in the United States. However, the incidence may be higher since some cases go undiagnosed or unreported.
Geographic distribution: MIS has been reported in many countries worldwide, but the incidence varies by region. In the United States, for example, the highest rates of MIS have been reported in the Northeast and Southeast regions.
The pathophysiology of multisystem inflammatory syndrome (MIS) is not yet fully understood, but it is believed to be related to a dysregulated immune response to the SARS-CoV-2 virus, which causes COVID-19. The virus triggers an immune response that involves the production of cytokines and other inflammatory molecules, which help to fight off the infection. However, in some people with MIS, this immune response becomes overactive and causes widespread inflammation.
It is thought that MIS may be a type of delayed immune response occurring several weeks after the initial COVID-19 infection. A persistent viral antigen may trigger this delayed response, stimulating the immune system even after clearing the virus.
The inflammation associated with MIS can affect multiple organ systems, including the heart, lungs, kidneys, brain, and gastrointestinal tract. MIS can cause myocarditis in the heart, which is heart muscle inflammation. In the lungs, it can lead to acute respiratory distress syndrome (ARDS), a severe lung injury. In the kidneys, it can cause acute kidney injury, and in the brain, it can lead to encephalitis, which is inflammation of the brain tissue.
MIS may be caused by a delayed immune response to SARS-CoV-2, which occurs weeks after the initial infection. This delayed response may be triggered by persistent viral antigens or the formation of autoantibodies that target host tissues. MIS may also be related to host factors, such as genetic predisposition to dysregulated immune responses or the presence of comorbidities.
MIS shares some similarities with other inflammatory conditions, such as Kawasaki disease and toxic shock syndrome, which may suggest a shared etiology.
The etiology of MIS is complex and likely involves multiple factors, including both viral and host factors.
The most important prognostic factor in MIS is the severity of illness at presentation. Patients with more severe symptoms, such as cardiovascular shock or respiratory failure, are at higher risk of adverse outcomes, including death. Other factors associated with worse outcomes include neurological symptoms, elevated inflammatory markers, and abnormal laboratory values, such as high levels of troponin or D-dimer.
Early recognition and treatment of MIS are also important prognostic factors. Patients who receive timely medical attention, including supportive care and immunomodulatory therapies, are more likely to recover without serious complications. In contrast, delays in diagnosis or treatment can lead to rapid deterioration and poor outcomes.
The clinical history of MIS typically begins with a prodromal phase, characterized by nonspecific symptoms such as fever, fatigue, and gastrointestinal symptoms.
This prodromal phase is usually followed by a hyperinflammatory phase, which is marked by the onset of more severe symptoms, such as:
High fever
Rash
Conjunctivitis
Mucocutaneous lesions (such as cracked lips)
Swollen lymph nodes
Abdominal pain
Vomiting and diarrhea
Respiratory symptoms (such as cough, shortness of breath, or chest pain)
Cardiac symptoms (such as chest pain or palpitations)
MIS can affect multiple organ systems, including the respiratory, gastrointestinal, cardiovascular, and nervous systems. Some patients may develop severe complications such as acute respiratory distress syndrome (ARDS), myocardial dysfunction, shock, and multiorgan failure.
The severity and type of symptoms can vary from patient to patient, but some common findings on physical examination may include:
Fever: Patients with MIS typically have a high fever that may be persistent and difficult to control with antipyretic medications.
Rash: A rash may be present, which can vary in appearance from maculopapular to petechial or purpuric.
Conjunctivitis: Conjunctivitis, or eye inflammation, is common in patients with MIS.
Mucocutaneous lesions: Patients may develop mucocutaneous lesions, such as cracked lips or a strawberry tongue.
Lymphadenopathy: Swollen lymph nodes may be present, particularly in the neck region.
Abdominal findings: Abdominal examination may reveal tenderness, distension, or hepatosplenomegaly. Patients may also have diarrhea, vomiting, or other gastrointestinal symptoms.
Respiratory findings: Respiratory examination may reveal signs of respiratory distress, such as tachypnea, crackles, or wheezing.
Cardiac findings: Cardiac examination may reveal signs of myocardial dysfunction, such as tachycardia, gallop rhythm, or murmurs.
Neurological findings: Patients may develop neurological symptoms, such as altered mental status, seizures, or focal deficits.
Kawasaki disease: Kawasaki disease is a systemic vasculitis that can affect children under the age of 5 years. It shares many features with MIS, including fever, rash, conjunctivitis, and mucocutaneous lesions.
Toxic shock syndrome: Toxic shock syndrome is a rare but serious bacterial infection that can cause fever, rash, and multiorgan dysfunction.
Sepsis: It is a systemic inflammatory response to infection that can cause fever, hypotension, and organ dysfunction.
Viral infections: Other viral infections, such as adenovirus, enterovirus, and influenza, can cause fever, rash, and multiorgan dysfunction.
Autoimmune disorders: Autoimmune disorders, such as systemic lupus erythematosus (SLE), can cause fever, rash, and multiorgan dysfunction.
Drug reactions: Drug reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, can cause fever, rash, and mucocutaneous lesions.
Malignancy: Rarely, malignancies such as lymphoma can present with fever, lymphadenopathy, and multiorgan dysfunction.
Treating multisystem inflammatory syndrome (MIS) typically involves a combination of supportive care and specific therapies to control inflammation and prevent organ damage.
Intravenous immunoglobulin (IVIG): IVIG is a blood product containing antibodies and other proteins that can help control inflammation. IVIG is typically given as a single infusion, and the dose depends on the patient’s weight and disease severity.
Corticosteroids: Corticosteroids are potent anti-inflammatory medications that can help control the systemic inflammation seen in MIS. The NIH guidelines recommend using high-dose methylprednisolone or dexamethasone for severe cases of MIS.
Biologic agents: Biologic agents, such as tocilizumab or anakinra, can help block specific inflammatory pathways that are thought to contribute to MIS. These medications are typically reserved for patients with severe or refractory disease.
Supportive care: Supportive care, such as intravenous fluids, respiratory, and hemodynamic support, may be necessary for patients with severe organ dysfunction.
https://www.ncbi.nlm.nih.gov/books/NBK587347/
medtigo
Multisystem inflammatory syndrome (MIS)
Updated :
August 23, 2023
Multisystem inflammatory syndrome (MIS) is a rare but severe condition linked to COVID-19, especially in children and adolescents. It is also known as multisystem inflammatory syndrome in children (MIS-C) or pediatric multisystem inflammatory syndrome (PMIS).
MIS is a type of hyperinflammatory response in which different organs in the body become inflamed. The symptoms of MIS can vary, but they typically include fever, rash, abdominal pain, vomiting, diarrhea, and inflammation in the eyes, mouth, and throat. MIS can lead to organ dysfunction, shock, and even death in more severe cases.
MIS appears to be a delayed immune response to COVID-19, occurring several weeks after the initial infection. The exact cause of MIS is not yet fully understood, but it is thought to be related to an overactive immune response triggered by the virus. Although MIS is rare, it is essential to be aware of the symptoms and seek medical attention immediately if they occur, particularly in children and adolescents who have had COVID-19 or been exposed to someone with COVID-19.
Age and gender: MIS appear to be more common in children and adolescents, particularly those between the ages of 5 and 14. However, it can occur in young adults up to age 21. MIS also appears to affect boys and girls equally.
Timing: MIS typically occurs several weeks after a COVID-19 infection rather than during the acute phase of the illness. The exact timing can vary, but most cases have been reported 2-6 weeks after the initial infection.
Incidence: MIS is a rare complication of COVID-19. According to the Centers for Disease Control and Prevention (CDC), as of December 2021, approximately 8,000 cases of MIS were reported in the United States. However, the incidence may be higher since some cases go undiagnosed or unreported.
Geographic distribution: MIS has been reported in many countries worldwide, but the incidence varies by region. In the United States, for example, the highest rates of MIS have been reported in the Northeast and Southeast regions.
The pathophysiology of multisystem inflammatory syndrome (MIS) is not yet fully understood, but it is believed to be related to a dysregulated immune response to the SARS-CoV-2 virus, which causes COVID-19. The virus triggers an immune response that involves the production of cytokines and other inflammatory molecules, which help to fight off the infection. However, in some people with MIS, this immune response becomes overactive and causes widespread inflammation.
It is thought that MIS may be a type of delayed immune response occurring several weeks after the initial COVID-19 infection. A persistent viral antigen may trigger this delayed response, stimulating the immune system even after clearing the virus.
The inflammation associated with MIS can affect multiple organ systems, including the heart, lungs, kidneys, brain, and gastrointestinal tract. MIS can cause myocarditis in the heart, which is heart muscle inflammation. In the lungs, it can lead to acute respiratory distress syndrome (ARDS), a severe lung injury. In the kidneys, it can cause acute kidney injury, and in the brain, it can lead to encephalitis, which is inflammation of the brain tissue.
MIS may be caused by a delayed immune response to SARS-CoV-2, which occurs weeks after the initial infection. This delayed response may be triggered by persistent viral antigens or the formation of autoantibodies that target host tissues. MIS may also be related to host factors, such as genetic predisposition to dysregulated immune responses or the presence of comorbidities.
MIS shares some similarities with other inflammatory conditions, such as Kawasaki disease and toxic shock syndrome, which may suggest a shared etiology.
The etiology of MIS is complex and likely involves multiple factors, including both viral and host factors.
The most important prognostic factor in MIS is the severity of illness at presentation. Patients with more severe symptoms, such as cardiovascular shock or respiratory failure, are at higher risk of adverse outcomes, including death. Other factors associated with worse outcomes include neurological symptoms, elevated inflammatory markers, and abnormal laboratory values, such as high levels of troponin or D-dimer.
Early recognition and treatment of MIS are also important prognostic factors. Patients who receive timely medical attention, including supportive care and immunomodulatory therapies, are more likely to recover without serious complications. In contrast, delays in diagnosis or treatment can lead to rapid deterioration and poor outcomes.
The clinical history of MIS typically begins with a prodromal phase, characterized by nonspecific symptoms such as fever, fatigue, and gastrointestinal symptoms.
This prodromal phase is usually followed by a hyperinflammatory phase, which is marked by the onset of more severe symptoms, such as:
High fever
Rash
Conjunctivitis
Mucocutaneous lesions (such as cracked lips)
Swollen lymph nodes
Abdominal pain
Vomiting and diarrhea
Respiratory symptoms (such as cough, shortness of breath, or chest pain)
Cardiac symptoms (such as chest pain or palpitations)
MIS can affect multiple organ systems, including the respiratory, gastrointestinal, cardiovascular, and nervous systems. Some patients may develop severe complications such as acute respiratory distress syndrome (ARDS), myocardial dysfunction, shock, and multiorgan failure.
The severity and type of symptoms can vary from patient to patient, but some common findings on physical examination may include:
Fever: Patients with MIS typically have a high fever that may be persistent and difficult to control with antipyretic medications.
Rash: A rash may be present, which can vary in appearance from maculopapular to petechial or purpuric.
Conjunctivitis: Conjunctivitis, or eye inflammation, is common in patients with MIS.
Mucocutaneous lesions: Patients may develop mucocutaneous lesions, such as cracked lips or a strawberry tongue.
Lymphadenopathy: Swollen lymph nodes may be present, particularly in the neck region.
Abdominal findings: Abdominal examination may reveal tenderness, distension, or hepatosplenomegaly. Patients may also have diarrhea, vomiting, or other gastrointestinal symptoms.
Respiratory findings: Respiratory examination may reveal signs of respiratory distress, such as tachypnea, crackles, or wheezing.
Cardiac findings: Cardiac examination may reveal signs of myocardial dysfunction, such as tachycardia, gallop rhythm, or murmurs.
Neurological findings: Patients may develop neurological symptoms, such as altered mental status, seizures, or focal deficits.
Kawasaki disease: Kawasaki disease is a systemic vasculitis that can affect children under the age of 5 years. It shares many features with MIS, including fever, rash, conjunctivitis, and mucocutaneous lesions.
Toxic shock syndrome: Toxic shock syndrome is a rare but serious bacterial infection that can cause fever, rash, and multiorgan dysfunction.
Sepsis: It is a systemic inflammatory response to infection that can cause fever, hypotension, and organ dysfunction.
Viral infections: Other viral infections, such as adenovirus, enterovirus, and influenza, can cause fever, rash, and multiorgan dysfunction.
Autoimmune disorders: Autoimmune disorders, such as systemic lupus erythematosus (SLE), can cause fever, rash, and multiorgan dysfunction.
Drug reactions: Drug reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, can cause fever, rash, and mucocutaneous lesions.
Malignancy: Rarely, malignancies such as lymphoma can present with fever, lymphadenopathy, and multiorgan dysfunction.
Treating multisystem inflammatory syndrome (MIS) typically involves a combination of supportive care and specific therapies to control inflammation and prevent organ damage.
Intravenous immunoglobulin (IVIG): IVIG is a blood product containing antibodies and other proteins that can help control inflammation. IVIG is typically given as a single infusion, and the dose depends on the patient’s weight and disease severity.
Corticosteroids: Corticosteroids are potent anti-inflammatory medications that can help control the systemic inflammation seen in MIS. The NIH guidelines recommend using high-dose methylprednisolone or dexamethasone for severe cases of MIS.
Biologic agents: Biologic agents, such as tocilizumab or anakinra, can help block specific inflammatory pathways that are thought to contribute to MIS. These medications are typically reserved for patients with severe or refractory disease.
Supportive care: Supportive care, such as intravenous fluids, respiratory, and hemodynamic support, may be necessary for patients with severe organ dysfunction.
https://www.ncbi.nlm.nih.gov/books/NBK587347/
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