Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 - Diagnosis and treatment (2024)

Print

Diagnosis

Multisystem inflammatory syndrome in children (MIS-C) diagnosis is based on a child's symptoms and on ruling out similar conditions. Lab tests can help this process.

Providers rule out active cases of COVID-19 by testing for the virus with a swab of the nose. They also may swab the back of the throat. Providers also use blood tests to rule out inflammatory conditions such as Kawasaki disease, sepsis or toxic shock syndrome.

Many children with MIS-C test negative for a current infection with the COVID-19 virus. But proof of a prior infection can be gathered from an antibody test if a child had COVID-19 but didn't have any symptoms. It also can be collected by noting infections among a child's close contacts. Most kids who get MIS-C have a link to the virus that causes COVID-19 within 2 months of getting sick.

Providers also may order tests to look for inflammation and other signs of MIS-C:

  • Lab tests, such as blood and urine tests, including tests for the level of an inflammatory protein in the blood.
  • Imaging tests, such as a chest X-ray, an echocardiogram, an abdominal ultrasound or a CT scan.
  • Other tests, depending on symptoms.

Treatment

Children with MIS-C are treated in a hospital. Some need treatment in a pediatric intensive care unit. Treatment is supportive care and efforts to lower inflammation in any affected vital organs to protect them from permanent damage. Treatment depends on the type and severity of symptoms and which organs and other parts of the body are affected by inflammation.

Supportive care may include:

  • Fluids, if levels are too low, a condition called dehydration.
  • Oxygen to help with breathing.
  • Blood pressure medicines to treat low blood pressure related to shock or to help with heart function.
  • A breathing machine called a ventilator.
  • Medicines that lower the risk of blood clots, such as aspirin or heparin.
  • In very rare cases, extracorporeal membrane oxygenation (ECMO) using a machine that does the work of the heart and lungs.

Treatment to limit swelling and inflammation may include:

  • Antibiotics.
  • Steroid therapy.
  • Intravenous immunoglobulin (IVIG), a blood product made up of antibodies.
  • Other types of treatment, such as targeted therapies aimed at lowering high levels of proteins called cytokines, which can cause inflammation.

There is no proof that MIS-C is contagious. But there's a chance that your child could have an active infection with the COVID-19 virus or another type of contagious infection. So the hospital will use infection control measures while caring for your child.

More Information

  • Extracorporeal membrane oxygenation (ECMO)

Coping and support

If your child is seriously ill with MIS-C, you may feel overwhelming anxiety and fear. Because MIS-C is rare, you likely don't know anyone who has been through this experience. To help cope with the emotional toll this can take, ask for support. This can range from discussing your feelings with loved ones and friends to asking for help from a mental health professional. Ask your health care team for advice. For your own sake and that of your child, don't try to handle this anxiety and distress by yourself.

Preparing for your appointment

If your child has emergency warning signs of MIS-C or is severely sick, take your child to the nearest emergency department. Or call 911 or your local emergency number. Remember to wear a mask to protect yourself and others.

If your child's symptoms are not severe, contact your child's pediatrician or other health care professional. The provider may want to assess your child or refer you to a provider who specializes in infectious diseases.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. Make a list of:

  • Your child's symptoms, including when they started.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medicines, vitamins or other supplements your child takes, including the dosages.
  • Any group activities your child recently took part in, including the dates.
  • Questions to ask the health care professional.

What to expect from your doctor

Your health care professional is likely to ask you, and your child, depending on your child's age, several questions, such as:

  • When did the symptoms begin?
  • How severe are the symptoms?
  • Has your child been tested for COVID-19?
  • Has your child been exposed to anyone who tested positive for the COVID-19 virus?
  • Does your child go to school?
  • Has your child been involved in any recent group activities, such as sports?
  • Who has your child been in close contact with recently?

Preparing for the appointment makes sure you have time to get all of your questions answered. It helps you learn what the next steps are and why they're important.

By Mayo Clinic Staff

July 22, 2023

Print

  1. For parents: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/mis/mis-c.html. Accessed Dec. 20, 2022.
  2. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://emergency.cdc.gov/han/2020/han00432.asp. Accessed Dec. 30, 2022.
  3. Living guidance for clinical management of COVID-19. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2. Accessed Dec. 30, 2022.
  4. AskMayoExpert. Multisystem inflammatory syndrome in children (MIS-C). Mayo Clinic; 2020. Accessed Jan. 3, 2023.
  5. Information for healthcare providers about multisystem inflammatory syndrome in children (MIS-C). Centers for Disease Control and Prevention. https://www.cdc.gov/mis/mis-c/hcp/index.html. Accessed Jan. 3, 2023.
  6. Coronavirus disease 2019 (COVID-19): How to protect yourself & others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed Jan. 3, 2023.
  7. Son MBF, et al. Coronavirus disease 2019 (COVID-19): Multisystem inflammatory syndrome in children. https://www.uptodate.com/contents/search. Accessed Dec. 30, 2022.
  8. DeSimone DC (expert opinion). Mayo Clinic. Jan. 4, 2023.
  9. Multisystem inflammatory syndrome in children (MIS-C) interim guidance. American Academy of Pediatrics. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance. Accessed Jan. 3, 2023.
  10. Aronoff SC, et al. The natural history of severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children (MIS-C): A systematic review. Journal of the Pediatric Infectious Diseases Society. 2020; doi:10.1093/jpids/piaa112.
  11. Ahmed M, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020; doi:10.1016/j.eclinm.2020.100527.
  12. Feldstein LR, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. The New England Journal of Medicine. 2020; doi:10.1056/NEJMoa2021680.
  13. Dufort EM, et al. Multisystem inflammatory syndrome in children in New York state. The New England Journal of Medicine. 2020; doi:10.1056/NEJMoa2021756.
  14. Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-1 infection — United Kingdom and United States, March-August 2020. MMWR Recommendations and Reports.2020; doi: 10.15585/mmwr.mm6940e1.
  15. Stay up to date. When you've been fully vaccinated. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html. Accessed Jan. 3, 2023.
  16. Melgar M, et al. Council of State and Territorial Epidemiologists/CDC surveillance case definition for multisystem inflammatory syndrome in children Associated with SARS-CoV-2 infection — United States. MMWR Recommendations and Reports. 2022; doi:dx.doi.org/10.15585/mmwr.rr7104a1.
  17. Multisystem inflammatory syndrome in adults (MIS-A). Centers for Disease Control and Prevention. https://www.cdc.gov/mis/mis-a.html. Accessed Dec. 30, 2022.

Related

Associated Procedures

  • Chest X-rays
  • CT scan
  • Echocardiogram
  • Extracorporeal membrane oxygenation (ECMO)
  • Ultrasound

Multisystem inflammatory syndrome in children (MIS-C) and COVID-19

Related information

  • Mayo Clinic Q and A: COVID-19 and multisystem inflammatory syndromes in children and adults - Related informationMayo Clinic Q and A: COVID-19 and multisystem inflammatory syndromes in children and adults
  • COVID-19 in babies and children - Related informationCOVID-19 in babies and children
  • Coronavirus disease 2019 (COVID-19) - Related informationCoronavirus disease 2019 (COVID-19)

CON-20492798

  • Multisystem inflammatory syndrome in children (MIS-C)
Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 - Diagnosis and treatment (2024)

FAQs

How do you treat multisystem inflammatory syndrome in COVID patients? ›

Intravenous immunoglobulins (IVIG) Anti-inflammatory medications. Complete care in our pediatric intensive care unit (PICU) Respiratory (breathing) support.

How common is MIS-C in children after COVID? ›

But in children with MIS-C , after infection with the COVID-19 virus, the blood vessels, digestive system, skin or eyes become swollen and irritated. MIS-C is rare. It most often happens within 2 months after having COVID-19 . The child may have had a known infection.

Does multisystem inflammatory syndrome go away? ›

Prognosis of multi-system inflammatory syndrome in children

Most patients diagnosed with MIS-C recover quickly with treatment. Because this is a newly discovered syndrome, however, the long-term outlook of this condition is still unknown. If your child has been treated for MIS-C, they may need follow-up clinical care.

What are the imaging findings of multisystem inflammatory syndrome in children associated with COVID-19? ›

HIGHLIGHTS. In children with MIS-C associated with COVID-19, the most common thoracic imaging abnormalities were cardiomegaly, congestive heart failure or pulmonary edema, and pleural effusions, whereas in patients with COVID-19, pneumonia is a common abnormality.

What is the best treatment for Covid inflammation? ›

For people with COVID-19 who are in the hospital

Another option is a corticosteroid, such as dexamethasone. That medicine helps lower inflammation. Other medicines include baricitinib (Olumiant) and tocilizumab (Actemra).

What are the long term effects of MIS-C? ›

This can affect many organ systems, including the heart. When children are diagnosed with MIS-C, they may have decreased heart function (meaning how the heart squeezes), enlargement of the coronary arteries (the blood vessels that bring oxygenated blood to the heart) and heart rhythm problems.

How do you diagnose multisystem inflammatory syndrome? ›

How is multisystem inflammatory syndrome in children diagnosed? A healthcare provider will diagnose MIS-C in your child after a physical exam and testing. They'll review your child's symptoms and ask you questions about how long they've had a fever and if and when they tested positive for COVID-19.

What is inflammation after COVID in children? ›

MIS-C is a rare condition that sometimes occurs in children who have had COVID-19 infection. Symptoms of MIS-C typically develop two or more weeks following infection with COVID-19 and involves inflammation of different parts of the body, such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal system.

How do you test for MIS-C? ›

The doctor will also order blood tests to check markers of inflammation and organ function, as well as for a possible bacterial or viral infection. Because MIS-C can affect the heart, the doctor may recommend an electrocardiogram (sometimes called ECG or EKG), a painless test that measures heart function.

Does MIS-C require hospitalization? ›

Once a child has been diagnosed with multisystem inflammatory syndrome (MIS-C), they will be hospitalized and may receive care from a variety of specialists. Some children will need to be in the intensive care unit (ICU) to closely monitor symptoms.

How to reduce inflammation in a child? ›

If treatment is needed, your doctor may recommend:
  1. resting an injured area.
  2. raising the area above the level of the heart to help with swelling.
  3. wrapping the area with a compression bandage to help with swelling.
  4. putting ice on the area to help with pain and swelling (put a towel between the ice and the skin)

Is MIS-C an autoimmune disease? ›

Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 2–6 weeks. The median age of patients with MIS-C is 6–11 years.

What are the criteria for multisystem inflammatory syndrome in children? ›

Multisystem inflammatory syndrome in children (MIS-C) is defined as a clinically serious condition requiring hospitalization involving fever, multi-system organ dysfunction, and an increase in inflammatory biomarkers.

Which of the following is a common symptom of pediatric multisystem inflammatory syndrome? ›

Symptoms of MIS-C may vary from child to child. The main symptoms to watch for are a persistent fever (lasting more than 24 hours and usually present for several days), your child appearing fatigued and ill, rash, red eyes, abdominal pain, vomiting, diarrhea, or loss of appetite or not drinking enough fluids.

What are the features of intestinal disease associated with COVID related multisystem inflammatory syndrome in children? ›

MIS-C presents with fever and evidence of systemic inflammation, which can manifest as cardiovascular, pulmonary, neurologic, and gastrointestinal (GI) system dysfunction. Presenting GI symptoms are seen in the majority, including abdominal pain, diarrhea, and vomiting.

How do you treat multisystem inflammatory syndrome in adults? ›

In addition to the clinical manifestations, the diagnosis of MIS-A requires laboratory evidence of inflammation and SARS-CoV-2 infection. The appropriate treatment for MIS-A remains unclear; anti-inflammatory agents, including intravenous immunoglobulin and corticosteroids, are commonly used.

Does MIS-C get better on its own? ›

Most children diagnosed with MIS-C make a complete recovery. It can be life-threatening and severe in rare cases. They'll need treatment in a healthcare facility, most likely a hospital.

What is multisystem inflammatory syndrome after COVID adults? ›

Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon and under-recognised postinfectious manifestation that presents 4–6 weeks after COVID-19 infection. Patients affected tend to be young or middle-aged, from ethnic minority backgrounds and previously healthy.

What are the symptoms of multisystem inflammatory? ›

Symptoms of MIS-C may vary from child to child. The main symptoms to watch for are a persistent fever (lasting more than 24 hours and usually present for several days), your child appearing fatigued and ill, rash, red eyes, abdominal pain, vomiting, diarrhea, or loss of appetite or not drinking enough fluids.

References

Top Articles
Latest Posts
Recommended Articles
Article information

Author: Pres. Lawanda Wiegand

Last Updated:

Views: 5287

Rating: 4 / 5 (71 voted)

Reviews: 94% of readers found this page helpful

Author information

Name: Pres. Lawanda Wiegand

Birthday: 1993-01-10

Address: Suite 391 6963 Ullrich Shore, Bellefort, WI 01350-7893

Phone: +6806610432415

Job: Dynamic Manufacturing Assistant

Hobby: amateur radio, Taekwondo, Wood carving, Parkour, Skateboarding, Running, Rafting

Introduction: My name is Pres. Lawanda Wiegand, I am a inquisitive, helpful, glamorous, cheerful, open, clever, innocent person who loves writing and wants to share my knowledge and understanding with you.