Children's Wisconsin hospital identifies cases of multisystem inflammatory syndrome in children
Children's Wisconsin hospital believes it has identified seven suspected cases of multisystem inflammatory syndrome in children in Wisconsin, the first known cases in the state.
The new inflammatory illness has been found in children who have been infected with or exposed to the coronavirus and causes swelling in different organs, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.
The cases have been referred to the Wisconsin Department of Health Services.
Of the seven children with suspected cases, two remain hospitalized in good condition, a Children's spokesman said. The other five were discharged after brief hospital stays and are at home doing well, he said. All of the children were under age 5.
Multisystem inflammatory syndrome can present with many different symptoms, including a persistent high fever, abdominal pain, vomiting, diarrhea, rash, swelling of the hands and feet, and red eyes and tongue.
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According to Children's Wisconsin, when multisystem inflammatory syndrome was first identified globally and in the United States in late April and early May, the hospital created a team to help identify and treat children with cases. This team includes pediatric experts from critical care, infectious disease, hospital medicine, immunology, emergency medicine, rheumatology, hematology, cardiology and primary care.
"This is a very rare condition even for those children we know have COVID-19," said Michael Gutzeit, chief medical officer at Children's Wisconsin.
"It does appear to be associated with COVID-19, but there is no proof that it is caused by COVID-19. We need to gather much more information."
The severe inflammatory disease appears similar, but not the same as Kawasaki disease. But where Kawasaki disease primarily affects the heart and blood vessels, leading to aneurysms or ballooning blood vessels, the new condition can affect the digestive tract, brain, kidney, heart and skin.
Gutzeit said there is no single "red flag" symptom, but urged parents to be alert to any of the following: severe vomiting, diarrhea, an inexplicable rash, trouble breathing and significant fatigue. Symptoms have varied among the patients examined at Children's.
At present, doctors at Children's are treating these pediatric patients with immunoglobulin, a protein considered an essential part of the human immune system. Aside from immunoglobulin, doctors are tailoring their care to the specific symptoms.
On a Zoom call with media Friday, Gutzeit said the majority of cases are in southeast Wisconsin and there is still more to learn about the syndrome.
“While we know a lot about COVID-19, we still have a lot more to learn, and in a very similar way this syndrome is something even newer and only more recently recognized,” Gutzeit said. “There’s still quite a bit to learn about it.”
Frank Zhu, medical director for infection control and prevention control at Children's, is also part of the team investigating the syndrome.
"MIS-C is still extremely rare in children and, while it can be serious, most do recover with medical care," Zhu said.
Zhu said the syndrome is difficult to diagnose and although it is similar to Kawasaki disease, this syndrome is associated with COVID-19, unlike Kawasaki disease.
"We do not know for sure, but the current working diagnosis is this is likely a post-infectious complication of COVID-19," Zhu said. "These patients obviously often do not have positive tests in their nose for the virus, but have positive antibodies ... which suggests to us that this is likely not infectious."
Another aspect that separates this syndrome from Kawasaki disease is it can affect teenagers at a higher rate, Zhu said.
"The best treatment for this is still under investigation," Zhu said. "What has been done for these patients initially is to treat them similar to Kawasaki disease for the ones that are significantly ill and hospitalized."
Zhu said they have treated the patients' inflammation, given them steroids and medication to try to prevent blood clots.
Children's officials encourage parents to contact their pediatricians if they believe their child has the symptoms associated with the syndrome.
"Once they're hospitalized, some of the children can get ill quite quickly," Zhu said. "If you have a suspicion or a concern or if you're child looks recently ill, contact your physician as quickly as possible."