Medical experts raise concerns over Multisystem Inflammatory Syndrome in children and adults

AMID the recent death of a sevenyearold Kalamboli boy due to Multisystem Inflammatory Syndrome and more such fatalities across the world health experts have expressed concerns over the inflammatory disease underscoring the need for its timely treatmentMIS C children and A adults can present 2 to 12 weeks after Covid19 and is seen in 12 per cent patients In the case of Std II student Shreyash reported by midday on July 12 the child died due to MIS though his parents claimed he had no Covid symptomsDr Wiqar Shaikh professor of medicine Grant Medical College and Sir JJ Group of Hospitals said MIS which involves swelling of the heart lungs brain and nerves kidneys and skin is one of the many conditions triggered by Covid He said it results in dysregulation of the bodyrsquos immune system causing damage to blood vessels in multiple organs Citing a Lancet article of September 2020 Dr Shaikh said MISrsquo symptoms include fever muscle pain diarrhoea vomiting conjunctivitis breathlessness dizziness skin rash heart and kidney failure MIS also mimics Kawasakirsquos disease another inflammatory condition in children However MIS due to Covid is far more virulent he saidAlso read Covid19 cases in Mumbai remain stableDr Shaikh said there is no definitive test for MIS but the estimation of Creactive protein ferritin levels procalcitonin and Interleukin6 levels could provide circumstantial evidence He said antiinflammatory drugs such as corticosteroids and Intravenous ImmunoGlobulin are given to patients A drug called Anakinra originally marketed for rheumatoid arthritis has now been used in MIS with successDr Subhash Hira Professor of Global Health University of WashingtonSeattle said ldquoMIS occurs after a few weeks of recovering from acute Covid illness or a few weeks after the second jab of a vaccine with symptoms like highgrade fever muscular and joint pains and swellings nausea vomiting and diarrhoea and a faint nonitchy rash on the body These are associated with signs of multisystem inflammation such as high heart rate of gt140min with myocarditis high proteinuria of gt300 ug uncontrolled hypertension uncontrolled or recently precipitated diabetes mellitus brain inflammation called encephalopathy etcrdquoDr Hira said ldquoThey MIS patients improve well with therapy of intravenous steroids dexamethasone 6thinspmg daily The syndrome is potentially more complicated in adults than in childrenrdquo In the case of elderly patients body pain and swellings remain for several months he saidPaediatric expert viewDr Fazal Nabi Director Pediatrics Jaslok Hospital said ldquoSymptoms of MISC include fever for more than 3 days along with rashconjunctivitis diarrheavomiting abdominal pain Diagnosis is often made if clinical symptoms along with laboratory reports suggest Covid19 induced inflammation which should follow the diagnostic criteria as per Directorate General of Health Services MOHFW Government of IndiardquoDr Nabi said MISC often has symptoms seen in other fevers and bacterial infections and some patients fully recover without getting diagnosed Children suffering from MISC are often less than 1 per cent of the total Covid19 infected population said the expertDr Nabi said they still do not know how to prevent postCovid response of the body so itrsquos better to prevent active infection by following a host of measuresmdashvaccination of 18 population social distancing along with cough etiquette hand hygiene wellventilated rooms and cleaning or disinfection of frequently used surfaceslinenWith the new Delta variant expected to trigger a third wave Dr Nabi suggested measures to keep children safe He said a mask is not recommended for kids under 5 years while those between 611 years may wear it under adult supervision Hands must be kept clean while handling masks with soap water or alcohol based handrub If a child is infected with mild symptoms or isolated at home it is advised that heshe is accompanied by a caretaker who has either recovered or received vaccination he saidAlso grandparents should be asked to stay away from children when they are isolated While good nutrition of the child is to be maintained throughout along with routine hygiene measures immunisation of the whole family will prevent severe infection in any of them in the 3rd wave if it comesCDC criteria for MISAgtgt Severe illness requiring hospitalisation in a person aged ge21 yearsgtgt Positive test result for current or previous SARSCoV2 infection nucleic acid antigen or antibody during admission or in the previous 12 weeksgtgt Severe dysfunction of one or more organ systems eg hypotension or shock heart dysfunction arterial or venous thrombosis or acute liver injurygtgt Laboratory evidence of severe inflammation eg raised C Reactive Protein Ferritin DDimer or Interleukin6gtgt Absence of severe respiratory illness is also a key finding