(CNN) – The US Centers for Disease Control and Prevention. USA (CDC) issued a health notice to thousands of doctors across the country on Thursday, advising them to be on the lookout for a new problem syndrome that may be associated with covid-19 infection.
The so-called multi-systemic inflammatory syndrome in children (MIS-C) has been observed in children all Europe and in at least 18 US states, in addition to the District of Columbia.
Doctors in the UK first alerted other doctors to the syndrome in April. Since then, doctors in other countries, including Italy and France, have reported groups of similar cases.
“From about four or five weeks ago, in Europe they described a form of what actually sounded like toxic shock,” said Dr. Jeffrey Burns of Children’s Hospital and Harvard Medical School in Boston. Burns has been coordinating a series of chat video regulars among doctors around the world comparing notes on pediatric cases of covid-19.
“There were a few at first and then more,” Burns told CNN.
The cases were originally believed to be Kawasaki disease, a rare inflammatory condition that generally affects the major arteries and heart. But there were too many cases for it to be Kawasaki, and the doctors agreed that it was a different inflammatory syndrome. Many, but not all, of the children tested positive for either a current covid-19 infection or a past infection.
It is rarely fatal and most children recover, Burns said.
“During March and April, covid-19 cases increased rapidly in New York City and New York State. In early May 2020, the New York City Department of Health and Mental Hygiene received reports of children with multi-system inflammatory syndrome, ”the CDC noted in its health councils.
New York Governor Andrew Cuomo said Thursday that the state Department of Health was investigating 110 cases of the syndrome. “It tends to occur in children who have been exposed to the covid virus and actually now have the antibodies … or still test positive for the covid virus,” Cuomo said at a press conference in Albany.
The CDC said it was still collecting information on the cases.
“There is currently limited information available on risk factors, pathogenesis, clinical course, and treatment for MIS-C. The CDC asks healthcare providers to report suspicious cases to public health authorities to better characterize this recently recognized condition in the pediatric population. ”
The notice provides a case definition to guide clinicians:
- A person under 21 years of age who has fever, evidence of inflammation according to the laboratory, and evidence of clinically severe disease requiring hospitalization, with multi-systemic involvement (more than 2) of organs (heart, kidney, kidney, respiratory, blood, gastrointestinal, dermatological, or neurological)
- No alternative diagnoses possible
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen testing; o exposure to covid-19 within 4 weeks prior to symptom onset
- Fever above 38 ° C for 24 hours or more
- Abnormal blood tests including: an elevated C-reactive protein (PCR), globular sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH) or interleukin 6 (IL-6), neutrophils high, low lymphocytes and low albumin
- Some people may meet full or partial criteria for Kawasaki disease, but must be informed if they meet the case definition for MIS-C
- Consider MIS-C in any infant death with evidence of SARS-CoV-2 infection