Due to the limited information available on this rare new diagnosis, clinical management has been largely based on expert opinion, including knowledge acquired from treating Kawasaki disease and other systemic inflammatory disorders of childhood, in addition to experience with COVID-19 in adults. Treatment is tailored for each individual child, with input from the various consulting specialists. Approaches vary. The RCPCH initially outlined a provisional approach to clinical management, including guidance on early medical management, monitoring and some general principles of treatment; for the UK, consensus has since been reached regarding a recommended pathway for clinical management (including access to registered clinical trials). The National Institutes of Health provides some general considerations. The American College of Rheumatology provides guidance for clinical management of MIS-C. The American Academy of Pediatrics has also provided some interim guidance. Other proposals have also been made. RCPCH guidance recommends that all affected children should be treated as having suspected COVID-19. Little specific information is available regarding therapeutic effectiveness. Most children who have been treated as for Kawasaki disease have recovered. Supportive care is a mainstay of therapy, and for mild or moderate disease it may be sufficient. Major complications may respond well to more aggressive supportive care. Cardiac and respiratory support may benefit children who present predominantly with shock. Strategies for clinical management tend to be broadly based on anti-inflammatory medications, treatment of shock, and prevention of thrombosis. Most children have received immunomodulatory treatment with intravenous immunoglobulin (IVIG). IVIG has been reported target IL-1β+ neutrophils and their activation in the affected children. Other anti-inflammatory treatments have been used, including corticosteroids at various doses. Good responses have been recorded for IVIG, with or without corticosteroids. Cases requiring steroids due to resistance to IVIG may be more common than in Kawasaki disease. In a minority of cases, cytokine blockers have been used as a supplemental therapy to inhibit production of IL-6 (tocilizumab) or IL-1 (anakinra); TNF-α-inhibitors (infliximab) have also been used. Inotropic or vasoactive agents are often used for children with cardiac dysfunction and hypotension. Anticoagulants have been used. Low-dose aspirin has been used as an antiplatelet drug. Treatment strategies are being considered to prevent serious long-term complications such as coronary artery aneurysms (the main complication of Kawasaki disease). Close outpatient follow-up by a paediatric cardiology team has been recommended.
Multisystem inflammatory syndrome in children
Kawasaki disease
Cutaneous manifestations of COVID-19
Systemic inflammatory response syndrome
Chest pain in children
complications of Typhus
Multiple organ dysfunction syndrome
complications of Sepsis