New spectrum of COVID-19 manifestations in children: Kawasaki-like syndrome and hyperinflammatory response

Article Figures & Data

TABLE 1

Case definition for Multisystem Inflammatory Syndrome in Children (MIS-C)

An individual < 21 years presenting with

Fever,^a laboratory evidence of inflammation,^b and evidence of clinically severe illness requiring hospitalization, with multisystem (> 2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
No alternative plausible diagnoses; AND
Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

Additional comments

Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection

↵a Fever > 38.0°C for ≥ 24 hours, or report of subjective fever lasting ≥ 24 hours.
↵b Including, but not limited to, 1 or more of the following: an elevated C-reactive protein, erythrocyte sedimentation rate, fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase, or interleukin 6, elevated neutrophils, reduced lymphocytes and low albumin.
RT-PCR = reverse transcription polymerase chain reaction Reproduced from Centers for Disease Control and Prevention website.⁷

TABLE 2

Comparison of MIS-C and Kawasaki disease in children

	MIS-C	Kawasaki disease
Median age, year (IQR)	9 (5.7-14)	2.7 (1.4-4.7)
High-risk population	African American, Hispanic, Afro-Caribbean	Asian
Gastrointestinal symptoms	+++	+
Shock	++	+
Low ejection fraction	↓↓	Normal or ↓
Coronary abnormality	+	++
Intensive care support	+	++
White blood cell	↑↑	↑
Neutrophil	↑↑	↑
Lymphocyte	↓↓	Normal
Platelet	↓	↑↑
CRP	↑↑↑	↑
Ferritin	↑↑	Normal or ↑
NT-proBNP	↑↑↑	Normal or ↑
Troponin	↑	Normal or ↑
D-dimer	↑↑↑	↑

CRP = C-reactive protein; IQR = interquartile range; MIS-C = multisystem inflammatory syndrome in children; NT-proBNP = N-terminal-proB-type natriuretic peptide
Adapted from references 13–16.