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a lag of several weeks between the peak of COVID-19 How can MIS-C be treated?
cases within communities, and the rise of MIS-C cases. Patients should be referred to their paediatricians as early
as possible. Prompt referral to a specialist is essential
In South Africa, the Western Cape was the first as most patients will require admission. Each patient’s
epicentre in our country and thus reached their first condition must be discussed early with the Paediatric
(and hopefully last) peak of COVID-19 cases earlier Intensive Care team together with the Rheumatology,
than the rest of the provinces. By 31 July 2020, this Infectious Diseases, Immunology and Cardiology teams.
province already reported 23 cases of MIS-C.
Management involves a multidisciplinary team effort. The
Here in Gauteng, we have recently passed our peak of aim of treatment is to reduce the ongoing inflammation
COVID-19 cases, so we are thus starting to see a steady by using immunomodulatory medication, for example,
rise in cases of children presenting with MIS-C. intravenous immunoglobulin, steroids as well as other
agents in order to avoid long term damage to the patient.
How does MIS-C present?
Children can show a wide range of symptoms. Some All parents as well as child health professionals should
may have a rash, some may present with abdominal be vigilant and have a low threshold to recognise MIS-C
pain, diarrhoea or vomiting. Other features may include and promptly refer these patients to the appropriate
a headache, shortness of breath, sore throat, red facilities to get treatment. Since COVID-19 is a relatively
‘strawberry tongue’, conjunctivitis (red eyes), swollen new disease to us, there are still many unknowns with
hands and feet, muscle pain and enlarged lymph nodes. regards to this disease process. Ongoing research
Heart failure is also common, together with acute kidney will no doubt play an important role in assisting us to
injury. All children diagnosed with this condition have better understand the COVID-19 disease as well as its
a persistently high fever for more than 24 hours. complications and long-term outcomes in children.

What is interesting to note is that most of these children
were not very ill, nor did they have obvious symptoms REFERENCES
at the time they were infected with the Coronavirus. 1) Yuen KS, Ye ZW, Fung SY, Chan CP, Jin DY. SARS-CoV-2 and COVID-19: The
most important research questions. Cell Biosci. 2020;10:40. Published 2020
Mar 16. doi:10.1186/s13578-020-00404-4
How is it diagnosed? 2) Royal College of Paediatrics and Child Health Guidance – Paediatric
There is currently no specific test that will tell you if multisystem inflammatory syndrome temporally associated with COVID-19.
a child definitely has MIS-C. A combination of blood 5 May 2020. https://www.rcpch.ac.uk/resources/guidance-paediatric-
tests and many other investigations including a multisystem-inflammatory- syndrome-temporallyassociated-covid-19
3) WHO. Multisystem inflammatory syndrome in children and adolescents
cardiac echo may be done by the doctor. The results, temporally related to COVID-19 Scientific Brief. 15 May 2020. https://www.
in correlation with other findings, may assist with who.int/news-room/commentaries/detail/multisystem- inflammatory-
the diagnosis. On most occasions, blood tests will syndrome-in-children-and- adolescents-with-covid-19
reveal high inflammatory markers. The SARS-CoV-2 4) Webb K, Abraham DR, Faleye A, et al. Multisystem inflammatory
syndrome in children in South Africa. Lancet Child Adolesc Health 2020;
PCR test may be positive or negative. We now have published online August 21 2020. http://dx.doi.org/10.1016/S2352-
antibody testing available in South Africa and if these 4642(20)30272-8
are positive, this may indicate previous exposure to 5) European Centre for Disease Prevention and Control Paediatric
inflammatory multisystem syndrome and SARSCoV-2 infection in children.
the virus and hence may assist with a diagnosis. https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-risk

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