Researchers are now hunting what is the cause of a rare COVID-19 linked immune disease in children called Multisystem Inflammatory Syndrome MIS-C.
In the beginning of March 2020, Audrey Odom John recognised a kind of new disease in one of her teenage patients. John is chief of paediatric infectious disease at Children’s Hospital of Philadelphia (CHOP).
Within a few weeks John came across two more children having the same symptoms like rashes, inflammation and fever. Out of these three cases two patients had Covid-19 positive people in their family.
However, John was not able to establish a connection between the new disease and Covid-19, but late in April John was sure about the link as an alert came from the United Kingdom.
With rising cases of children having such symptoms CHOP and other paediatric specialists worldwide have tried to understand this disease and came to a conclusion that this new disease is called Multisystem Inflammatory Syndrome (MIS-C) in children. It is something different from Kawasaki disease.
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Doctors had now recognised it and also found an effective treatment. But now they are trying to find out how they can spot it in early stages so that it can be cured quickly.
In order to find out a link between MIS-C and COVID-19, doctors have studied the blood samples from 14 children who suffered from MIS-C and compared them to several children and adults that suffered from Covid-19.
It was found that the inflammatory agents were much higher in the blood samples of MIS-C patients than the sickest adult patient suffering from COVID-19. It was caused due to higher activation of T cells.
Doctors say that MIS-C can be treated effectively with immunosuppressants and various other therapies. Different strategies are being tried across the globe to treat this inflammatory syndrome.
Since November more than 100 patients have been enrolled in the program called PRISM. It is sponsored by the National Institutes of Health. Till now 250 patients suffering from MIS-C and COVID-19 have been enrolled; the researchers will collect their blood, urine and saliva samples.
“All of our efforts … now are to try to capture these samples before [children] start to be treated with these very potent medications,” Virginia Pascual, a pediatric rheumatologist and director of the Gale and Ira Drukier Institute for Children’s Health at Weill Cornell Medicine says.
That’s not easy, says Steven Webber, pediatrician-in-chief at Vanderbilt University, who is leading the study. For parents whose child has fallen suddenly, critically, ill, “It’s hard to think straight,” he says. “And then someone comes along and says, ‘We would really love for you to be in this important study.’”
According to Pascual, this intense response of the immune system could not necessarily be due to the SARS-CoV-2 virus. It could also be due to a subsequent exposure to another virus after COVID-19 infection that causes this abrupt response from the immune system. And the good news is that all these theories can be tested.
It can be cured effectively if the patient gets tested well in time. However such testing facilities are not available at all the healthcare centres. Although most children have recovered, “I don’t think the low mortality is inherent to the disease,” Webber says.
It is also found that the chances of suffering from MIS-C are higher in teenagers and rare in those who are in their 20s.
John is still hoping for accurate diagnosis and targeted treatment for this disease. “Our current approach is a hammer” to squash the entire immune system, John says, and it can have side effects like fluid buildup in the lungs. “There’s definitely room to take a precision immunology approach,” she says. One year after the mystery of MIS-C emerged, she’s eager for answers.
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