Ep. 57 - LiveWell Talk On...Multi-System Inflammatory Syndrome in Children (Dr. Dilli Bhurtel) May 27, 2020

Ep. 57 - LiveWell Talk On...Multi-System Inflammatory Syndrome in Children

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Dilli Bhurtel, physician, UnityPoint Clinic Pediatric Cardiology

Dr. Arnold (00:10):

This is LiveWell Talk On..multi-system inflammatory syndrome in children. I'm Dr. Dustin Arnold, chief medical officer at St. Luke's Hospital. Multi-System inflammatory syndrome in children has been a trending topic of late as the condition may be linked to COVID-19 infection or exposure in children. Joining us today is Dr. Dilli Bhurtel, from UnityPoint Clinic pediatric cardiology.

Dr. Bhurtel

Thank you for having me here.

Dr. Arnold

Let's start off with what this condition is multi a system inflammatory syndrome in children. Just walk us through what's going on.

Dr. Bhurtel

So exactly, this condition involves, the post-infectious process after certain infections and now we're thinking this is it related the coronavirus infection. After the infection is done, the body produces the immune response and now this immune response, it's affecting the immunities affecting their own body, specifically in children, which is affecting multiple organs.

That's why we're calling it multi-system. It involves abdomen, spleen, it involves their heart and their brain, and then system. So this multisystem involvement, it makes them very sick. And anything that we were confusing this with, whether it is a Kawasaki like illness, and that's where the alert came up from United Kingdom on April 27 saying that, we're seeing the kids like Kawasaki, but that they are not really fitting the criteria of Kawasaki illness. They are more sick and they're behaving like toxic shock syndrome kids. So they indicated this is a new trend coming up but this is not right here. Keep an eye on it – then our colleagues around East coast already started seeing the same trend.

They're not fitting the criteria for Kawasaki. They have definitely a different trend and they are showing some features of cost. Okay. But they are having other features which are not linked to Kawasaki.

Dr. Arnold

That's what we've been seeing based on Kawasaki. I always remember Kawasaki motorcycles. So Kawasaki, Mo M starts with motorcycle.. And it affects the medium size blood vessels. Yes. Is that the same with multi-system inflammatories? It's a medium blood vessels?

Dr. Bhurtel

We don't know much about it. We have seen some of the cases which involved in this medium sized vessels and coronary arteries and what we are seeing more involvement of the myocardium and myo carditis - the heart function gets depressed so that was not seen in typical Kawasaki disease.

We have seen such scenarios but not on not on typical classical cause second digits to really make it very simple. I think we can discuss what is Kawasaki, you know and how it's related and how it is different.

So Kawasaki  disease as we know is almost like we have known about it the last 50 years and it's a febrile illness. Children present with fever, usually typically less than five years old. A fever for five days is a classical presentation. Then they have pink or red eyes, RAs of any kind involving from phase two all body and lips and oral cavity tenderness

So if you have a fever for five days or more and then you have four of the criteria that we just talk, then we put them as Kawasaki disease. We don't have any blood tests to confirm or refute Kawasaki. So it's been a challenge even to diagnose Kawasaki in children. Thankfully it's not that common. It's rare and our colleague and we are very aware of this condition and we're picking up, you know, 67 cases a year and we've been diagnosing and managing them now with the MIC, multi systemic inflammatory syndrome in children. What we're seeing is they may not need to have fever for five days. That's a little different that they appear sick. They have fever, it could be just for 24 hours.

CDC has this come up with this definition here. We don't need the fever for five days. It's different than Kawasaki. We may have just 24 hours of fever, but they have this abdominal symptoms, abdominal pain, vomiting, diarrhea and they are tired. That's okay. That's alerting people and they have this skin manifestation, pink eye…and the clue here is that inflammatory markers that the plot tests that would show significant elevation of these inflammatory markers. When we put these things together like the febrile illness, elevation of the inflammatory markers and this clinical constellation of symptoms in a child who has recent contact or recent diagnosis, of COVID - 19. Then we're saying that, okay, this is MISC.

Multi inflammatory syndrome in children. That is the difference between Kawasaki and MISC.

Dr. Arnold I think even in adult, which is my specialty of course. It’s serious. Does is Kawasaki's disease associated with any sort of prodromal exposure and infection.

Dr. Bhurtel (06:58):

And lots of research going on. It's been thought about any three to four weeks earlier, vital infections or that trigger and some children saws that hyper immune response to that infection. That theory has been there. So we have not yet found the real link, but we know that it is again, the same immune response.