COVID-19 Multi system inflammatory syndrome in children (MIS-C)

Author: FITivate | Published date: March 7, 2022 | Category: Medical
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As we speak, the COVID-19 virus is still spreading rapidly across the world. The risk of severe disease and death has been the highest in older people and in persons with underlying chronic conditions such as cardiac disease, chronic lung disease and cancer. Thankfully, the condition is largely mild in children.

What is MIS-C?

However as of mid-2020, clusters of children in Europe and North America have been reported to require ICU care with a multi system inflammatory condition due to COVID-19 that bears some resemblance to Kawasaki disease and toxic shock syndrome. This condition is now known as Multisystem Inflammatory Syndrome in Children associated with COVID-19, ( MIS-C ). In this article we will be discussing the diagnostic criteria for this syndrome and what are the signs and symptoms to look out for that should prompt you to bring your child to the emergency department or nearest doctor.

Multisystem inflammatory syndrome in children is an uncommon illness that can occur 2-8weeks after the initial COVID-19 infection.

The incidence of MIS-c has been reported to be about 0.14% among all children with COVID19 infection. In Singapore, as of 9 NOV 2021, a total of 5 cases of MIS-C were reported to MOH.

Diagnosing MIS-C

Both the Centre for Disease Control and Prevention ( CDC ) and World health organisation ( WHO ) have published diagnostic criterias.

Diagnostic criteria from CDC (1)

It basically means that we need to suspect MIS-C in someone younger than 2, who has been tested positive for COVID-19 within the past 4 weeks. Presenting now with fever and muti system organ damage that has no other plausible explanation for the signs and symptoms.

Diagnostic criteria from WHO (2)

Of which Singapore is currently adopting.It lays out more specific pointers which are easily identifiable.

  • Age 0-19
  • With evidence of current or recent COVID-19 infection
  • High fever of 38.5 degrees celcius for more than 3 days
  • Various signs and symptoms of each organ system involvements
  • Elevated markers of inflammation in the blood such as CRP and Procalcitonin
  • Excluding other sources of bacteria or viral infection

The salient features that you should be looking out for as worried parents.

  • If your child younger than 19 years old has been diagnosed with COVID-19 within the past 2 months,
  • And If he or she developed a sudden fever of more than 3 days
  • Be careful if your child is also having
  1. lethargy, drowsiness or confusion
  2. headache
  3. red and swollen eyes
  4. red and swollen hands and feet
  5. rash on the body
  6. Shortness of breath
  7. chest pain
  8. abdominal pain, vomiting or diarrhoea


There are treatments available for MIS-C and thankfully , most children recover from it. At this point, the medical world is still not sure why it occurs and which kids will get it. There are evidences which suggest that a small proportion of these kids may get long term heart complications.

But what is important is for all parents to know about MIS-c and to know what to look out for so that you can bring your child to the doctor as soon as possible. Early diagnosis gives you better recovery.

By : Dr Chen Yiming

Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)



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