C T Online Desk: A post-Covid health condition developing among children, medically known as multisystem inflammatory syndrome in children or MIS-C, is becoming a growing cause for concern among Bangladeshi paediatricians.
MIS-C is a medical condition that causes inflammation to multiple body parts, including the heart, kidney, brain, lungs, skin and eyes.
The cause of the health condition is still being investigated after it was first reported in the UK in 2020.
But deaths caused by the condition have been confirmed across the globe, including in Bangladesh.
MIS-C without medical attention could be fatal with some international studies suggesting that it could cause 10 times more deaths than Covid-19 is known to cause among children.
‘The condition occurs because of an exaggerated immunological reaction of body to viral infection,’ explained child health expert Mohammad Hanif, adding that the condition could have a very high rate of mortality.
Children who have had Covid-19 must be carefully observed to see if they suffer continued illness or weakness or parts of their body get inflamed, physicians said.
The Institute of Epidemiology, Disease Control and Research in a study found 243 cases of MIS-C in nine hospitals in 2021 and 11 of them died because of the condition.
The study report was not officially published yet.
But until September last year, the IEDCR officially said, there were 111 cases of MIS-C identified by 15 hospitals.
Of the cases, 53 occurred in children aged between 0 and 5 years, 31in children between 5 and 10 and 23 in children between 10 and 15.
Only four cases occurred between 15 and 20 years.
‘Exhaustion or continued weakness among Covid survivor children could be an important indicator of developing the condition,’ said IEDCR principal scientific office ASM Alamgir.
He said that children with the condition could also complain about body and head ache, suffer frequent spells of fever or other health conditions.
The condition was not known before the arrival of Covid-19, physicians said, adding that even in the first wave of the pandemic the condition was not much reported.
The pandemic began in late December 2019 but the MIS-C was first reported in April the next year.
The condition may develop after two–four weeks of suffering from Covid-19 or even later, said physicians, adding that medical intervention can cure this condition.
The US Centers of Disease Control and Prevention advised that a paediatrician should be consulted if a child has fever along with one or more of conditions such as stomach pain, bloodshot eyes, diarrhoea, dizziness or lightheadedness, skin rash and vomiting.
The CDC said that it was still investigating MIS-C and did not know why it did not affect all Covid-infected children.
The WHO defines the condition as MIS-C if a children has fever for more than three days and two of the conditions such as rash or signs of oral, hand or feet inflammation, hypotension or shock, acute gastrointestinal problems such as diarrhoea, vomiting or abdominal pain, among others.
The nine hospitals that have reported cases of MIS-C in Bangladesh are Dhaka Shishu Hospital, Dhaka Medical College Hospital, BSMMU, Evercare Hospital, United Hospital, Bangladesh Specialised Hospital, Universal Medical College and Hospital, MR Khan Shishu Hospital and Institute of Child Health and Chattogram Maa-O-Shishu Hospital.
‘We have had a good number of cases of MIS-C and cases are growing,’ said Shafi Ahmed of Dhaka Shishu Hospital.
Officials at the IEDCR said that the number of MIS-C cases is likely to be higher than reported as all hospitals do not report their cases to them.
It has been reported that the first case of MIS-C was identified by Evercare Hospital in Dhaka in May 2021.
The first death caused by the condition is believed to have been reported by Square Hospital in October 2021.
According to a Dhaka Shishu Hospital research in December 2020, which studied 12 cases of MIS-C, multi-organ dysfunction and systemic inflammation were clearly evident with MIS-C in children and appear distinct from the Kawasaki disease.
Multisystem inflammatory syndrome in children led to serious and life-threatening complications, especially when there was a cardiac involvement, hypotension and acute kidney injury, the research concluded, adding that patients with MIS-C should ideally be managed in a paediatric intensive care environment since rapid clinical deterioration may occur.
Out of 12 patients, 2 died, the research said, adding that the contributing causes of death included complications like hypotension, shock, myocarditis and coagulopathy.
The average duration of hospitalisation was 11 days and the ICU stay was 5 days among the 12 children aged between 17 days and 13 years. About 56 per cent of the children were male.
The WHO released a treatment guideline for children with multisystem inflammatory syndrome in November 2021, over a year after describing the condition first in May 2020.
‘Children with this condition need specialised care and may need to be admitted to intensive care. Although MIS-C is a serious condition, with the right medical care, children with this condition recover,’ the WHO said while releasing the treatment guideline.
