Table 1.
Case Definition of the New Multi-Systemic Inflammation Illness Temporarily Associated with the COVID-19 Pandemic.
| NHS- The Royal College of Paediatrics and Child Health | CDC | WHO | |
|---|---|---|---|
| Name of the condition | Paediatric multisystem inflammatory syndrome (PMIS) temporally associated with COVID-19 | Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) | Multisystem inflammatory syndrome in children and adolescents with COVID-19 |
| Release date | 05/01/2020 | 05/14/2020 | 05/15/2020 |
| Age (years) | Child | <21 | 0–19 |
| Fever | Persistent fever >38.5°C | Fever >38.0°C for ≥ 24 hours, or report of subjective fever lasting ≥24 hours | Fever ≥ 3 days |
| Clinical findings | Single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features. This may include children fulfilling full or partial criteria for Kawasaki disease | Evidence of clinically severe illness requiring hospitalization, with multisystem (≥ 2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological) | Two of the following:1. Rash or bilateral non-purulent conjunctivitis or muco-cutaneous Inflammation signs (oral, hands or feet).2. Hypotension or shock.3. Cardiac (myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including echocardiographic findings or elevated troponin/NT-proBNP))4. coagulopathy (by PT, APTT, elevated D-dimers)5. Acute gastrointestinal problems (diarrhea, vomiting, or abdominal pain) |
| Evidence of COVID infection | SARS-CoV-2 PCR testing may be positive or negative | Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms | Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19. |
| Evidence of inflammation | Neutrophilia, elevated CRP and lymphopaenia | Including, but not limited to, one or more of the following: an elevated CRP, ESR, fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin | Elevated markers of inflammation such as ESR, CRP, or procalcitonin. |
| Exclusion of other microbial cause | Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice) | No alternative plausible diagnoses | No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes. |
| Special note | May include children fulfilling full or partial criteria for KD. | Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C | |
| Reference | https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatricmultisystem-%20inflammatory%20syndrome-20200501.pd | https://emergency.cdc.gov/han/2020/han00432.asp | https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 |
APTT: Activated partial thromboplastin time, CDC: Centers for Disease Control and Prevention, CRP: C-reactive protein, COVID-19: 2019 Novel Coronavirus Disease, ESR: Erythrocyte sedimentation rate, KD: Kawasaki disease, NHS: National Health Service, NT-proBNP: N-terminal pro hormone B-type natriuretic peptide, PT: Prothrombin time, RT-PCR: Reverse transcription polymerase chain reaction, SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2, WHO: World health organization.