While the confirmed cases with coronavirus disease 2019 (COVID-19) are still increasing rapidly worldwide, the pediatric cases are of some specific clinical feature: less susceptible, less severe, and was associated with the emerging inflammatory condition called the multisystem inflammatory syndrome in children (MIS-C).
Though children were less susceptible to the COVID-19, they still played a role in disease transmission upon the school re-opened in the United States, United Kingdom, and South Korea.1 , 2 The pediatric cases made up 10% of all US cases in October, compared with 2% in April, 2020.3 The dilemma between the negative impact of childhood mental health due to the lack of social group activity and the potential increased disease transmission in school is a vital issue for pediatricians and public health experts to focus on. Hopefully a balanced and yet practical way can be come up with to keep mandatory education for school children amid the pandemic.4
The severe diseases related to COVID-19 in children were also reported with various presentations, compared to adults,5 such as MIS-C related to COVID-19. Distinct from the Kawasaki disease (KD), MIS-C presented with older age, a higher proportion of African or Hispanic children affected, and diffuse cardiovascular involvement suggestive of a generalized immune-mediated disease.6 As for the clinical manifestations, patients with MIS-C also presented with more gastrointestinal tract symptoms and more extensive heart function disorientation.7 Jafarpur et al. described a case with systemic inflammation and possible infection of COVID-19.8 However, the case they described lacks a laboratory-confirmed diagnosis of COVID-19 despite the positive finding of bilateral ground-glass pattern in chest CT.8 Serologic testing was also not performed to prove the infection; thereby the case failed to meet the diagnostic criteria of MIS-C and could only be classified as a probable case.6 Though the treatment of KD and MIS-C were almost the same, precise diagnosis between the two diseases remains essential, considering patients with MIS-C usually had more cardiac involvement and required more intensive care. The pathogenesis may also differ according to the latest report by Consiglio.9 The T cell subsets discriminated KD patients from MIS-C, and IL-17A drove hyperinflammation in KD but not MIS-C.9 Because of the potential immunopathogenic difference between the two diseases and the uncertainty of adequate treatment of MIS-C, pediatricians should be able to distinguish KD and MIS-C in the differential diagnosis in order to optimize the treatment for each.
Declaration of competing interest
The authors have no conflicts of interest relevant to this article.
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