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Multisystem Inflammatory Syndrome in Children: IAP Guidelines
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease2019 (COVID-19) or pediatric inflammatory multisystem syndrome (PIMS) was initially reported in the United Kingdom and the United States in April 2020 following a surge in COVID-19 infections in the population.It has the presentation of hyperinflammatory syndrome with involvement of...
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease2019 (COVID-19) or pediatric inflammatory multisystem syndrome (PIMS) was initially reported in the United Kingdom and the United States in April 2020 following a surge in COVID-19 infections in the population.
The Indian Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for Multisystem Inflammatory Syndrome in Children. The lead author for these guidelines on Multisystem Inflammatory Syndrome in Children is Dr. Rakesh Lodha along with co-author Dr. Jolly Chandran and Dr. Mahendra Jain. The guidelines come Under the Auspices of the IAP Action Plan 2022, and the members of the IAP Standard Treatment Guidelines Committee include Chairperson Remesh Kumar R, IAP Coordinator Vineet Saxena, National Coordinators SS Kamath, Vinod H Ratageri, Member Secretaries Krishna Mohan R, Vishnu Mohan PT and Members Santanu Deb, Surender Singh Bisht, Prashant Kariya, Narmada Ashok, Pawan Kalyan.
Following are the major recommendations of guidelines:
In May 2020, the World Health Organization (WHO) and the Centers for Disease Control (CDC) issued separate diagnostic criteria based on available/published information in case reports and case series analysis. These criteria are enlisted in Table 1.
TABLE 1: The WHO criteria for MIS-C.
All 6 criteria must be met
Age 0–19 years
Fever for ≥3 days
Clinical signs of multisystem
involvement (at least two of the following)
Elevated markers of inflammation
Elevated markers of inflammation (e.g., ESR, CRP, or procalcitonin)
Rule out other diagnoses
No other obvious microbial cause of inflammation, including bacterial sepsis and staphylococcal/streptococcal toxic shock syndromes/tropical infectious diseases, i.e., malaria, dengue, scrub typhus, leptospirosis, and enteric fever
Recent or current SARS-CoV-2
infection or exposure
- Centers for Disease Control and Prevention. (2020). Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 (COVID-19). [online] Available from: https:// emergency.cdc.gov/han/2020/han00432.asp. [Last accessed June, 2022].
- Elsevier.health. (2022). Multisystem Inflammatory Syndrome in children (MIS-C). [online] Available from: https://elsevier.health/en-US/preview/multisystem-inflammatory-syndrome-in-childrenmis-c. [Last accessed June, 2022].
- Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol. 2021;73(4):e13-29.
- McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis—a critical review of its pathogenesis and treatment. Front Pediatr. 2020;8:626182.
- Ministry of Health and Family Welfare. (2022). Revised Comprehensive Guidelines for Management of COVID-19 in Children and Adolescents (below 18 years). [online] Available from: https://www. mohfw.gov.in/pdf/RevisedComprehensiveGuidelinesforManagementofCOVID19inChildren andAdolescents below18years.pdf. [Last accessed June, 2022].
- Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children (Basel). 2020;7(7):69.
- World Health Organization (2020). Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief. [online] Available from: https://www.who.int/publications-detail/ multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. [Last accessed June, 2022].
The guidelines can be accessed on the official site of IAP: https://iapindia.org/standard-treatment-guidelines/
Ayesha has completed B.pharma from the United Institute of Pharmacy and currently pursuing a pharmaceutical MBA from Jamia hamdard. She is working as an intern with Medical Dialogue.