Minireviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Jun 25, 2023; 12(3): 193-203
Published online Jun 25, 2023. doi: 10.5501/wjv.v12.i3.193
Pediatric multisystem inflammatory syndrome associated with COVID-19: Insights in pathogenesis and clinical management
Marcel Silva Luz, Fabian Fellipe Bueno Lemos, Samuel Luca Rocha Pinheiro, Hanna Santos Marques, Luís Guilherme de Oliveira Silva, Mariana Santos Calmon, Karolaine da Costa Evangelista, Fabrício Freire de Melo
Marcel Silva Luz, Fabian Fellipe Bueno Lemos, Samuel Luca Rocha Pinheiro, Luís Guilherme de Oliveira Silva, Mariana Santos Calmon, Karolaine da Costa Evangelista, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Hanna Santos Marques, Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Author contributions: All authors equally contributed to this paper with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; and all authors agree to be accountable for all aspects of the work in ensuring that questions that are related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Supported by the Scientific Initiation Scholarship Programme (PIBIC) of the National Council for Scientific and Technological Development, CNPq, Brazil; and CNPq Research Productivity Fellow (PQ).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
Received: December 29, 2022
Peer-review started: December 29, 2022
First decision: April 13, 2023
Revised: April 28, 2023
Accepted: May 24, 2023
Article in press: May 24, 2023
Published online: June 25, 2023
Processing time: 174 Days and 6.2 Hours
Abstract

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been a major challenge to be faced in recent years. While adults suffered the highest morbidity and mortality rates of coronavirus disease 2019, children were thought to be exclusively asymptomatic or to present with mild conditions. However, around April 2020, there was an outbreak of a new clinical syndrome related to SARS-CoV-2 in children - multisystemic inflammatory syndrome in children (MIS-C) - which comprises a severe and uncon-trolled hyperinflammatory response with multiorgan involvement. The Centers for Disease Control and Prevention considers a suspected case of MIS-C an individual aged < 21 years presenting with fever, high inflammatory markers levels, and evidence of clinically severe illness, with multisystem (> 2) organ involvement, no alternative plausible diagnoses, and positive for recent SARS-CoV-2 infection. Despite its severity, there are no definitive disease management guidelines for this condition. Conversely, the complex pathogenesis of MIS-C is still not completely understood, although it seems to rely upon immune dysregulation. Hence, in this study, we aim to bring together current evidence regarding the pathogenic mechanisms of MIS-C, clinical picture and management, in order to provide insights for clinical practice and implications for future research directions.

Keywords: Pediatric multisystem inflammatory disease; COVID-19 related; Multisystem inflammatory syndrome in children; COVID-19; SARS-CoV-2; Etiology; Disease management

Core Tip: Multisystem inflammatory syndrome in children (MIS-C) comprises a severe and out-of-control inflammatory response with multiorgan dysfunction following severe acute respiratory syndrome coronavirus 2 infection. Despite its severity, there are no definitive disease management guidelines for this condition. Conversely, the complex pathogenesis of MIS-C is still not completely understood, although it seems to rely upon immune dysregulation. Hence, in this study, we aim to bring together current evidence regarding the pathogenic mechanisms of MIS-C, clinical picture and management, in order to provide insights for clinical practice and implications for future research directions.