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Covid-19 HSE Clinical Guidance and Evidence

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Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2

Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (CD19-210-001 / 03.02.22)

  • Guidance for Consultants and other healthcare professionals caring for children presenting with Paediatric Multisystem Inflammatory Disease.
Paediatric multisystem inflammatory syndrome (PIMS)
  • Severe COVID-19 continues to be very rare in children.
  • Paediatric Multisystem Inflammatory Syndrome (PIMS) also referred to as Multisystem Inflammatory Syndrome in Children (MIS-C) occurs in less than 0.5% of children following symptomatic or asymptomatic COVID-19 infection. It generally occurs in children who were previously healthy. Children of all ethnicities may be affected but children of black or Asian (non-Chinese) ethnicity are more frequently and more severely affected. 
  • PIMS/MIS-C can be associated with significant morbidity but early appropriate treatment is usually curative. The majority of cases require PICU admission and multidisciplinary input. A high index of suspicion for the condition and early recognition are essential.
  • Earlier experience from here and elsewhere saw PIMS/MIS-C cases in the weeks following increases in COVID-19 activity in the community.
  • Following the recent surge of infections in children, please consider this diagnosis in any child or adolescent who appears to have a significant systemic inflammatory response.
  • Clinical features include, but are not limited to: persistent fever, rash, conjunctivitis, and in more severe cases, hypotension/tachycardia and/or shock. Symptoms and signs may overlap with those of complete or incomplete Kawasaki disease or toxic shock syndromes. Vomiting, diarrhoea and abdominal pain may also be prominent. The majority of cases test negative for SARS-CoV-2 by PCR.
  • When PIMS/MIS-C is suspected, please contact Paediatric Infectious Diseases Team, CHI at Temple Street to guide further investigation and management. If the child has signs of shock or might benefit from Intensive Care please contact the PICU referral line on 1800-222378.
Useful Resources

Guidance Development Group
  • Dr Ellen Crushell, Consultant Paediatrician & National Clinical Lead for Children
  • Dr Louise Kyne, Consultant Paediatrician, Dean of the Faculty of Paediatrics
  • Dr Patrick Gavin Consultant Paediatrician Infectious Diseases
  • Dr Cathy Gibbons Consultant Paediatric Intensivist

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