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Global Health
October 20, 2020

New Insights on COVID-19’s Hyperinflammation in Children

JAMA. 2020;324(15):1489. doi:10.1001/jama.2020.20151

A rare, life-threatening hyperinflammatory syndrome that some children develop after coronavirus disease 2019 (COVID-19) is distinct from Kawasaki disease, according to a collaboration among European scientists.

Although most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or no symptoms, some develop a Kawasaki-like condition called multisystem inflammatory syndrome in children (MIS-C) about 4 to 6 weeks after their infection. To understand why, the investigators studied the immune responses of 41 children with mild COVID-19, 13 others who had MIS-C, and 28 children who were treated for Kawasaki disease before the pandemic.

They found that the MIS-C inflammatory response is distinct from the cytokine storm seen in adults with severe COVID-19 and from hyperinflammation in children with Kawasaki disease. Patients with MIS-C had less interleukin-17A–mediated inflammation and distinct autoantibodies compared with children who had Kawasaki disease. The results lay the groundwork for future studies on the mechanism of MIS-C.

“There is an urgent need to better understand why a small minority of children infected with SARS-CoV-2 develop MIS-C, and we are adding a piece to the puzzle,” corresponding author Petter Brodin, MD, PhD, pediatrician and researcher at the Karolinska Institutet, said in a statement. “Better knowledge of the pathogenesis is important for development of optimal treatments that can dampen the cytokine storm and hopefully save lives.”

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