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CDC and WHO case definitions of multisystem inflammatory syndrome in children

CDC and WHO case definitions of multisystem inflammatory syndrome in children
CDC case definition WHO case definition
All 7 criteria must be met: All 6 criteria must be met:
  1. Age <21 years
  2. Fever
    • Documented fever ≥38.0°C (≥100.4°F)
      or
    • Report of subjective fever
  3. Severe illness requiring hospitalization or resulting in death
  4. Laboratory evidence of systemic inflammation (CRP ≥3 mg/dL)
  5. Multisystem involvement – New-onset manifestations in 2 or more categories:
    • Shock
    • Cardiovascular (elevated troponin or LVEF <55% or CA dilation, aneurysm, or ectasia on echocardiogram)
    • Hematologic (platelet count <150,000 cells/microL or absolute lymphocyte count <1000 cells/microL)
    • Gastrointestinal (abdominal pain, vomiting, or diarrhea)
    • Dermatologic (erythema or edema of hands or feet, oral mucositis, drying or fissuring of the lips, strawberry tongue, conjunctivitis, or other rash)
    1. Confirmation of SARS-CoV-2 infection with any of the following:
      • Positive RNA (eg, RT-PCR) during hospitalization or within 60 days prior or postmortem
      • Positive antibodies (serology) associated with current illness
      • Positive antigen test during hospitalization or within 60 days prior or postmortem
    2. or
    3. Evidence of exposure – Close contact with a confirmed or probable COVID-19 case within 60 days prior to hospitalization
  6. No alternative plausible diagnoses
  1. Age 0 to 19 years
  2. Fever for >3 days
  3. Clinical signs of multisystem involvement (at least 2 of the following):
    • Rash, bilateral nonpurulent conjunctivitis, or mucocutaneous inflammation signs (oral, hands, or feet)
    • Hypotension or shock
    • Cardiac dysfunction, pericarditis, valvulitis, or coronary abnormalities (including echocardiographic findings or elevated troponin/BNP)
    • Evidence of coagulopathy (prolonged PT or PTT; elevated D-dimer)
    • Acute gastrointestinal symptoms (diarrhea, vomiting, or abdominal pain)
  4. Elevated markers of inflammation (eg, ESR, CRP, or procalcitonin)
  5. No other obvious microbial cause of inflammation, including bacterial sepsis and staphylococcal/streptococcal toxic shock syndromes
  6. Evidence of SARS-CoV-2 infection
    • Any of the following:
      • Positive SARS-CoV-2 RT-PCR
      • Positive serology
      • Positive antigen test
      • Contact with an individual with COVID-19
This table outlines the CDC's and WHO's case definitions of MIS-C. Patients who meet these criteria should be considered to have MIS-C and should be reported. In addition, MIS-C should be considered in any pediatric death with evidence of SARS-CoV-2 infection.
CDC: Centers for Disease Control and Prevention; CRP: C-reactive protein; LVEF: left ventricular ejection fraction; CA: coronary artery; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; RNA: ribonucleic acid; RT-PCR: reverse transcription polymerase chain reaction; COVID-19: coronavirus disease 2019; WHO: World Health Organization; BNP: brain natriuretic peptide; PT: prothrombin time; PTT: partial prothrombin time; ESR: erythrocyte sedimentation rate.
References:
  1. CDC/CSTE Standardized Case Definition for Surveillance of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection. Available at: https://cdn.ymaws.com/www.cste.org/resource/resmgr/ps/ps2022/22-ID-02_MISC.pdf (Accessed on January 27, 2023).
  2. World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief. 2020. Available at: https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 (Accessed on May 17, 2020).
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