In June, Digital Journal reported on an emerging new disease – Multisystem Inflammatory Syndrome in adults (MIS-A).
The symptoms of MIS-A are somewhat similar to those seen in children, and can included a rash, low blood pressure, fever, aches and pain.
This was something new. This rare complication of COVID-19 was first seen in children – almost from the start of the pandemic -and was given the designation MIS-C by the CDC in May, with the C standing for children. Kids were developing dangerous inflammation around the heart and other organs, often weeks after their initial infections with SARS-CoV-2, the virus that causes Covid-19.
Documented case of MIS-A
Earlier this summer, Dr. Alisa Femia, the director of inpatient dermatology at NYU Langone Health in New York City, was looking at a 45-year-old Hispanic patient’s chart, which included several photos of the man. The man had been caring for his wife, a COVID-19 patient at home, according to AOL.com.
The symptoms that stood out were the dusky-red circular patches on the palms of his hands and the soles of his feet. His eyes were pink, and his lips were extremely chapped. “Before I even saw the patient,” Femia recalled, “I said: ‘This hasn’t been reported yet. This must be MIS-A.'”
Dr. Femia and her colleagues published details of the case in The Lancet in July to alert other physicians to be on the lookout for similar patients.
On admission, the man’s COVID-19 test was positive, and a chest X-Ray showed the typical signs of the coronavirus. However, his vital signs throughout admission were notable for persistent fever despite antipyretics, hypotension (systolic blood pressure 80–90 mm Hg), tachycardia with episodes of atrial fibrillation with rapid ventricular response, and minimal oxygen requirements.
The patient had the full constellation of symptoms for Kawasaki’s Disease, and met the American Heart Association’s criteria for a diagnosis of Kawasaki-like multisystem inflammatory syndrome associated with COVID-19. He did recover, thanks to a multidisciplinary approach to his care and treatment.
Physicians need to be on the lookout for MIS-A
But many doctors may not, in fact, be recognizing the condition in adults, according to NBC News. Just a few dozen cases of MIS-A have been reported. And not all patients have obvious rashes.
Dr. Sapna Bamrah Morris, clinical lead for the Health Care Systems and Worker Safety Task Force, part of the CDC’s Covid-19 response, detailed 27 cases in a report the agency published last week.
MIS-A’s “true prevalence is unknown,” Morris said. “We have to get physicians realizing that. It may be rare, but we don’t know. It might be more common than we think.”
According to the CDC report published on October 8, 2020, In the Morbidity and Mortality Weekly Report (MMWR), many MIS-A patients report fevers, chest pain or other heart problems, diarrhea or other gastrointestinal issues — but not shortness of breath. And diagnostic tests for Covid-19 tend to be negative.
However, tests for COVID-19 antibodies tend to be positive – meaning they were infected two to six weeks previously, even if they never had symptoms. “Just because someone doesn’t present with respiratory symptoms as their primary manifestation does not mean that what they’re experiencing isn’t as a result of Covid-19,” Morris said.
And the illness in adults can be very severe. Ten patients in the CDC report needed to be hospitalized in intensive care units. Some needed to be put on ventilators. Two have died. The CDC report also showed that members of racial and ethnic minority groups appear to be disproportionately affected. Nearly all patients with MIS-A were African American or Hispanic.
While some kind of genetic link may be possible, Covid-19 has been shown to “disproportionately affect underrepresented minorities, probably due to socioeconomic factors,” Femia said. Underlying health conditions that raise the risk for Covid-19 complications, such as obesity and Type 2 diabetes, also tend to be more prevalent among members of racial and ethnic minority groups.
The need to learn more
The world has only known about the SARS-CoV-2 virus that causes COVID-19 for about a year, and in that time, doctors and researchers have made great strides in not only learning how the virus replicates, but in developing treatments and even a vaccine.
However, there is no proven treatment for this new complication, MIS-A. Dr. Jill Weatherhead, an assistant professor of infectious diseases and tropical medicine at Baylor College of Medicine in Houston, points out that the CDC case reports show that doctors have tried a variety of medications for MIS-A patients, including steroids and drugs that might affect the immune system, called interleukin-6 inhibitors.
“The problem with these diseases is that we don’t know the mechanisms that are causing MIS-A and MIS-C,” Weatherhead said. “It’s difficult to know what the standard treatment should be until we have more information.”
Bottom Line? The CDC says further research is needed to understand the pathogenesis and long-term effects of this condition. Ultimately, the recognition of MIS-A reinforces the need for prevention efforts to limit the spread of SARS-CoV-2.
