ANDREW CABALLERO-REYNOLDS, AFP / File
Documented case of MIS-A
Earlier this summer, Dr. Alisa Femia, director of inpatient dermatology at NYU Langone Health in New York City, presented a 45-year-old Hispanic medical record that contained several photos of the man. The man had taken care of his wife, a COVID-19 patient at home, according to AOL.com. The symptoms that stood out were the dark red circular spots on his palms 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 has not yet been reported. This must be MIS-A. “Dr. Femia and her colleagues published details of the case in The Lancet in July, alerting other doctors to look out for similar patients. When admitted, the man’s COVID-19 test was positive and a chest x-ray showed typical signs of the coronavirus. However, his vital functions 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 demand.
Christophe SIMON, POOL / AFP
The patient had the full constellation of symptoms for Kawasaki disease and met the American Heart Association’s criteria for a diagnosis of Kawasaki-like multisystem inflammatory syndrome associated with COVID-19. He recovered thanks to a multidisciplinary approach to his care and treatment.
Doctors need to look out for MIS-A
Many doctors may not recognize the condition in adults, according to NBC News. Only a few dozen cases of MIS-A have been reported. And not all patients have obvious rashes. Dr. Sapna Bamrah Morris, clinical director of the Health Systems and Occupational Safety Task Force, which is part of the CDC’s Covid-19 response, explained 27 cases in a report the agency released last week. MIS-A “true prevalence is unknown,” said Morris. “We have to get the doctors to see that. It may be rare, but we don’t know. It could be more common than we think. ”
Navy Medicine aus Washington, DC
According to the CDC’s weekly report on Morbidity and Mortality (MMWR), published October 8, 2020, many MIS-A patients report fever, chest pain or other heart problems, diarrhea or other gastrointestinal problems – 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 before, even if they never had symptoms. “Just because someone doesn’t have respiratory symptoms as the primary manifestation doesn’t mean that what they’re experiencing isn’t due to Covid-19,” Morris said. And the disease in adults can be very severe. Ten patients in the CDC report had to be hospitalized in intensive care units. Some had to be connected to fans. Two died. The CDC report also showed that members of racial and ethnic minorities appear to be disproportionately affected. Almost all of the patients with MIS-A were African American or Hispanic American. While some kind of genetic link may be possible, Covid-19 has been shown to “disproportionately affect underrepresented minorities, likely due to socio-economic factors,” Femia said. Fundamental health conditions that increase the risk of Covid-19 complications, such as obesity and type 2 diabetes, are also more common among racial and ethnic minority groups.
The need to learn more
The world has only known the SARS-CoV-2 virus, which causes COVID-19, for about a year. During this time, doctors and researchers have made great strides not only learning how the virus replicates, but also developing treatments and even a vaccine. However, there is no proven treatment for this new complication, MIS-A. Dr. Jill Weatherhead, 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 drugs for MIS-A patients, including steroids and possibly drugs that affect the immune system called interleukin-6 inhibitors. “The problem with these diseases is that we don’t know the mechanisms that cause MIS-A and MIS-C,” said Weatherhead. “It is difficult to know what standard treatment should be until we have more information.” The CDC says more 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.
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