From the Guidelines
The acute inflammatory response in children to a viral illness typically involves fever, malaise, and localized symptoms specific to the affected organ system, with the most recent evidence suggesting that immunomodulatory treatment, such as anakinra, may be beneficial in cases of severe COVID-19 with hyperinflammation 1. The inflammatory response begins when viral pathogens trigger pattern recognition receptors, activating the innate immune system. Children often develop fever (38-40°C), which helps inhibit viral replication and enhance immune function. Other common manifestations include fatigue, decreased appetite, myalgia (muscle pain), and irritability. Depending on the virus, children may exhibit respiratory symptoms (cough, rhinorrhea, sore throat), gastrointestinal symptoms (vomiting, diarrhea), or skin manifestations (rash). Some key points to consider in the management of febrile children include:
- The risk of serious bacterial infection (SBI) is higher in younger children, particularly those under 3 months of age 1
- The presence of a viral infection does not preclude the coexistence of a bacterial infection 1
- Supportive care, including hydration, rest, and antipyretics, is the mainstay of treatment for most viral illnesses in children
- Immunomodulatory treatment, such as anakinra, may be beneficial in cases of severe COVID-19 with hyperinflammation 1 The inflammatory response involves increased blood flow to infected areas, release of cytokines and chemokines, and recruitment of neutrophils and macrophages. This process causes the classic signs of inflammation: redness, warmth, swelling, and pain. While this response is protective, excessive inflammation can sometimes cause more harm than the virus itself, as seen in conditions like viral myocarditis or severe respiratory infections. In terms of treatment, the use of glucocorticoids, such as dexamethasone, may be considered in pediatric patients with severe COVID-19 and signs of hyperinflammation, although the evidence is still limited and conflicting 1. Targeted neutralization of inflammatory cytokines, such as IL-1 or IL-6, may also be beneficial in reducing pathologic inflammation in COVID-19 1.
From the Research
Acute Inflammatory Response in Children with Viral Illness
The acute inflammatory response seen in children with a viral illness, particularly those with COVID-19, is characterized by:
- Fever
- Gastrointestinal symptoms
- Rash
- Conjunctivitis
- Elevated inflammatory markers
- Coagulation factors
- Cytokines 2, 3, 4, 5, 6
Clinical Presentation
Children with multisystem inflammatory syndrome in children (MIS-C) may present with a range of symptoms, including:
- Fever and gastrointestinal symptoms
- Neurologic and dermatologic findings
- Abdominal pain
- Shock
- Cardiogenic or distributive shock 2, 3, 4, 5
Laboratory and Imaging Findings
Laboratory tests may reveal:
- Elevated inflammatory markers
- Abnormal electrocardiogram or echocardiogram
- Coagulation factors
- Cytokines 2, 3, 4, 5, 6
Treatment and Management
Treatment for MIS-C typically involves: