Multisystem Inflammatory Syndrome In Adults

What is a multisystem inflammatory syndrome?

Multisystem inflammatory syndrome (MIS) is a condition that affects  multiple areas of the body and organs like the arteries, heart, brain, liver, kidney, skin, eyes, etc. These areas become inflamed after COVID-19 infection, making it an inflammatory condition². It is worth noting that MIS is a very rare syndrome but can affect recovered COVID-19 patients between 2 to 12 weeks after the initial COVID-19 infection. MIS syndrome was first diagnosed in children and adolescents as (MIS-C) and later diagnosed in young adults (MIS-A)².

MIS-A syndrome symptoms can be hard to differentiate from COVID-19 symptoms, especially in adults with cardiac dysfunction and other comorbidities. It is also important to note that although cases of MIS-A are not as frequent compared to MIS-C, they are slowly increasing.

What causes multisystem inflammatory syndrome?

The exact cause of MIS-A hasn’t yet been discovered, especially because some people can develop it while others don’t, making it even more unclear. According to the case series of MIS-A, the syndrome evolves after COVID-19 infection, which tends to cause immune response dysfunction.⁴ However, it is clear that immune system differences and genetics are major factors in the existence of multisystem inflammatory syndrome.

What are the symptoms of the multisystem inflammatory syndrome in adults?

These are some of the symptoms⁴ of MIS-A:

• Fever,
• Conjunctivitis (inflammation of the eye tissue also called “pink eye”)
• Inflammatory markers like C-reactive protein, albumin, etc
• Abdominal pain
• Cervical lymphadenopathy (lymph nodes in the neck)
• Rashes
• Cardiovascular issues
• Vomiting
• Dizziness, lightheadedness,or low blood pressure (hypotension)
• Diarrhea or other gastrointestinal issues
• Shortness of breath or breathing difficulties
• Severe heart disease
• Arterial thrombosis
• Myocarditis (inflammation of the heart muscle)
• Easy bleeding and bruising
• Pericarditis
• Arrhythmias
• Neuropathy
• Seizures
• Meningitis
• Pulmonary embolism

How are MIS syndrome, coronavirus, and Kawasaki disease related?

MIS syndrome is also thought to be associated with coronavirus because people normally get affected by MIS syndrome about 2 to 6 weeks after contracting COVID-19. MIS syndrome has been underdiagnosed, and its pathophysiology⁴ is misunderstood due to the fact that MIS-A patients have almost all similar symptoms of severe COVID-19 infection.

Severe coronavirus infection causes very high levels of inflammation in the body, mostly accompanied by respiratory problems. On the contrary,¹ MIS-A rarely shows respiratory symptoms but mostly affects organs outside the lungs, such as renal, hematologic, gastrointestinal, and other body systems.

What is Kawasaki disease?

According to The Centers for Disease Control and Prevention (CDC) and the Journal of the Pediatric Infectious Diseases Society, Kawasaki disease, also known as Kawasaki syndrome, originated in Japan and was first described by a Japanese pediatrician Dr. Tomisaku Kawasaki in 1967¹. Like COVID-19 and MIS-A, Kawasaki disease is also known for causing inflammation, especially in the blood vessels. Kawasaki disease can damage coronary arteries and even cause heart attacks if not diagnosed and treated early.

Several studies³ in the United Kingdom, France, Italy, Japan, the United States, and Iran during the early months of the coronavirus pandemic documented case reports showing a stable increase of a disease that almost resembled Kawasaki disease. The researchers then concluded that, like the coronavirus, Kawasaki could be related to airborne infections.

How is MIS-A diagnosed and treated?

MIS-A diagnosis

For you to be diagnosed⁵ with MIS-A, you must:

• Meet case definition and clinical criteria for MIS-A diagnosis as instructed by the clinicians.
• Have been hospitalized for more than 24 hours.
• Describe your medical history, and answer in-depth questions about your symptoms, previous medical conditions, and if you have contracted coronavirus before.
• Afterward, you will undergo a physical examination, including measuring blood pressure, body temperature, heart rate, and other biomarkers.

Conventional Treatments

Treatment for MIS-A primarily focuses on reducing inflammation and managing symptoms. Intravenous immunoglobulin (IVIG) is commonly administered to help modulate the immune response and reduce inflammation.⁵ Corticosteroids are another treatment option used to suppress the immune system and reduce inflammation.³ Additionally, supportive care, including fluid management and medications to support organ function, is important  for managing severe cases.

Alternative Treatments

Some patients may explore alternative treatments alongside conventional methods. These can include the use of special anti-inflammatory diets, which focus on reducing foods that can cause inflammation, such as processed foods and sugars, and increasing the intake of anti-inflammatory foods like fruits, vegetables, and omega-3 fatty acids.⁴ Herbal supplements, such as turmeric and ginger, which have anti-inflammatory properties, can be considered by some patients. However, it is important to discuss any alternative treatments with a healthcare provider to ensure they are safe and appropriate.

Brain Retraining and Its Role in Managing MIS-A

Brain retraining, a form of neuroplasticity therapy, involves techniques designed to rewire the brain and improve its function. This approach can be beneficial for patients recovering from MIS-A by helping manage stress, anxiety, and chronic pain, which are common post-infection issues. Techniques such as mindfulness, cognitive-behavioral therapy (CBT), or cognitive reappraisal, similar to what is used in the re-origin program, and biofeedback can assist in reducing the hyperinflammatory response by promoting relaxation and stress management.⁵

Mindfulness and CBT can help patients develop coping strategies to manage the psychological impact of MIS-A. Biofeedback, which involves monitoring physiological functions and learning to control them, can aid in reducing symptoms such as heart rate variability and blood pressure, thereby reducing overall stress and inflammation.¹

Prevention Strategies for MIS-A

Preventing MIS-A largely involves preventing COVID-19 infection, as MIS-A develops following COVID-19. Key preventive measures include:

• Vaccination: Staying up-to-date with COVID-19 vaccines and boosters is the most effective way to prevent severe COVID-19 infection and consequently MIS-A.²
• Hygiene Practices: Regular hand washing with antibacterial soap, using hand sanitizers, wearing masks, and maintaining social distancing, especially in crowded places, are essential preventive measures.
• Avoiding Close Contact: Avoiding close contact with individuals who have tested positive for COVID-19 helps reduce the risk of infection.
• Ventilation: Ensuring proper ventilation in indoor spaces can help reduce the transmission of the virus.⁵

Conclusion

Multisystem Inflammatory Syndrome in Adults (MIS-A) is a severe condition associated with COVID-19 that requires timely diagnosis and appropriate treatment. Conventional treatments focus on reducing inflammation and managing symptoms, while alternative treatments and preventive strategies aim to support overall health and prevent the condition. Brain retraining can play a significant role in managing the long-term effects of MIS-A by promoting neuroplasticity and helping patients cope with the psychological and physiological impacts of the syndrome. If you are interested in finding out how brain retraining can help you better manage MIS-A or another chronic condition, join the re-origin program today.

References

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2. Sharma, C., Ganigara, M., Galeotti, C., Burns, J., Berganza, F. M., Hayes, D. A., Singh-Grewal, D., Bharath, S., Sajjan, S., & Bayry, J. (2021). Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nature reviews. Rheumatology, 17(12), 731–748. https://doi.org/10.1038/s41584-021-00709-9, PubMed
3. Patel, P., DeCuir, J., Abrams, J., Campbell, A. P., Godfred-Cato, S., & Belay, E. D. (2021). Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. JAMA network open, 4(9), e2126456. https://doi.org/10.1001/jamanetworkopen.2021.26456, PubMed
4. Kunal, S., Ish, P., Sakthivel, P., Malhotra, N., & Gupta, K. (2022). The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review. Heart & lung : the journal of critical care, 54, 7–18. https://doi.org/10.1016/j.hrtlng.2022.03.007, PubMed
5. Sancho-Shimizu, V., Brodin, P., Cobat, A., Biggs, C. M., Toubiana, J., Lucas, C. L., Henrickson, S. E., Belot, A., MIS-C@CHGE, Tangye, S. G., Milner, J. D., Levin, M., Abel, L., Bogunovic, D., Casanova, J. L., & Zhang, S. Y. (2021). SARS-CoV-2-related MIS-C: A key to the viral and genetic causes of Kawasaki disease?. The Journal of experimental medicine, 218(6), e20210446. https://doi.org/10.1084/jem.20210446, PubMed