Fig. 1. A
Proposed definitions for the hyperinflammatory multisystem syndrome associated to COVID 19 in children (4-6)
| Royal College of Pediatric and Child Health | Centers for Disease Control | World Health Organization |
|---|---|---|
| Persistent fever | Age <21 years with fever (≥38.0°C for ≥24 hours or posi- tive anamnesis for fever lasting ≥24 hours) | Age 0-19 years Fever >3 days |
| Inflammation (neutrophilia, elevated CRP and lymphopenia) + evidence of a single or multi-organ dysfunction | Inflammation and evidence of clinically severe illness requiring admission + multi- system (≥2) organ involvement (cardiac, gastrointestinal, renal, hematologic, dermatologic or neurologic) | AND 2 of the following: - acute gastrointestinal symptoms (vomiting, diarrhea or abdominal pain) - rash or bilateral non-purulent conjunctivitis or both (oral, hands and feet signs) - echocardiographic signs of myocardial dysfunction, pericarditis, valvulitis or coronary abnormalities, or increased troponin/NT proBNP - evidence of coagulopathy (elevated D-dimer, impaired PT or PTT |
| Children fulfilling complete or partial criteria for Kawasaki disease | Laboratory findings – one or more of the following: elevated CRP, ESR, fibrinogen, procalci- tonin, D-dimer, LDH, ferritin, interleukin 6, neutrophilia, lymphopenia and hypoalbuminemia | AND Elevated inflammatory biomarkers (ESR, CRP or procalcitonin) |
| Exclusion of other microbial cause (bac- terial sepsis, enterovirus infection asso- ciated with myocarditis, staphylococcal or streptococcal shock syndromes) | No proof of plausible alterna- tive diagnoses | AND No other identifiable microbial cause |
| RT-PCR for SARS-CoV-2 infection posi- tive/negative | COVID-19 exposure within 4 weeks before the onset of symptoms Positive RT-PCR, antigen test or serology for SARS-CoV-2 infection | AND Possible contact with COVID-19 patients OR Positive RT-PCR, antigen test or serology for SARS-CoV-2 infection |