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It was just over two weeks ago that the UK's NHS issued the first alert (see PICS: NHS Alert On Possible Severe Pediatric COVID-19 Complication) on children with a severe inflammatory syndrome similar to Kawasaki Disease, suspected to be linked to COVID-19 infection.
A few days later the Royal College of Paediatrics and Child Health published a case definition and preliminary guidance on the treatment of this condition (see RCPCH: Case Definition For Pediatric Inflammatory Syndrome).
Case definition:
- A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features (see listed in Appendix 1 ). This may include children fulfilling full or partial criteria for Kawasaki disease.
- Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
- SARS-CoV-2 PCR testing may be positive or negative
All stable children should be discussed as soon as possible with specialist services to ensure prompt treatment (paediatric infectious disease / cardiology / rheumatology*).
There should be a low threshold for referral to Paediatric Intensive Care using normal pathways.
Last Tuesday the New York City Health department issued a HAN Alert On Pediatric Multi-System Inflammatory Syndrome, announcing 15 hospitalized cases in NYC, and calling for immediate reporting of similar cases by physicians.
A little over 24 hours later (Apr 6th), the State of New York followed up with a Health Advisory, which increased the number of hospitalized suspect cases in New York State (including NYC) to 64.Now that the alert has gone out, it is not a surprise that more suspected cases have come to light, both in New York State and in other regions around the country (see NBC report). Yesterday New York Governor Cuomo's office released the following brief update.
MAY 10, 2020 Albany, NY
Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces New York is Notifying 49 Other States of COVID-Related Illness in Children(Excerpt)
Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced New York State is notifying 49 other states across the country of emerging cases of COVID-related illness in children. The State is currently investigating 85 reported cases in New York where children - predominantly school-aged - are experiencing symptoms similar to an atypical Kawasaki disease or a toxic shock-like syndrome possibly due to COVID-19. The illness has taken the lives of three young New Yorkers and an additional two deaths are currently under investigation.(Continue . . .)
Although we are still learning about this syndrome, many doctors believe this syndrome is the result of a lingering, over active immune system response which can appear in children days or even weeks after a mild (or even asymptomatic) COVID-19 infection.
Below you'll find a couple of reports from two major children's hospitals around the country, which you'll want to read in their entirety. First up, Children's Hospital of Los Angeles.
Pediatric Inflammatory Multisystem Syndrome (PIMS): What Parents Should Know
Published on
May 8, 2020
(excerpt)
What is PIMS?
PIMS stands for pediatric inflammatory multisystem syndrome. It describes a new health condition seen in children who have been infected with novel coronavirus, recovered from it and later have an immune response that results in significant levels of inflammation in organ systems and symptoms. PIMS is similar to other inflammatory conditions like Kawasaki disease and toxic shock syndrome. Children who have PIMS generally did not have obvious symptoms when they were infected with novel coronavirus, like cough, and generally were healthy prior to developing PIMS.(SNIP)
Your child’s doctor or pediatrician is likely to discuss several symptoms with you, and will be particularly alert to children who have experienced a high fever for four or more days combined with other symptoms that may include:
- Abdominal pain without another explanation
- Both eyes appearing pink or red
- Enlarged lymph node (“gland”) on one side of the neck
- Fever for seven or more days in an infant, for which no other explanation is identified
- Red, cracked lips or red tongue that looks like a strawberry
- Rash
- Swollen hands and feet, which might also be red
(Continue . . . )
COVID-19 and a serious inflammatory syndrome in children: Unpacking recent warnings
Posted on May 8, 2020 by Nancy Fliesler
(excerpt)
Key take-homes
Two things are clear about this still-mysterious pattern of illness. First, thus far it is rare. But second, clinicians who suspect a case should consult promptly with pediatric infectious disease, rheumatology, or critical care specialists. Because some children get sicker rapidly, they should be cared for in hospitals with tertiary pediatric/cardiac intensive care units. Their cases should be discussed with pediatric specialists in infectious disease, rheumatology, and cardiology to anticipate and manage aspects of the illness.
(Continue . . . )
And finally, a review in today's edition of Physician's Weekly.
Covid-19: Kawasaki-Like Syndrome in Kids May be Tied to Virus
Posted by admin | May 11, 2020
Death of 5-year-old boy in NY being investigated as Covid-related
A rare multisystem inflammatory syndrome believed to be linked to coronavirus had been reported in 73 hospitalized children in and around New York City as of Friday, May 8, and the illness has also sickened children in Boston, Los Angeles, and other cities in the U.S. and Europe.(Continue . . . )
Although children generally do very well with COVID-19 infection, some very small percentage appear vulnerable to this serious autoimmune response.
Because this syndrome can occur even in children who were asymptomatically infected with COVID-19, parents should maintain a high degree of suspicion if their kids develop any of the typical symptoms (described above) and contact their doctors immediately.
