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| Credit NIAID |
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A little over 5 weeks ago we saw the first alert - issued by the UK's NHS - on a newly recognized inflammatory syndrome in children which has been tentatively and temporally linked to COVID-19 (see PICS: NHS Alert On Possible Severe Pediatric COVID-19 Complication).
Since then we've seen a barrage of reports - from the UK and in United States - including:
RCPCH: Case Definition For Pediatric Inflammatory Syndrome
NYC HAN Alert On Pediatric Multi-System Inflammatory Syndrome
New York DOH Advisory On Pediatric Multi-System Inflammatory Syndrome
Update On Pediatric Multi-System Inflammatory SyndromeThree weeks ago the CDC released their own HAN Advisory (see CDC HAN: Multisystem Inflammatory Syndrome In Children (MIS-C)), instructing doctors across the nation on how recognize and report the condition, and in mid-May the CDC held a COCA Call on Multisystem Inflammatory Syndrome in Children (MIS-C).
Around the same time the World Health Organization issued a Scientific Brief: Multisystem Inflammatory Syndrome in Children & Adolescents with COVID-19, with a new case definition, and instructions for reporting cases.
Last week we looked at JPIDS: Multisystem Inflammatory Syndrome in Children : A Case Series, which detailed of six critically ill children with Multisystem Inflammatory Syndrome in Children (MIS-C), and found the syndrome presented with fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes.
Today we have another report - this time published in the BMJ - that looks at 21 children and adolescents (aged ≤18 years) at a Paris University Hospital with features of Kawasaki disease who were admitted between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020.
From the BMJ Newsroom:
Today we have another report - this time published in the BMJ - that looks at 21 children and adolescents (aged ≤18 years) at a Paris University Hospital with features of Kawasaki disease who were admitted between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020.
Of these 21 cases, 19 (90%) showed evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21)The authors note that:
In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.First a link to the full research article, followed by a link to accompanying editorial, and lastly, some excerpts from a press release from the BMJ.
ResearchKawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2094 (Published 03 June 2020)
Cite this as: BMJ 2020;369:m2094
Julie Toubiana, associate professor12, Clément Poirault, resident doctor1, Alice Corsia, doctor3, Fanny Bajolle, doctor4, Jacques Fourgeaud, pharmacist5, François Angoulvant, professor6, Agathe Debray, doctor1, Romain Basmaci, professor7, Elodie Salvador, doctor3, Sandra Biscardi, doctor8, Pierre Frange, professor9, Martin Chalumeau, professor110, Jean-Laurent Casanova, professor1112, Jérémie F Cohen, associate professor110, Slimane Allali, doctor1
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Editorials
Pediatric inflammatory syndrome temporally related to covid-19
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2123 (Published 03 June 2020)
Cite this as: BMJ 2020;369:m2123
Mary Beth F Son, director
Author affiliations MaryBeth.Son@childrens.harvard.edu
Though rare, this condition warrants surveillance as well as collaborative research
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From the BMJ Newsroom:
Syndrome thought to be linked to covid-19 seems more common among children of African ancestry
Condition is rare but findings should prompt high vigilance, say researchers
An inflammatory syndrome in children and adolescents, believed to be linked to covid-19, seems to be more common among children of African ancestry, finds a small study from a hospital in Paris, published by The BMJ today.
The syndrome has been compared with Kawasaki disease, a rare condition which mainly affects children under five. Experts have said that it may be an “antibody mediated or delayed response” to covid-19 that happens several weeks after infection.
Cases have also been seen in Italy, the UK and the US.
In this study, patients had characteristics that differ from those with classic Kawasaki disease. For example, an unusually high proportion had gastrointestinal symptoms (abdominal pain, often with vomiting and diarrhoea), unstable blood pressure, and inflammation of the heart muscle (myocarditis).
The researchers say further studies are needed, but these findings “should prompt high vigilance” among doctors, particularly in countries with a high proportion of children of African ancestry.
They describe 21 children and adolescents (average age 7.9 years) with features of Kawasaki disease who were admitted to a hospital in Paris between 27 April and 11 May 2020. Over half of the children (12; 57%) were of African ancestry.
Twelve children presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. Nineteen (90%) had evidence of recent covid-19 infection.
All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers in their bloodstream.
Despite 17 patients (81%) needing intensive care support, all patients were discharged home by 15 May 2020, after an average of 8 days in hospital, with no serious complications.
The researchers point to some limitations, such as the small number of patients, and stress that this is an observational study, so can’t establish a causal link with covid-19 infection.
Nevertheless, they say this Kawasaki-like multisystem inflammatory syndrome seems to be more common in children of African ancestry, suggesting an effect of either social and living conditions or genetic susceptibility, and shows different clinical symptoms to classic Kawasaki disease.
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