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Sixty-four children and adolescents in New York State are suspected of having a mysterious inflammatory syndrome linked to COVID-19, the New York Department of Health said in an alert released Wednesday. A growing number of similar cases – including at least one death – have been reported in other parts of the United States and Europe, although the phenomenon is still not well understood.
Pediatricians say parents shouldn’t panic; the condition remains extremely rare. But researchers are also taking a close look at this emerging syndrome, and say that parents should be on the lookout for symptoms in their children that may warrant a quick call to the doctor – a fever that lasts for several days and severe abdominal pain with repeated vomiting, after which the child does not feel better.
” Yes [the child is] you look particularly sick, you should definitely call the doctor, “says Dr. Sean O’Leary, pediatric infectious disease specialist at Children’s Hospital Colorado Anschutz Medical Campus and member of the American Academy of Pediatrics Infectious Disease Committee .
The new condition associated with COVID-19 is called the pediatric multi-system inflammatory syndrome. Symptoms include persistent fever, extreme inflammation, and signs of one or more organs not functioning properly, says cardiologist Jane Newburger, professor of pediatrics at Harvard Medical School and director of the Kawasaki program at Boston Children’s Hospital.
“It’s still very rare, but there has been a spate of cases. Doctors and scientists are working hard to understand the mechanisms involved, and why only certain children are so severely affected, “says Newburger.
Some symptoms may resemble features of Kawasaki disease shock syndrome. Kawasaki disease is an acute illness in children resulting in fever with symptoms such as a rash; conjunctivitis; redness of the lips, tongue and mucous membranes of the mouth and throat; swelling of the hands and / or feet; and sometimes an enlarged group of lymph nodes on one side of the neck, says Newburger. Some children with the disease develop an enlarged coronary artery and aneurysms in these blood vessels.
A small percentage of Kawasaki cases develop symptoms of shock, which can include a sharp drop in systolic blood pressure and difficulty with adequate blood supply to the body’s organs. Kawasaki disease and KDSS affect young children more often, although they can sometimes affect adolescents, says Newburger.
Some cases of the new inflammatory syndrome have overlapping features with KD or with KDSS – including a rash, conjunctivitis, and swelling of the hands or feet. The new inflammatory syndrome can affect not only young children but also older children and adolescents.
But patients with the new syndrome have lab results that look very different, in particular, “heart inflammation to a greater extent than we usually see in Kawasaki shock syndrome”, which is usually very rare, said O’Leary. In New York and London, which have seen a large number of COVID-19 cases, “these types of patients are seen more frequently”.
Some patients “arrive very, very sick,” with low blood pressure and high fever, says O’Leary. Some children have had coronary artery aneurysms, but most have none, he adds.
Other patients have symptoms more similar to toxic shock syndrome, with abdominal pain, vomiting and diarrhea, and high levels of inflammation in the body, including the heart, says O’Leary. Most of the cases are treated in the intensive care unit, he said. Treatment includes intravenous immunoglobulins, which can “calm the immune system,” says Newburger, as well as steroids and cytokine blockers.
Evidence to date in Europe, where reports of the syndrome first appeared, suggests that most children will recover with appropriate supportive care, says O’Leary, although a teenager, a boy 14-year-old in London died, according to a report published Wednesday in The Lancet.
Most children with the syndrome, note O’Leary and Newburger, have either tested positive for current coronavirus infection or for antibodies to the virus, suggesting that they were infected earlier and recovered .
And, according to case reports, some of the children with inflammatory syndrome who tested negative for coronavirus tests had at one time been exposed to someone known to have COVID-19. The inflammatory syndrome may appear days or weeks after COVID-19 disease, according to doctors, suggesting that the syndrome stems from the immune system’s response to the virus.
“One theory is that when you start making antibodies to SARS-COV-2, the antibody itself can cause an immune response,” says Newburger. “This only happens in sensitive individuals whose immune systems are built in a particular way. This does not happen to everyone. It’s still a really rare event in children. “
In late April, the National Health Service of the United Kingdom issued a pediatrician alert regarding the syndrome. Reports have also surfaced in France, Spain and Italy, and are likely dozens worldwide, according to Newburger and O’Leary, although doctors still don’t have precise figures. Newburger says there needs to be a registry where doctors can report cases “so we can start generating statistics.”
“Doctors in all countries talk to each other, but we need to have some structure and some science so that everyone can interpret,” she said.
Earlier this week, the New York City Department of Health released an alert saying that 15 children aged 2 to 15 had been hospitalized for the syndrome. Newburger says she has also been contacted about cases in New Jersey and Philadelphia.
Although the precise link of the syndrome with the coronavirus is not yet clear, O’Leary says that the fact that children in most of these cases are positive for exposure to the virus in one way or another , provides a point of evidence. The huge number of cases – small in absolute terms, but still “much higher than we would normally expect for things like severe Kawasaki or toxic shock syndrome” – provides another, he says.
Then there is the fact that most reports of the syndrome came from the UK and New York, places that have been affected by a large number of COVID-19 cases.
“This is pure speculation at this point,” he says, “but the UK cluster grew about a month after their COVID-19 infections increased, suggesting that it is some kind of immune phenomenon. “