Pediatric Multi-System Inflammatory Syndrome

Post Reply New Topic

New York Governor Andrew Cuomo on Tuesday directed the state's hospitals to prioritize COVID-19 testing for children showing symptoms of "pediatric multi-system inflammatory syndrome," a mysterious illness affecting children that's believed to be related to COVID-19. There are already more than 50 cases of the illness in New York City alone, according to CBS New York, and the state is investigating approximately 100 total statewide.

Two children and a teenager have died from the illness in New York State, according to a press release from Cuomo's office.

"We have been behind this virus every step of the way and even as we are now beginning to see the numbers on the decline, the virus is still surprising us," Governor Cuomo said in the release. "Initially we thought COVID-19 didn't affect children, and now we're dealing with a disturbing issue where we have about 100 cases of an inflammatory disease in children that seems to be created by the virus."

New York is leading the investigation of this situation and we are advising all hospitals and medical providers to prioritize diagnostic testing for any children that are displaying symptoms of this illness," he added.

Mayor Bill de Blasio said Tuesday that New York has at least 52 cases of the illness, and one of the deaths. Ten more cases are pending.

"It's sobering. It's bluntly frightening, and I want to say to parents out there: If you're hearing this information about pediatric multi-system inflammatory syndrome and it sounds scary, it does sound scary. I'm speaking as a parent myself," de Blasio said.

Of the 62 confirmed or possible cases, 25 tested positive for the coronavirus and 22 had COVID-19 antibodies.

Often times when they get the results back from COVID-19, the results may actually be negative," New York City Health Commissioner Dr. Oxiris Barbot said Monday. "We are encouraging pediatricians to also do antibody testing for these children, more so to confirm the diagnosis, not as an indication of whether or not it's going to then impact the case moving forward."

Experts say the illness bears some resemblance to a rare condition called Kawasaki disease.

Mayor Bill de Blasio said early detection makes all the difference, and parents should be on the lookout for persistent fever, rash, abdominal pain and vomiting.

"If your child is off, if your child doesn't have energy, if your child is not themselves and has at least one of these symptoms, call immediately to your doctor, your health care provider," he said. "If you see multiple symptoms, even more urgent."

Officials say care should be sought immediately if a child has:

Prolonged fever (more than 5 days).
Difficulty feeding (infants) or is too sick to drink fluids.
Severe abdominal pain, diarrhea or vomiting.
Change in skin color - becoming pale, patchy, and/or blue
Trouble breathing or is breathing very quickly.
Racing heart or chest pain.
Decreased amount or frequency of urine
Lethargy, irritability or confusion.
Doctors say kids over the age of 2 should wear masks whenever they go outside, practice social distancing and stay indoors as much as possible.

Researchers in Italy announced Wednesday that they have identified 10 cases of young children with COVID-19 symptoms that resemble Kawasaki disease, a rare inflammatory disorder.

Their findings, which were published by the Lancet, are similar to reports from New York, where more than 70 children have developed symptoms similar to the rare disease that can cause heart problems after becoming infected with the new coronavirus, SARS-CoV-2.

We noticed an increase in the number of children being referred to our hospital with an inflammatory condition similar to Kawasaki disease around the time the SARS-CoV-2 outbreak was taking hold in our region," Dr. Lucio Verdoni, a pediatrician at the Papa Giovanni XXIII Hospital in Bergamo, Italy, said in a press release. He co-authored the Lancet report.

In the Lombardy region of Italy, where Verdoni and his colleagues are based, only 19 children had been diagnosed with Kawasaki disease in the five years before February, when the COVID-19 outbreak began, they said.

The 10 cases between February and April could represent a 30-fold increase, although the researchers caution that it is difficult to draw firm conclusions with such small numbers.

Verdoni and his colleagues performed a retrospective review of patient notes from all 29 children admitted to their pediatric unit with symptoms of Kawasaki disease between January 2015 and April 20. Before the COVID-19 outbreak, the hospital treated roughly one case of the disease every three months, they found.

The increase could not be attributed to an increase in hospital admissions, as the number of patients admitted during that time period actually was six-fold lower than before COVID-19 was first reported in the area, they said.

The children admitted to the hospital with Kawasaki-like symptoms since the start of the outbreak -- with a mean age of 7 1/2 -- were up to three years older than those in pre-outbreak cases, and all but two tested positive for SARS-CoV-2.

They also appeared to experience more severe symptoms than past cases, with more than half suffering heart complications, compared with just two of the 19 treated before the pandemic.

In all, half of the children had signs of toxic shock syndrome, while none of those treated before February 2020 had the complication. Toxic shock syndrome -- a release of toxins in the body often caused by a bacterial infection, rather than a viral one, like SARS-CoV-2 -- produces initial symptoms similar to Kawasaki and can lead to multiple organ failure.

Eight of the COVID-19 cases also required additional treatment with steroids, compared with just four of the 19 in the pre-outbreak group.

Although two of the patients treated for Kawasaki-like illness after the start of the outbreak tested negative for SARS-CoV-2 on an antibody test, the researchers noted that the test used is not 100 percent accurate, suggesting these could be false negative results.

In addition, one of the children recently had been treated with a high dose of immunoglobulin, a standard regimen for Kawasaki disease, which could have masked any antibodies to the virus.

Taken together, the authors said their findings represent an association between an outbreak of SARS-CoV-2 virus and an inflammatory condition similar to Kawasaki disease.

"In our experience, only a very small proportion of children infected with SARS-CoV-2 develop symptoms of Kawasaki disease," said study co-author Dr. Annalisa Gervasoni, a pediatric specialist at the Papa Giovanni XXIII Hospital.

"However, it is important to understand the consequences of the virus in children, particularly as countries around the world grapple with plans to start relaxing social distancing policies," she said.

New York Governor Andrew Cuomo said Wednesday that 14 other states are now investigating cases of a mysterious illness appearing in children that is potentially related to the coronavirus. The governor urged parents to "be aware" of the inflammatory syndrome believed to be connected to COVID-19.

New York has now identified over 100 cases of the "pediatric multi-system inflammatory syndrome."

"New York is in many ways the tip of the arrow here," Cuomo said. "(We are) looking at 102 cases where children who may have been infected with the COVID virus show symptoms of an inflammatory disease like Kawasaki Disease, or toxic shock-like syndrome."

According to the governor, 14 other states, as well as Washington D.C. and five European countries, have reported cases. The states are: California, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, Ohio, Pennsylvania, Utah and Washington.

According to the governor, 14 other states, as well as Washington D.C. and five European countries, have reported cases. The states are: California, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, Ohio, Pennsylvania, Utah and Washington.

Cuomo said that because the syndrome may not show up until weeks after coronavirus infection, and does not present as a normal COVID-19 case, it may not have been initially diagnosed as related to the virus.

COVID-19 symptoms are predominantly respiratory; but the Kawasaki-like syndrome seen in children appears to be caused by an inflammation of blood vessels, presenting cardiac symptoms. Predominant symptoms include prolonged fever, abdominal pain and a skin rash. Afflicted children, however, have also shown had changes in skin color (becoming, pale, patchy, or blue), difficulty feeding (for infants), difficulty breathing, a racing heart, as well as lethargy, irritability or confusion.

According to the governor, the state's department of health has told hospitals to prioritize COVID-19 testing for children who come in with any of the symptoms related to the inflammatory syndrome.

"This is a parent's worst nightmare," he said.

There is a mysterious syndrome effecting children with CV,Mass General has also noted this.

They used to say CV wasn't going to effect children but they were wrong.

Italian doctors say they've got the first scientific evidence linking the coronavirus to a rare but deadly inflammatory disease in children. The condition, called pediatric multisystem inflammatory syndrome, has been reported in more than a dozen states across the U.S., including Louisiana, Mississippi, California and New York. Over 100 children have been affected in New York alone, three of whom died, according to Governor Andrew Cuomo.

Doctors had suspected early on that coronavirus played a role in the new disorder by triggering an excessive immune reaction, but there was no clear proof that the two were linked.

Reported in The Lancet medical journal, the new evidence comes from doctors in Bergamo, the epicenter of coronavirus infections and deaths in Italy, where the nationwide reported death toll is more than 30,000, behind only Britain and the United States.

Doctors at the Papa Giovanni XXIII hospital compared a series of 10 cases of the illness with cases of a similar rare condition in children called Kawasaki disease, finding a 30-fold increase in cases of Kawasaki-like disease in patients between February and April.

The acceleration of cases occurred at a pace of about one every three months, indicating a cluster that was fueled by the coronavirus outbreak, especially, the authors noted, since overall hospital admissions were much lower than usual during national stay-at-home orders.

"Our study provides the first clear evidence of a link between SARS-CoV-2 infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus," said Dr. Lorenzo D'Antiga, director of child health at the hospital, in The Guardian.

None of the 10 children in Bergamo died, but the authors reported that their symptoms were much more severe than those of the children with Kawasaki disease. Heart complications were more common, as were lower counts of platelets. A type of white blood cell typical of coronavirus patients was also more prevalent.

Five of the children experienced shock, which did not occur in any of the Kawasaki patients.

The researchers also highlighted that eight of the 10 children tested positive for COVID-19 antibodies, indicating that the children had been infected with the virus weeks earlier. They suspect that the two other children may have been false negatives, due to imperfect tests.

While Kawasaki disease tends to strike infants and preschoolers, the 10 children with the mysterious disorder were generally several years older. The average age of the Kawasaki patients was 3; the average age of the children with this condition was 7 and a half.

The doctors warn that the "strong association" between the coronavirus and the inflammatory condition should be taken into account as governments around the world ease lockdown restrictions.

But they also stressed that the disorder is exceedingly rare, diagnosed in no more than one in 1,000 children exposed to the virus. Only a small fraction require intensive care, and even fewer die.

The U.S. Centers for Disease Control and Prevention has said it will soon issue an alert asking doctors to report cases of children with symptoms of the syndrome.

A report from the U.S. Centers for Disease Control and Prevention found that nearly 600 children have been hospitalized in the United States with a rare inflammatory syndrome associated with the novel coronavirus during the pandemic.

The CDC had issued warnings to health care providers and parents in May about multisystem inflammatory syndrome in children, or MIS-C.

The CDC report covered illnesses that began from mid-February to mid-July. Forty states reported cases.

The agency found that as of July 29, a total of 570 child patients were diagnosed with MIS-C, according to state health departments across the country. The CDC also found that all MIS-C patients had tested positive for the coronavirus, and 10 died.

According to the CDC, MIS-C is a condition that causes various parts of the human body to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.

While symptoms of MIS-C can vary from case to case, they can include a persistent fever, rash, conjunctivitis, stomach ache, vomiting, diarrhea, swollen lymph nodes in the neck, swollen hands and feet, cracked lips and a tongue that is redder than usual, according to Harvard Health, a blog by Harvard Medical School.

“We do not yet know what causes MIS-C. However, many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19," the CDC said.

The CDC said that the inflammatory condition was first reported in the United Kingdom as early as late April, and on May 12, New York City Mayor Bill de Blasio said 100 children in the city had been diagnosed for MIS-C. Of the 100, 55 tested postive for COVID-19 or had antibodies.

“The underlying problem that results in MIS-C seems to be a dysfunction of the immune system,” said Dr. Ermias Belay, who is leading the CDC team looking into MIS-C cases.

Some children with the syndrome have symptoms resembling Kawasaki disease, another rare childhood condition that can cause swelling and heart problems.

The immune system kicks into overdrive when it sees the virus, releasing chemicals that can damage different organs, Belay said.

The CDC report found that 13% of kids with the condition were White, while more than 40% were Hispanic and 33% were Black. Overall, about half of U.S. children are White, around 25% Hispanic and about 14% are Black, according to population estimates.

Scientists are still learning about the condition. Experts say genetics has nothing to do with why some racial and ethnic groups are more likely to get seriously sick from the novel coronavirus or die from it. But it's not yet clear if genetics play a role in the childhood inflammatory condition, according to Dr. Cyrus Shahpar, who oversees epidemic prevention efforts for a not-for-profit data and advocacy organization called Vital Strategies, and Belay.

Health experts say that while the condition remains relatively rare, it is serious. Parents should be vigilant and report any symptoms to a doctor — particularly if children have a prolonged fever lasting more than a couple days.

“Parents really shouldn’t be afraid to take their child to their pediatrician if they’re worried they’re sick,” said Dr. Sean O’Leary, pediatric infectious disease specialist at Children’s Hospital Colorado.

“They should also, of course, make sure they are keeping up on their well-child care and their vaccinations. The diseases we prevent with vaccines are actually much more severe in children than COVID-19, so we want to make sure to protect children from those diseases.”