A new inflammatory syndrome linked to Covid-19 affecting children is currently in the news. It is called Pediatric Multisystem Inflammatory Syndrome. I feel it is important for pediatricians to make our patients aware of this. In particular, since the syndrome can affect the heart, I feel it is important for pediatric cardiologists to be on top of this. This new inflammatory syndrome has similarities to other known inflammatory diseases that can affect the heart, Kawasaki disease and toxic shock syndrome.
The first US case may have been a 6 month old from Santa Clara County who presented with classic Kawasaki disease symptoms in March. The infant was hospitalized and underwent standard Kawasaki disease treatment. Because of hospital protocol at Lucile Packard Children’s Hospital Stanford, she was tested for Covid-19 with positive test results. Since that time, the New York City Health Department announced 15 cases of Pediatric Multisystem Inflammatory Syndrome between April 29 and May 3. Of those 15, 4 tested positive for Covid-19 and 6 tested positive for SARS-CoV-2 antibodies. New York State then reported 64 total suspected cases. Cases have also been reported in Kentucky, California, Washington and Michigan.
The publication The Lancet described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. All of these children were previously healthy with no comorbidities. These cases were noted in late April and since the original publication, over 20 cases have been described. More than half of these children had SARS-CoV-2 antibodies. These patients did not have respiratory symptoms.
This inflammatory syndrome shares similarities to Kawasaki disease and toxic shock syndrome. Kawasaki disease typically affects children younger than 5. However, this inflammatory syndrome has affected a number of teens along with younger children. The typical patient has presented with persistent fever above 101 degrees, rash, red eyes (conjunctivitis), and red lips/tongue. Gastrointestinal symptoms such as abdominal pain, nausea, vomiting and diarrhea are common. Some of these children are quite sick and have presented with lethargy and low blood pressure. On studies of the heart including EKG, echocardiogram and blood work signs of inflammation are common. Inflammation of the small blood vessels supplying blood to the heart muscle (coronary arteries) has been seen. Also, direct inflammation of the heart muscle (myocarditis) has been seen.
This appears to be a post-infectious hyperinflammatory or hyperimmune response that may appear weeks after the initial encounter or infection with Corona virus. We, the pediatric medical community, have appropriately counseled parents in the early stages of this pandemic that children are not getting sick at the same rates as adults. For the most part, this still holds. However, we feel additional vigilance is needed in light of this new inflammatory syndrome that is affecting children. Parents have appropriately kept children out of the doctor’s office, emergency room and urgent care except in cases of significant symptoms. It is easy to imagine a scenario where a parent calls the pediatrician’s office to report fever and rash and perhaps lethargy in a previously healthy child. With a lack of respiratory symptoms, this parent might receive reassurance and be told to call back or make an appointment for any worsening symptoms. However, cases like this require stricter scrutiny, and it is appropriate in many cases for these children to be seen by the pediatrician in person. This disease is still new to all of us. We’re all learning on the fly. We’re here to support you. Please don’t hesitate to contact us with any questions.