Kawasaki syndrome or MIS-C: Children are now also facing the brunt of COVID-19
A 14-year-old girl was admitted to a Mumbai hospital with rashes and high fever, classic symptoms of Kawasaki syndrome.
By and large, COVID-19 has not been infecting younger children as they have a better immunity system and almost no issues of co-morbidities. However, around April, children in the US started developing inflammatory symptoms that were similar to those of Kawasaki syndrome. There have been several reports of cases among children in France, Italy, Spain and Britain that have shown similar symptoms.
New York Governor Andrew Cuomo said the symptoms included "inflammation of the blood vessels, which in turn could cause heart problems". The syndrome also shares symptoms with toxic shock and Kawasaki disease, which is associated with fever, skin rashes, swelling of the glands, and in severe cases, inflammation of arteries of the heart.
A study in The Journal of American Medical Association termed this new symptom as “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19” (PIMS) while the WHO called it Multisystem Inflammatory Syndrome in Children (MIS-C). It is a new condition observed in children who have recovered from COVID-19 or are recovering.
The CDC had put out new guidelines to help doctors identify these new conditions among children. The guidance defines the condition as occurring in children under 21 with fever, evidence of inflammation, illness severe enough to require hospitalization and impairment of multiple organs such as the heart, kidneys, blood vessels, gut, skin and nerves. Doctors should rule out other plausible diagnoses and the children should test positive for a current infection or for antibodies that show they have had a recent infection.
Patterns in imaging findings
A recent study conducted by the doctors at the Evelina London Children’s Hospital in London, UK has examined the spectrum of imaging findings in children with these new inflammatory conditions.
It began when the hospital saw a rise in children who were admitted with a variety of symptoms that including fever, headaches, abdominal pain, rash, and conjunctivitis. While laboratory results showed that they shared some similarities to those of Kawasaki syndrome or toxic shock syndrome, the symptoms were atypical and more severe.
"Our hospital saw an unprecedented cluster of children presenting with MIS-C, a new hyperinflammatory syndrome in children related to the current COVID-19 pandemic—the recognition of which led to a national alert,” said Shema Hameed the lead author and the consultant pediatric radiologist at the hospital in a statement.
The researchers performed a 'retrospective review' of the 'clinical, laboratory and imaging findings' of the first 35 children, under age 17, who were admitted to the hospital and met the classic definition for MIS-C. The children included 27 boys and eight girls, with an average age of 11 years old.
A retrospective review is a process of determining coverage after treatment has been given. They analyse patient care data to support the coverage determination process.
According to a press statement, the study found that that the children that fever was most common in 33 children or 94 percent. Gastrointestinal symptoms including abdominal pain, vomiting and diarrhoea were present in 30 (86 percent) of the children, the rash was seen in 13 children (37 percent) and conjunctivitis in 9 children (26 percent). Twenty-one children (60 percent) were in shock.
Clinical status was severe enough to warrant management in the pediatric intensive care unit in 24 of 35 children (69 percent), of which 7 (20 percent) required mechanical ventilation and 20 (57 percent) inotropic support. Two children required extracorporeal membrane oxygenation (ECMO) due to severe myocardial dysfunction. Lab tests also revealed that all of the children had abnormal white blood cell counts.
The study also found a pattern in the imaging findings as well. The children that were part of the study had airway inflammation, rapidly progressive pulmonary edema, coronary artery aneurysms and extensive abdominal inflammatory changes within the right iliac fossa.
The iliac fossa is a large, smooth, concave surface on the internal surface of the ilium bone. The ilium is part of the three fused bones that make up the hip bone.
Pulmonary edema is a condition caused by excess fluid in the lungs and is usually caused by a heart condition.
The findings of this study have been published in the journal Radiology.
MIS-C cases in India
Recently, The Indian Express reported that a 14-year-old girl was admitted to a Mumbai hospital with rashes and high fever, classic symptoms of Kawasaki syndrome. She has been transferred to the ICU on Friday, last week as her conditions had worsened. She has been tested positive for COVID-19 after her father also tested positive. She has been put on a “high dose” of steroids, immunoglobulins, and immunosuppressant drug tocilizumab.
“It is not Kawasaki disease, but similar to it,” said Dr Tanu Singhal, a paediatric infectious disease expert at the Kokilaben hospital, Mumbai as patients who are infected with Kawasaki patients also exhibiting red tongue and eyes. “Children mostly develop the Kawasaki-like symptoms two-three weeks after a Covid-19 infection.”
Singhal also said she has seen two other cases in Mumbai - one at SRCC Hospital and another at a private hospital in Jogeshwari. Both the patients had inflammation, fever and rashes but had tested negative for Covid-19.
An eight-year-old boy from Chennai was the first case, that was reported in India, to be infected with MIS-C. The boy was in a critical condition and was admitted to the ICU in Kanchi Kamakoti CHILDS Trust Hospital, Chennai, reported Hindustan Times. He showed symptoms of toxic shock syndrome and Kawasaki disease according to the pre-print paper published in the journal of Indian Paediatrics on 10 May. He was also treated with "intravenous immunoglobulin and tocilizumab” and recovered within two weeks.
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