Doctors around the world have reported more cases of a rare but potentially lethal inflammatory syndrome in children that appears to be linked to coronavirus infections, reports The Guardian. Nearly 100 cases of the unusual illness have emerged in at least six countries, with doctors in Britain, the US, France, Italy, Spain and Switzerland now reported to be investigating the condition.
The first cases came to light this week when the UK’s National Health Service (NHS) issued an alert to paediatricians about a number of children admitted to intensive care units with a mix of toxic shock and a condition known as Kawasaki disease, an inflammatory disorder that affects the blood vessel, heart and other organs. So far 19 children have been affected in the UK and none have died.
The French health minister, Olivier Veran, is quoted in the report as saying that the country had more than a dozen children with inflammation around the heart, and while there was insufficient evidence to prove a link with coronavirus, he said the cases were being taken “very seriously.”
Many of the children having treatment for the new syndrome have tested positive for coronavirus, but others have not. Some doctors suspect the syndrome is a “post-infection inflammatory response” where the immune system overreacts in the wake of an infection. This would suggest that in some children the disease has two phases – the initial infection and a secondary immune response that takes hold later.
The report says the new syndrome, which has yet to be named, dominated discussion between leading doctors on a teleconference about COVID-19 in children hosted last week by the World Health Organisation.
Fifteen children in New York City have been hospitalised for what officials called a “multi-system inflammatory syndrome” that the local health department is investigating as a possible consequence of a COVID-19 infection. Stat News reports that the children in New York, ages 2 to 15, had high fevers and elevated levels of inflammatory markers, signs that are common in shock and Kawasaki disease, the city’s health department said.
The patients, who were hospitalised from 17 April to 1 May, also showed symptoms including rash, abdominal pain, vomiting, and diarrhoea. Five of the children had to be placed on ventilators; none have died.
Only four of the patients tested positive for an active case of COVID-19, but six of the negative cases showed evidence of a previous infection based on blood tests.
“What we’ve asked for is for the global network of clinicians to be on alert for this and to ensure that they capture information on children systematically so that we can better understand what is occurring in children and so that we can better improve our understanding and guide treatment,” Maria Van Kerkhove, a World Health Organisation coronavirus expert, said at last week’s briefing . She said that the cases reported in Europe appeared to be rare.
The bulletins issued by New York City’s health department and a group of British paediatricians warned clinicians to be on the lookout for signs of Kawasaki disease, which can be difficult to diagnose. Other public health agencies have also started to inform providers about the possible connection between COVID-19 and the condition and are asking them to report suspected cases. It’s likely that as doctors review hospitalisations of sick children, more examples will come to light.
Kawasaki disease causes inflammation in arteries, particularly those that supply the heart with blood. If it’s not treated quickly, it can lead to blocked blood flow and heart damage. It’s most common in children under 5, but can affect teenagers as well. There is no known cause for the disease, but it’s thought that it occurs when an infection causes the body’s own immune system to overreact. In people with serious COVID-19 infections, much of the widespread organ damage is similarly caused not directly by the virus, but by the immune reaction heading into overdrive.
“We do not yet know if the coronavirus produces a similar immune response in children,” Michael Portman, a paediatric cardiologist and director of the Kawasaki Disease Clinic at Seattle Children’s Hospital said. “Adults with the coronavirus often show a massive immune response, which is in some ways similar to that occurring in children with Kawasaki disease.”
Jane Burns, a paediatrician and director of the University of California San Diego’s Kawasaki Disease Research Centre writes that COVID-19 “may be a trigger for some children to develop KD,” in line with how there were different triggers for different children based on genetics. But, she added, “there is no information to suggest that children who have had KD are at increased risk for complications of COVID-19 infection compared to the general population.”
[link url="https://www.theguardian.com/society/2020/apr/29/more-cases-of-rare-syndrome-in-children-reported-globally"]Full report in The Guardian[/link]
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