Multi-system inflammatory disease in Covid-19 infected children

On April 27, 2020, The Sun, a British newspaper with an American edition, published an article about a National Health Service warning about a new presentation of the Covid-19 infection in children; it even had flashy pictures of the new syndrome. The alert was sent to general practitioners in North London where the chiefs of health care delivery said: “there is growing concern that a Covid-19 related inflammatory syndrome is emerging in children in the UK…Over the last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.”

On April 27, 2020, the Pediatric Intensive Care Society of the United Kingdom issued a statement warning health care providers and parents that there was “an increased number of novel presentations of a multi-system inflammatory disease in critically ill children infected with Covid-19.” They recommended parents to seek proper professional help if their children had any of the following symptoms:

  1. Becomes pale, mottled and feels abnormally cold to the touch
  2. Has pauses in their breathing (apneas), has an irregular breathing pattern or starts grunting
  3. Severe difficulty in breathing, becoming agitated or unresponsive
  4. Is going blue round the lips
  5. Has a fit/seizure
  6. Becomes extremely distressed (crying inconsolably despite distraction), confused, very lethargic (difficult to wake) or unresponsive
  7. Develops a rash that does not disappear with pressure (the Glass test)
  8. Has testicular pain, especially in teenage boys

On May 4, 20220, the New York City Department of Health issued its Health Alert #13 stating that 15 children in New York City hospitals have been identified with a multi-system inflammatory syndrome that resembles Kawasaki disease and/or toxic shock syndrome. The NYC experts said that: “clinical features vary, depending on the affected organ system, but have been noted to include features of Kawasaki disease or features of shock; however, the full spectrum of disease is not yet known. Persistent fever and elevated inflammatory markers (CRP, troponin, etc.) have been seen among affected patients. Patients with this syndrome who have been admitted to pediatric intensive care units (PICUs) have required cardiac and/or respiratory support. Only severe cases may have been recognized at this time.”

On May 9, 2020, Governor Andrew M. Cuomo of New York informed in his daily update that three children had died of this multi-inflammatory syndrome in the New York area hospitals. Moreover, they had already identified up to 75 children with the syndrome. They were initially admitted without any respiratory symptoms but they all tested positive either for the virus or its antibodies. He warned that it is a developing serious situation.

Sadly, the emergence of this Kawasaki-like syndrome might just be the tip of the iceberg.

Stay distant. Stay safe. Stay beautiful.

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