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Coronavirus Disease 2019
New CDC Report on Kawasaki-Like Disease in COVID-19 Children
Multisystem inflammatory syndrome in children and the SARS-CoV-2 coronavirus.
Posted August 14, 2020
In the midst of the coronavirus 2019 (COVID-19) global pandemic, a mysterious syndrome has been reported in children with some symptoms that are similar to Kawasaki disease (KD). A new report published today by the Centers for Disease Control and Prevention (CDC) provides insights on the multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.
“Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition that has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents,” wrote the CDC report authors.
Multisystem inflammatory syndrome in children involves the inflammation where one more areas of the body become swollen, and often red and painful according to the Mayo Clinic. A majority of cases of MIS-C had symptoms that include elevated markers of inflammation, shock, gastrointestinal distress, and cardiac issues. Other symptoms of MIS-C include vomiting, diarrhea, stomach pains, skin rash, red eyes, redness or swelling of the lips and tongue, unusual fatigue, and redness or swelling of the hands or feet, and fever that lasts 24 hours or more. In severe cases, there is difficulty breathing, chest pain or pressure, bluish lips or face, severe stomach pain, and the inability to wake up or remain awake.
There are MIS-C symptoms that are similar to those of Kawasaki disease (KD). KD is a severe syndrome that affects over 4,200 American children each year according to the Kawasaki Disease Foundation, a 501(c)(3) nonprofit organization. It is named after Japanese pediatrician Tomisaku Kawasaki who described the disease in 1967, and the cause of the illness is unknown to this day.
KD causes inflammation in the coronary artery wall that if not treated, could seriously damage the heart. Symptoms of Kawasaki Disease include bloodshot eyes, body rash, strawberry tongue, cracked and inflammation of the lips, mouth, and throat, swollen red skin on palms and soles of feet, swollen lymph nodes, diarrhea, vomiting, abdominal pain, peeling of skin on the hands and feet, and fever that lasts at least five days.
“Distinguishing patients with MIS-C from those with acute COVID-19 and other hyperinflammatory conditions is critical for early diagnosis and appropriate management,” wrote the authors of the CDC report.
The CDC reports 570 cases of children in the U.S. with multisystem inflammatory syndrome as of July 29, 2020, with onset dates from March 2 - July 18, 2020, and 10 deaths. The CDC report includes data from New York City, the District of Columbia, and 40 state health departments. Among the 565 MIS-C patients who took either a serology or RT-PCR test for the SARS-CoV-2 coronavirus that cause COVID-19 disease, all of them had positive test results.
To put the frequency of the MIS-C who tested positive for the SARS-CoV-2 coronavirus in context, it is important to look at the overall number of COVID-19 child cases. In the United States, the number of child cases of COVID-19 increased 90 percent in a four-week period to 380,174 cumulative cases of children, according to a recent August report by the American Academy of Pediatrics (AAP) and Children’s Hospital Association. The 565 cases of MIS-C children that tested positive for the SARS-CoV-2 virus that causes COVID-19 disease represents roughly 0.15 percent of the total cumulative COVID-19 child cases.
Among the 570 reported MIS-C cases, 316 cases were in males, 254 cases in females, and the median age is 8 years old. In terms of ethnicity, a majority of the MIS-C pediatric cases in the U.S. were either Hispanic (40.5 percent) or black (33.1 percent), compared to 13.2 percent for white children. Over 25 percent of cases had the underlying medical condition of obesity. Among the cases, 86 percent had four or more organs affected.
The initial cases of multisystem inflammatory syndrome in children were first reported in Europe. It was called PIMS-TS, which stands for “pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.”
An unprecedented cluster broke out in a 10-day period in the United Kingdom in April 2020. Eight previously healthy children had symptoms of hyperinflammation, conjunctivitis, gastrointestinal distress, unrelenting fever, variable rash, peripheral edema, cardiovascular shock, and fever according to The Lancet. The children had detectable antibodies; however, each tested negative on the PCR test for SARS-CoV-2. All the children except for one were over the 75th percentile for weight; five were boys, and six were of Afro-Caribbean descent.
During the period between April 1 - May 10, 2020, 78 cases of multisystem inflammatory syndrome in children were reported by 21 pediatric intensive care units in the United Kingdom. The median age of the patients was 11 years old. A majority (78 percent) of patients were from ethnic minority backgrounds and male (67 percent).
In Bergamo, Italy, there were 10 children with a severe Kawasaki-like disease during February 18 - April 20, 2020. Out of these 10 children, eight tested positive for SARS-CoV-2 on either the serology test for antibodies, or the nasal swab PCR test, and two tested negative for both tests according to The Lancet.
To date, there are an estimated 1,000 cases of multisystem inflammatory syndrome in children globally in multiple countries according to The New England Journal of Medicine.
The CDC recommends, “As the COVID-19 pandemic continues, with the number of cases increasing in many jurisdictions, health care providers should continue to monitor patients to identify children with a hyperinflammatory syndrome with shock and cardiac involvement.”
Copyright © 2020 Cami Rosso All rights reserved.
