Researchers probe childhood syndrome
15 youngsters at Ste-justine Hospital have recovered and all tested negative
Researchers at Ste-justine Hospital are hoping that antibody testing will shed light on whether a mysterious illness that has sickened at least 15 children there is linked to COVID -19.
“We noticed a few weeks ago that we were seeing these children with these high fevers and very inflammatory-like conditions,” said Dr. Fatima Kakkar, a pediatric infectious diseases specialist and clinician-researcher at the hospital.
On Wednesday, the U.S. Centers for Disease Control and Prevention (CDC) said it would issue an alert telling doctors to report cases of multisystem inflammatory syndrome (PMIS), a rare syndrome associated with COVID -19 in children, Reuters reported.
At Ste-justine, the children — who ranged from infants to teenagers — presented with a constellation of symptoms, including persistent fever, rash and swollen lymph nodes, Kakkar said. Abdominal pain, vomiting and diarrhea also were seen. All of the children had elevated inflammatory markers in the blood, which can signal infection or disease.
“Since the beginning of April we’ve had at least 15 cases of this hyperinflammatory syndrome, where they come in with high fevers, lots of inflammatory markers in their blood, and different presentations: sometimes it’s a skin rash and sometimes it’s just a high fever,” Kakar said.
All of the children have recovered, and all tested negative for COVID-19, she added. Antibody tests will be performed in the next few weeks to determine whether any of them previously had been infected by the virus.
“The way to make that causal link is to actually find proof of prior exposure and that would be through serology,” Kakar said. “Other countries have published some preliminary data that does seem to find that there is an antibody association with COVID, but for now we haven’t confirmed that in our cases and that’s going to be our next step.”
The researchers are awaiting reliable antibody tests, which are expected to become available shortly.
The symptoms seen at Ste-justine, Montreal’s designated pediatric hospital for COVID-19, are similar to Kawasaki disease, a fairly rare illness that usually affects children under age 5.
The most common cause of acquired heart disease in children, it causes inflammation in blood vessels throughout the body. Symptoms include bloodshot eyes, cracked lips, a white tongue with red bumps, sore throat, swollen, purplish hands and feet and swollen lymph glands.
Kakar said the hospital usually sees a case of Kawasaki disease once or twice a month.
At the Montreal Children’s Hospital, there has not been a noticeable rise in Kawasaki-like symptoms, said pediatric rheumatologist Rosie Scuccimarri, adding the hospital typically treats 30 to 40 cases of Kawasaki disease per year.
In recent weeks, the hospital has seen a few cases of children presenting with Kawasaki-like symptoms but it’s not possible to say whether they are linked to the new syndrome, she said.
“We’ve had a few cases in this time period and all those children have tested negative for COVID. We’ll be doing the antibody testing once that becomes available,” Scuccimarri said. “Certainly we have not seen any severe cases. With the mild cases, those patients do well. The outcomes are good.”
Scuccimarri said it’s important that parents be alerted to the syndrome, since many people have been staying away from emergency wards because of the pandemic. Physicians also need to be made aware when assessing children, “so we make sure that we’re not dealing with this entity.”
And public-health authorities need to be alerted so they “have an opportunity to evaluate these kinds of decisions as whether schools should reopen or not, Scuccimarri said.
Joanna Merckx, a pediatric infectious diseases specialist at Mcgill University Health Centre, said there is no reason to panic.
“This is still very, very rare,” she said, adding PMIS is far more rare than severe complications of the measles. Every single case related to SARS-COV-2 is a serious thing because it affects a person, but we have to stay rational.”
Every single case related to SARS-COV-2 is a serious thing because it affects a person, but we have to stay rational.