Inflammatory syndrome in children often treatable
Parents already overwhelmed by the challenges of raising kids amid a global pandemic now have something else to worry about: a mysterious inflammatory disease most evident in New York – the nation’s coronavirus epicenter – but also popping up elsewhere. It’s too early to tell how big a concern it will become, but the illness came up during a Senate hearing Tuesday when Dr. Anthony Fauci of the White House coronavirus task force warned against rushing to reopen schools in the fall. He referenced “children presenting with COVID-19 who actually have a very strange inflammatory syndrome, very similar to Kawasaki syndrome. “I think we better be careful if we are not cavalier in thinking that children are completely immune to the deleterious effects (of the virus).’’ Doctors are calling the new ailment pediatric multisystem inflammatory syndrome, and it shares some traits with Kawasaki, which typically afflicts children under 5 years old. Their common symptoms: prolonged fever, a rash, conjunctivitis, swelling of the palms or soles of the feet, sometimes peeling of the skin in those areas and lymph node enlargement. On Tuesday, New York Gov. Andrew Cuomo said the state is investigating about 100 possible cases of the new disease, which has killed at least three and has also been spotted in Los Angeles, the San Francisco Bay Area (suspected), Chicago, Britain and Spain. Dr. Charles Schleien, chair of pediatrics at Northwell Health in New York, said his hospital has seen about 40 cases since mid-April and the majority showed antibodies similar to the coronavirus, meaning they had been infected, but had no symptoms of COVID-19. Several others tested positive for the virus and didn’t have symptoms either. Though a causal connection between the virus and the new illness has yet to be proven, “The relationship seems pretty strong,’’ Schleien said. “First of all, we never see these many kids with Kawasaki. Usually we’ll see a few kids a year. We won’t see three dozen over a period of a few weeks. So, given the numbers and given the fact it’s not acting exactly like Kawasaki, it looks like it’s probably a post-COVID-19 infec
tion inflammatory disease.’’
One difference from Kawasaki, which d evelops in about one in every 10,000 American children under 5 every year, is the age range for this disease stretches into adolescence. Schleien said he has seen it in minors as old as 14.
One fortuitous similarity, though, is that both can be treated effectively, usually with intravenous immunoglobulin and sometimes steroids, followed by aspirin. Hospital stays for patients may last two to four days. Parents are advised to check with a physician or take their children to an emergency room if their fever persists for more than two to three days, especially if some of the other symptoms appear, including a rapid heartbeat.
“The good news is that, like Kawasaki disease, almost all the kids are treatable,’’ Schleien said. “It is highly likely that, with treatment, they’re going to be fine. It’s not like the fear of COVID-19 where we know there are no treatments and it’s a matter of luck.’’
But the apparent link between the two raises concerns, and it’s reasonable to expect more cases to be identified at other COVID-19 hot spots now that there’s more awareness of the inflammatory syndrome.
Schleien said the illness has become such a hot topic among New York-area pediatricians that when his hospital hosted a video call to discuss it, more than 600 logged on and the website crashed.
The Centers for Disease Control and Prevention said it’s studying the rare disease and does not have statistics about its incidence.
“As more data are emerging, CDC is working with the Council of State and Territorial Epidemiologists and other domestic and international partners to better understand and characterize this new syndrome, its prevalence and risk factors for it; and to develop a case definition that will allow us to keep track of it,’’ the agency said through a spokesman.
On Wednesday, the CDC confirmed it plans to send out an alert in the next couple of days telling doctors to be on the lookout for the syndrome.
The children’s hospital next to the Stanford University campus, about 35 miles south of San Francisco, may have discovered the first case of the new disease in a 6-month-old baby who was initially diagnosed with Kawasaki, then tested positive for the coronavirus March 16.
Dr. Yvonne Maldonado, a professor of pediatric infectious diseases at the university, hosted a webinar that addressed the case on Friday as scientists try to find out whether the virus precipitates the syndrome.
“The question is, will this be something to look out for in children over time?’’ she said. “It may be that it’s another inflammatory reaction, like we’re seeing in adults who have inflammation of their lungs. It seems like this virus triggers in some people a really intense inflammatory response.’’
Researchers from the U.K., where a few dozen cases of the syndrome have been reported, participated in the webinar and pointed out that the few children who had COVID-19 symptoms did not show signs of the new disease.
However, children who remained asymptomatic despite being in a family with several infected and sick members developed the inflammatory response a week or two later.
Through the haze of uncertainty still surrounding the coronavirus and its offshoots, Maldonado wants to appease parents while reminding them to practice social distancing and encourage it on their children. And she has these messages about the new syndrome:
“We have to do two things,’’ she said. “We have to reassure people that it’s very rare. And at the same time, we need to make people aware this is not a madeup disease. This is real.’’
“The good news is that, like Kawasaki disease, almost all the kids are treatable.” Dr. Charles Schleien Chair of pediatrics at Northwell Health in New York