Lengthy-term follow-up wanted for uncommon inflammatory post-COVID syndrome in youngsters
Experts reviewed studies on multisystem inflammatory syndrome in children (MIS-C) to understand the typical pattern of this rare post-COVID syndrome.
Previous studies on the SARS-CoV-2 virus, which causes COVID-19 disease, suggest that children are very resistant to the infection and usually either have mild respiratory symptoms or are asymptomatic. However, in April 2020, pediatricians in the UK reported a small case of a new hyperinflammatory disease in children that appeared to emerge after SARS-CoV-2 infection. These children became seriously ill and had to be hospitalized, usually including intensive care assistance. Similar reports surfaced around the world, and the condition has been termed "Childhood Multisystem Inflammatory Syndrome" (MIS-C). To learn more about the typical symptoms and outcomes of MIS-C, child health experts at the University of Texas conducted a comprehensive review of published reports of the condition. They recently reported their findings regarding post-COVID syndrome in children in EClinical Medicine, a journal from The Lancet.
Rare post-COVID hyperinflammatory syndrome in children
The researchers reviewed the results of 39 observational studies on MIS-C that included 662 children between January and July 2020.
MIS-C developed between three and four weeks after SARS-CoV-2 infection. Fever (100%), abdominal pain or diarrhea (74%), and vomiting (68%) were the most common symptoms. Other symptoms were rash and conjunctivitis. 60 percent of the cases had hyperinflammatory shock (very low blood pressure). Blood tests showed abnormal inflammation, clotting, and heart markers.
A heart echocardiograph was performed in 90% of the children and in 54% of these cases the findings were abnormal. Heart damage included widening of the coronary arteries, decreased ability of the heart to pump blood, and the aneurysm (localized ballooning) of the coronary arteries.
Seventy-one percent of the children had to be treated in the intensive care unit, 22 percent had to be ventilated mechanically. The mean hospital stay was 8 days. Despite the severity of the disease, most children survived after intensive treatment with immunoglobulins and glucocorticosteroids. These treatments are used for other life-threatening inflammatory diseases. A total of 11 deaths were reported (death rate 1.7%). This death rate is higher than the total reported for children with COVID-19 (0.09%).
Almost half of the MIS-C cases had an underlying disease, and half of them were overweight. One worrying finding was that children could develop MIS-C even after an asymptomatic course of COVID-19.
Heart damage is common in children with MIS-C
MIS-C is a new childhood disease that is believed to be related to SARS-CoV-2, causing widespread inflammation, and affecting multiple organ systems. Though fortunately rare, MIS-C can occur after mild COVID-19 and is potentially fatal. However, with immediate, intensive treatment, most children who develop MIS-C survive. Around half of MIS-C cases had underlying illnesses, but are also seen in previously healthy children.
Damage to the heart and coronary arteries is common, but it is not yet clear whether this is permanent. "There is evidence that children with MIS-C have immense inflammation and possible tissue damage to the heart. We need to follow these children closely to understand the long-term effects they can have," said Dr. Alvaro Moreira, lead author of the review.
Written by Julie McShane, MA MB BS
References
1. Ahmed M., Advani S., Moreira A. et al. Multisystem Inflammatory Syndrome in Children: A Systematic Review. EClinical Medicine (Lancet Journal), published September 4, 2020. Doi: https://doi.org/10/1016/j.eclinm.2020.100527
2. University of Texas Health Science Center at San Antonio, press release September 4, 2020. Post-COVID syndrome is seriously damaging to children's hearts. https://www.eurekalert.org/pub_releases/2020-09/uoth-pss090420.php
Image by aalmeidah from Pixabay
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