From the beginning of the COVID-19 pandemic, children were a population left relatively untouched by the novel coronavirus. More recently, pediatric hospitals are sharing stories of children suffering from pediatric inflammatory multisystem syndrome (PIMS), also referred to as Kawasaki disease, inflammation syndrome, severe inflammation from COVID-19 or other names, reports Children’s Hospital Los Angeles (CHLA).
Though the information available about PIMS is still extremely limited due to the small numbers of cases compared with the staggering numbers of people affected by COVID-19, pediatric specialists around the country, including those at CHLA, are focusing their efforts on determining whether more cases exist.
CHLA experts noticed an increase in the number of patients diagnosed with Kawasaki disease (a rare pediatric condition characterized by inflammation of blood vessels and abnormal dilations of the arteries supplying the heart with blood) in the month of April as compared to the previous two years. CHLA’s team began testing to determine whether the patients seen in recent months had antibodies demonstrating past COVID-19 infection. This began as hospitals in the United Kingdom and New York City started reporting children with significant inflammation, toxic shock syndrome and symptoms of Kawasaki disease following infection with the novel coronavirus.
By conducting serology testing for antibodies, CHLA has diagnosed three of its patients with PIMS. Each child was initially believed to have Kawasaki disease and received treatment from the hospital’s team of experts in infectious diseases and Kawasaki disease. Positive antibody testing for each of the patients, combined with a set of symptoms consistent with other patients around the world and additional negative viral testing has led the CHLA team to diagnose these patients with PIMS.
Specialists in Cardiology and Infectious Diseases are now following up with additional patients who were recently diagnosed with Kawasaki disease at the beginning stages of the coronavirus pandemic to test them for antibodies of the virus causing COVID-19. Test results will help doctors carefully evaluate patients for PIMS and supply them with more information to better understand the impact of the novel coronavirus on the pediatric population.
PIMS is a new health condition seen in children who have been infected with novel coronavirus, recovered from it and later have an immune response that results in significant levels of inflammation in organ systems and symptoms. PIMS is similar to other inflammatory conditions like Kawasaki disease and toxic shock syndrome. Children who have PIMS generally did not have obvious symptoms when they were infected with novel coronavirus, like cough, and generally were healthy prior to developing PIMS.
PIMS is not contagious. In order to have PIMS, a child must have had the infection previously. It is believed that, for one to have the antibodies for COVID-19, a patient must be past the contagious stage of the disease. Symptoms include a high fever for four or more days combined with other symptoms:
· Abdominal pain without another explanation
· Both eyes appearing pink or red
· Enlarged lymph node (“gland”) on one side of the neck
· Fever for seven or more days in an infant, for which no other explanation is identified
· Red, cracked lips or red tongue that looks like a strawberry
· Rash
· Swollen hands and feet, which might also be red
Currently, the treatment for PIMS is a similar protocol to what is used to treat Kawasaki disease. The goal is to reduce the inflammation to avoid long-term damage to arteries in the child’s body and heart. This is accomplished through transfusions of plasma, which reduces the body’s own immune response that is causing the inflammation.
