Covid-19: Mysterious Kawasaki-like Illness Claims 3 Children as Cases Multiply

Three children in New York have died after showing symptoms of the mysterious illness now known as pediatric multi-system inflammatory syndrome (PMIS), and 14 other states have reported cases of the illness believed to be related to coronavirus.

At his daily press conference Wednesday, May 13, New York Governor Andrew Cuomo confirmed that 102 cases of the inflammatory illness similar to Kawasaki disease were being investigated in the state, and that the three deaths occurred among children who were 5, 7 and 18 years of age.

Cuomo said 60% of the pediatric cases in New York tested positive for SARS-CoV-2, and 40% tested positive for antibodies to the virus. Seventy percent of the cases required treatment in the ICU, and 19% resulted in intubation.

The illness has also been reported among children in Spain, France, England, Italy, and Switzerland.

“Parents have to be aware of this,” Cuomo said, noting that children with the illness may present with only some or none of the symptoms typically associated with Covid-19. Symptoms can include fever, abdominal pain, skin rash, change in skin color, difficulty feeding, trouble breathing, racing heart, irritability, and lethargy, he said.

“It is a wide array of symptoms, which makes it even harder for a parent to know exactly what they are dealing with,” Cuomo said. “If your child has been exposed to someone who had Covid, even if it was several weeks ago, that is a special alert in this situation.”

A case and comparison study published late Wednesday in The Lancet included 10 cases of the Kawasaki-like disease identified among young children in the Bergamo province of Italy after mid-February, which represents a 30-fold increase in reported cases over pre-Covid-19 outbreak levels.

In the five years prior to the Covid-19 outbreak in Italy, just 19 children were diagnosed with Kawasaki disease in the region. The 10 contemporary cases were all treated after mid-February and all 10 children tested positive for SARS-CoV-2 antibodies.

All 10 children survived, but the researchers noted that they tended to exhibit more serious symptoms than the children treated prior to the Covid-19 outbreak, with cardiac involvement reported in two of the 19 children treated prior to mid-February and in six of the 10 treated after this date.

Kawasaki disease shock syndrome (KDSS) occurred in five of the 10 children in the Covid-19 era group and in none of the 19 children treated earlier, and macrophage activation syndrome (MAS) also occurred in five of the 10 most recently treated children and in none of the 19 children treated prior to the Covid-19 outbreak.

Researcher Lucio Verdoni of the Hospital Papa Giovanni XXIII in Bergamo, Italy, and colleagues concluded that future research on Kawasaki-like disease in children exposed to coronavirus should focus on immune responses to viral triggers.

Children’s Hospital Los Angeles (CHLA) has a specialized team dedicated to the treatment of Kawasaki disease, which is a rare condition typically occurring in around 5,500 children nationwide each year.

In a Wednesday afternoon press briefing, pediatric cardiologist Jackie Szmuszkovicz, MD, said that during the month of April, CHLA experienced an unusual uptick in the number of cases of a syndrome that appeared to be similar to Kawasaki disease.

“When we recognized this new issue our team immediately began developing a plan to identify patients who might be affected by this syndrome promptly and to modify our diagnostic protocols accordingly,” she said.

The team alerted clinicians to be on the lookout for sick children with symptoms, including high fever persisting for four or five days, rash, red lips, red tongue, red eyes, swollen and/or red hands or feet, enlarged lymph nodes in the neck, and abdominal pain and/or diarrhea without another explanation.

“Because of our past experience with Kawasaki disease we also alerted them to be watchful for any infant who had fever for seven or more days for which another explanation was not identified,” she said.

None of the patients in the initial group tested positive for active SARS-CoV-2 virus on admission, but further testing identified three patients with antibodies to the virus, “indicating that the inflammatory Kawasaki-like illness that they experienced may have been a late response to previous infection with SARS-CoV-2,” Szmuszkovicz said.

Since April 1, physicians at Children’s Hospital Los Angeles have treated 16 cases of Kawasaki-like illness, and 14 of these children have been tested for antibodies to SARS-CoV-2.

Four had positive antibody testing and 10 had negative antibody testing, and the team is now following up with patients diagnosed from Jan. 1 of this year to determine if they have antibodies to the virus.

The three antibody positive patients ranged in age from 8 months to 2 years of age. All three have been discharged from the hospital, but a fourth patient with PMIS was recently admitted to the hospital and remains in critical condition, Szmuszkovicz said.

“What we are learning is that the manifestation of PMIS can range broadly from a syndrome similar to Kawasaki disease to a syndrome more similar to toxic-shock syndrome in some children,” she said.

CHLA chief medical officer Jim Stein, MD, said it is possible the children who tested negative for SARS-CoV-2 antibodies may have been exposed, but were not yet showing evidence of past exposure.

“Infection and the development of antibodies can be variable, so there can be a delay,” he said, adding that children may need to be rechecked to determine if they develop antibodies to the virus.

1. Three children in New York have died after showing symptoms of the mysterious illness now known as pediatric multi-system inflammatory syndrome (PMIS), and 14 other states have reported cases of the illness believed to be related to coronavirus.

2. Sixty percent of the pediatric cases in New York tested positive for SARS-CoV-2, and 40% tested positive for antibodies to the virus. Seventy percent of the cases required treatment in the ICU, and 19% resulted in intubation.

Salynn Boyles, Contributing Writer, BreakingMED™

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