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Sunday, July 5, 2020

Caring for Children With Multisystem Inflammatory Syndrome

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If there’s any concern that a child is not looking well, she said, that child needs to come in, get vital signs checked, and get lab work done. “It’s very anxiety-provoking for pediatricians in primary care, and also for very seasoned parents,” she said.

Dr. Philip Kahn, a pediatric rheumatologist at New York University School of Medicine, said some need intensive care, and others have relatively mild disease and may not get treated at all. But even most of the sick ones do well, he said: “The vast majority need treatment, they’re treated, they go home,” he said.

More detailed reports are appearing, detailing the clinical presentation and the clinical course of these children. An article published this month in JAMA looked at 58 children hospitalized in England. The median age was 9 years old. All of the children had persistent fevers, ranging from 3 to 19 days, and 45 of them had evidence of current or past Covid-19 infection.

Dr. Michael Levin, who is professor of international child health at Imperial College London, who was the senior author on the study, said that the children fall into three groups. Most concerning are the group with critical illness, with shock and multi-organ failure, particularly affecting the heart muscle.

Then there is a group of children who don’t require intensive care, but meet criteria for Kawasaki disease, a different illness with a constellation of similar clinical features, including fever, rash, conjunctivitis, red swollen hands and feet, and swollen lymph nodes.

And finally, he said, there is a much larger group of children with persistent fever who may have one or two of those features, but whose laboratory results indicate a high degree of inflammation.

Gastrointestinal symptoms were common, with half of the children in the study having abdominal pain, and many with vomiting and diarrhea. Thirty of the 58 had rashes, 26 had conjunctivitis. Some had sore throats, headaches, red swollen hands and feet, swollen lymph nodes. And their blood tests showed elevated markers of inflammation.

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