Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

Abstract

In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation. OBJECTIVES To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders. DESIGN, SETTING, AND PARTICIPANTS Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019. EXPOSURES Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization. MAIN OUTCOMES AND MEASURES Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders. RESULTS Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338]...

Clinical Characteristics of Pediatric Inflammatory Multisystem Syndrome Associated With COVID-19

“…Corticosteroids were prescribed for two patients with resistant Kawasaki disease with giant aneurism and multiorgan failure. As with other studies, the prognosis of most patients was good (4,5,7,13,15). Almost all our patients discharged without complication, except one case with giant aneurysms.…”

“…The primary diagnosis of our patients were KD, TSS, prolonged febrile seizure, appendicitis, and suspected sepsis or COVID-19. In the case series reported by Whittaker et al (7), the primary diagnosis was almost the same as this report, although one of our patients had prolonged febrile seizure, which could be the rst report.…”

“…Given that standard treatment for the disease has not been identi ed, this report provides our experience in management of these patients. Although children with COVID-19 are more likely to present fever and respiratory or gastrointestinal symptoms (13)(14)(15), but the most common presentation of our cases (8 cases of 10) at the time of onset was fever and rash with no respiratory symptoms, like the report of Whittaker et al (7) and only 3 of our cases had cough or any other respiratory complaints. On the other hand, 2 of our patients didn't show any respiratory complaints.…”

SARS-CoV-2 infection and replication in human fetal and pediatric gastric organoids

“…Most importantly, the ability of SARS-CoV-2 to persist in the GI tract after respiratory clearance, has not yet been fully elucidated in terms of viral infectivity, possibly impairing important public health and policy measures for the control of the disease. These concerns are particularly relevant in children who appear on average to suffer a less severe respiratory illness compared to adults, despite recording more prominent GI symptoms with clinical pictures mimicking appendicitis 28 , a hyperinflammatory shock syndrome (Paediatric Multisystem Inflammatory Syndrome -Temporally Associated with SARS-CoV-2, PIMS-TS) 29 , or acting as relatively asymptomatic carriers of the virus. Those risks have prompted clinical guidelines recommending the avoidance of aerosol producing procedures, including upper GI endoscopies, in children with confirmed or suspected COVID-19 for the safety of frontline clinical staff and other patients.…”

Extracardiac Imaging Findings in COVID-19 Associated Multisystem Inflammatory Syndrome in Children

“…Symptoms typically consist of a combination of fever, abdominal pain, rash, and conjunctivitis, with laboratory evaluation consistently showing elevated in ammatory markers, and cardiac evaluation often demonstrating hypotensive shock, myocardial dysfunction and occasionally coronary artery dilation or aneurysms. Importantly, few of these children present with respiratory symptoms, distinguishing it from the typical acute infectious presentation of COVID-19 [6].…”