COVID-19 (Paediatric multisystem inflammatory syndrome)

AKA: Paediatric Inflammatory Multi-system Syndrome – Temporally associated with SARS-CoV 2 

Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.

Case definition (RCPCH)

  1. A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). This may include children fulfilling full or partial criteria for Kawasaki disease. 
  2. Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
  3. SARS-CoV-2 PCR testing may be positive or negative

Demographics

So far the evidence suggests the following groups are more commonly effected:

  • BAEM groups disproportionally (but not exclusively)
  • Over 75th gentile for weight
  • Close contact with COVID-19, several weeks prior to presentation
  • School age children

There is some evidence emerging that this can also affect young adults – and adult teams are being made aware

Presentation

The presentation varies widely  from evidently very sick, to children looking relatively well initially. However, typically initial al features are:

  • Unrelenting Fever (typically >38.5°C, non-responsive to antipyretics)
  • Variable rash
  • Conjunctivitis
  • Peripheral oedema
  • Generalised extremity pain
  • Significant gastrointestinal symptoms (negative laparotomies have been performed)
  • Hypotension develops through the course of the disease – (however, some patient reportedly low very well despite significant hypotension)
  • Respiratory features are RARE

Unfortunately, even those that initially appear well can deteriorate very quickly. So we must stay alert for the condition

Management

  • Ensure Blood pressures are being performed
  • Treat as suspected COVID-19 (initial nasal swabs tend to be negative, but later test positive)
  • Supportive treatment
    • Patients are often very fluid sensitive  (5mg/kg can often be enough)
  • Paediatric involvement early – Local paediatric consultants will be liaising with regional specialists to confirm
    • due to the risk of rapid deterioration Paeds are happy for us to admit children with; Persistent fevers ≥4 days without an obvious cause (even if they otherwise appear well)

References

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