Recent reports of children experiencing Kawasaki disease and toxic shock syndrome symptoms tied to the COVID-19 pandemic are raising concerns among patients and physicians.
Most children with COVID-19 are asymptomatic or exhibit only mild symptoms. However, you may have seen stories in the news over the last couple of days about several cases of children falling ill both in Europe and in the New York City area with what has been termed "Pediatrics Multi-System Inflammatory System Associated with COVID-19."
Last week, the Pediatric Intensive Care Society in the United Kingdom issued a notice that some children were presenting with symptoms similar to toxic shock syndrome and Kawasaki Disease. Some of these children had a positive PCR (diagnostic) test for the SARS-CoV2 virus that causes COVID-19 but there were also other children who were PCR negative but were later found to have positive antibodies against the COVID19 virus.
On Monday, the New York City Department of Health issued its own bulletin describing 15 cases of children hospitalized in intensive care units in city hospitals with symptoms similar to what had been described in the UK.
According to the bulletin, these children ranged in ages from 2 to 15 years of age and they were hospitalized in the period between the 29th of April and the 3rd of May. Each of these children presented with a fever and more than half of them had a rash, abdominal pain, vomiting and/or diarrhea. These physical findings were also accompanied by elevated inflammatory markers like C reactive protein, sedimentation rate, and troponin. Interestingly, respiratory symptoms were reported in less than 50% of these cases.
Of these children, 4 had positive PCR (diagnostic) testing for the COVID-19 virus, 10 were negative, and 1 was indeterminate and then negative by repeat testing. 6 of the children with negative PCR testing were later found to be positive for COVID-19 antibodies by serology. The bulletin goes on further to note that more than half of the 15 cases required blood pressure support due to shock and 5 of the 15 required mechanical ventilation. You may have heard or read in the news that one of the cases led to a sudden cardiac arrest at home. Fortunately, that child’s 15 year old brother began chest compressions until EMTs arrived.
On Tuesday, the New York State Department of Health issued a statewide bulletin and said that the number of suspected cases of this inflammatory syndrome numbered 64 statewide and added that the syndrome may present days to weeks after an acute COVID-19 illness. Hospitals will now be required to immediately report suspected cases and will be required to perform a diagnostic and serological testing to detect the virus and antibodies against the virus.
It is important to be on the lookout for these symptoms as prompt treatment in an inpatient setting would be in order, regardless of whether it presents as a toxic shock syndrome, an incomplete Kawasaki disease presentation, a classic Kawasaki disease presentation or a mixture of all of these.
Kawasaki Disease, which usually affects children 5 years and younger, is the presence of a high fever of 5 or more days duration and also the presence of at least 4 of the following 5 findings:
1. Bilateral non purulent conjunctival injection (red bloodshot eyes)
2. A generalized rash, sometimes accentuated in the inguinal creases
3. Red, dry, crackled lips and an inflamed, swollen tongue often referred to as strawberry tongue due to its appearance
4. Changes at the hands and/or feet which may feature redness, peeling skin, and/or swelling
5. Swollen lymph nodes in the neck
Toxic shock syndrome can often look like Kawasaki Disease but it tends to be more abrupt, has more GI symptoms like nausea, vomiting, and abdominal pain earlier in the course of the illness, has more myalgia (muscle aches and pains) associated with it and like its name, is more likely to have a shock like presentation than Kawasaki Disease
As with many things during this pandemic, we continue to learn that COVID-19 can present in many mysterious ways, and this is another thing to add to the list. Call your pediatrician or family doctor immediately if your child has any symptoms.