Another two cases of a rare inflammatory syndrome have been identified in patients at Children’s Hospital Los Angeles, bringing the total to six, all of whom tested positive for COVID-19 antibodies, it was announced Friday.
The half dozen children diagnosed with multisystem inflammatory syndrome in children, or MIS-C, range in age from 4 months to 8 years old, and all have been “successfully discharged” from the hospital, said Jackie Szmuszkovicz, a pediatric cardiologist and Kawasaki disease specialist at CHLA.
Five of the six MIS-C cases presented like Kawasaki disease and one patient experienced shock symptoms, according to the hospital. All six children tested positive for COVID-19 antibodies, which can identify if someone had a prior infection, but none tested positive for active COVID-19 based on a nasal swab test and none were contagious when admitted for treatment, according to the hospital.
CHLA saw an uptick in April of diagnoses of Kawasaki disease, which is characterized by inflammation of blood vessels and unusual dilation of arteries that carry blood to the heart. That increase, which was also reported in late April by doctors in New York and the United Kingdom, prompted additional investigation. Children have since been diagnosed with MIS-C across the country.
A total of 21 Kawasaki disease patients at CHLA have been tested for the coronavirus since April 1. The remaining children will continue to be tested for antibodies that may develop later.
Treatment for Kawasaki disease can include IV immunoglobulin, anticoagulation, steroids and other immune system modulators. The treatment for patients showing shock symptoms includes respiratory support and inotropic medicines that affect the contraction of the heart muscle.
MIS-C, also identified as pediatric inflammatory multisystem syndrome or PIMS, has symptoms similar to both conditions and is treated similarly to Kawasaki disease.
“The goal is to reduce the inflammation to avoid long-term damage to arteries in the child’s body and heart,” according to CHLA. “This is accomplished through transfusions of plasma, which reduced the body’s own immune response that is causing the inflammation.”
Hospital officials said children with MIS-C likely never showed any symptoms of COVID-19 and were generally healthy before developing MIS-C.
Experts are still working to understand the link between MIS-C and the coronavirus and are not certain whether it also occurs in adults, according to the U.S. Centers for Disease Control and Prevention. There is limited information about risk factors, the clinical course of the syndrome and treatment, according to the CDC.
CHLA officials said possible symptoms of MIS-C include a high fever that persists for four or more days combined with indications such as abdominal pain, pink or red eyes, enlarged lymph nodes on one side of the neck, cracked lips or red tongue, a rash and swollen hands and feet.
Parents who suspect their child may have MIS-C should contact their pediatrician immediately, but any child experiencing serious illness should be taken to an emergency room.
CHLA’s pediatric specialists are sharing information with community pediatricians and other doctors worldwide.
“We have been communicating with pediatric specialists from centers across the country and around the world,” Szmuszkovicz said. “We are entering our patients in registries to help define the nature of the illness and demographics, and we are also collaborating on research projects to help define the best treatment and practices.”
More information about MIS-C can be found at CHLA.org on the hospital’s newsroom page.
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