The study detailed case reports for 21 children and teens hospitalized in Paris with some symptoms of Kawasaki disease over a two-week period. Most of these youth had signs of a recent COVID-19 infection, and it’s possible they were experiencing a delayed immune response to the novel coronavirus, SARS-CoV-2, the study team wrote. Most patients developed what’s known as myocarditis, a condition caused by inflammation of the heart muscle that makes it harder for the heart to pump blood and can cause a rapid or abnormal heartbeat. Many of the patients also had rashes and conjunctivitis, which, like myocarditis, are often seen in kids with Kawasaki disease. Unlike Kawasaki disease, which predominantly strikes children under 5 years old, the patients in this study were 8 years old on average and ranged in age from about 4 to 17 years. And, in another departure from Kawasaki disease, which disproportionately affects children of Asian ancestry, 57 percent of the patients in the current study were of African descent. “These clinical findings should prompt high vigilance among primary care and emergency doctors, and preparedness during the coronavirus disease 2019 pandemic in countries with a high proportion of children of African ancestry and high levels of community transmission,” wrote the research team, which was led by Julie Toubiana, MD, a pediatrician and doctor of infectious diseases at Necker-Enfants Malades Hospital in Paris. The report of cases from Paris follows several other reports of MIS-C associated with COVID-19 in children in the United States and Europe. In April, the Pediatric Intensive Care Society in London said in a statement that doctors are seeing a growing number of cases of children with MIS-C who require intensive care. As of mid-May, New York state was investigating 110 suspected cases, according to an announcement from Governor Andrew Cuomo. None of these case reports are controlled experiments that can prove COVID-19 directly causes MIS-C, and there is a lot that scientists still don’t know about how to predict who will develop this condition or how to prevent it. But mounting evidence does suggest that the symptoms of MIS-C are distinct from those of Kawasaki disease, says Moshe Arditi, MD, the director of the division of pediatric infectious diseases and immunology and the Kawasaki disease research program at Cedars-Sinai Medical Center in Los Angeles. It’s possible that MIS-C may develop in the wake of infection, triggered by the immune system’s battle with COVID-19, Dr. Arditi says. It’s also possible that the novel coronavirus may cause delayed hyper-inflammation, or that MIS-C is the way the body responds to repeat exposure to the virus. But the clinical features of MIS-C are not the same as what’s typically seen with Kawasaki disease, and include severe gastrointestinal symptoms, abdominal pain, diarrhea, vomiting, and acute kidney injury, Arditi says. The heart complications with MIS-C are also much more severe than what is typically seen with Kawasaki. Kids who do have Kawasaki also don’t appear to be at an increased risk for MIS-C. “There are no data at all to suggest that children with autoimmune disorders or kids who have had regular Kawasaki disease in the past are at increased risk of developing MIS-C following COVID-19 infection,” Arditi says. Based on what’s known so far about MIS-C, the U.S. Centers for Disease Control and Prevention (CDC) advises parents to call a pediatrician right away if kids develop any of the following symptoms:
FeverAbdominal painVomitingDiarrheaNeck painRashBloodshot eyesExtreme fatigue
Parents should seek emergency help right away, the CDC says, if kids have any of the following warning signs of MIS-C:
Trouble breathingPain or pressure in the chest that does not go awayNew confusionInability to wake up or stay awakeBluish lips or faceSevere abdominal pain
“Children with persistent high fevers, rashes, red eyes, or who are ill appearing or lethargic should be brought to their medical providers,” says Mary Beth F. Son, MD, the author of an editorial accompanying the Paris case reports in the BMJ and the director of the rheumatology program at Boston Children’s Hospital. Parents should be reassured that COVID-19 is rare in children and that most kids who do develop infections have mild cases. Not all kids with COVID-19 will develop MIS-C. “It should be emphasized that this is a rare syndrome, and it continues to be the case that children fare much better with SARS CoV-2 infections as compared to adults, especially older adults,” Dr. Son adds. “Following recommendations from health policy experts is the best way forward for decreasing transmission of infection, including distancing, hand-washing, and masking.” RELATED: Top Coronavirus Symptoms
