Inflammatory condition in children may be delayed complication of COVID-19, researchers say

The new inflammatory condition emerging among children may be a delayed complication of COVID-19, as there are some children who test negative for the disease but positive for coronavirus antibodies, suggesting the inflammatory condition may occur after the virus is no longer detectable on nasal swabs, researchers said.

On May 2, the International PICU COVID-19 Collaboration, coordinated by Jeffrey Burns, MD, chief of critical care medicine at Boston Children's Hospital, convened a Zoom conference to compare notes on pediatric multisystem inflammatory syndrome potentially associated with COVID-19, which has sickened nearly 100 children in the U.S.

The International PICU COVID-19 Collaboration reviewed data from several dozen cases in Europe and the U.S. The condition is linked to certain symptoms associated with toxic shock syndrome and incomplete Kawasaki disease, an illness that causes inflammation of the blood vessels. The children who had the inflammatory condition had persistent fevers, inflammation and poor function in one or more organs, among other symptoms. Many children also had bleeding disorders, diarrhea and other gastrointestinal symptoms.

Until now, the children appear to be recovering well from the inflammatory syndrome, and some have only needed supportive care.

The condition appears to be linked to COVID-19, though not all children with then inflammatory syndrome tested positive for the new coronavirus.

"We have these clusters of illness where we can't say it's caused by COVID, but clearly it's temporally related," said Mary Beth Son, MD, rheumatologist at Boston Children's Hospital during the conference.

It is also not clear why this condition is emerging only now. One panelist suggested that the antibodies that children are making to the new coronavirus are creating an immune reaction in the body, which activates an inflammatory process.

But the panelists said two things are clear: first, the condition is rare; and second, clinicians who see a suspected case of the condition should consult with pediatric infectious disease, rheumatology or critical care specialists.

The panelists also said that children with unexplained fever and evidence of inflammation should be carefully followed to help determine the condition's progression. Children with confirmed cases of the condition should have serial echocardiograms, as many children with the condition have low heart function.

Boston Children's Hospital also launched a national study in April, at more than 35 U.S. children's hospitals, to study COVID-19 in children. The study has $2.1 million in funding from the CDC and will examine why some children remain unaffected by the new coronavirus and why some develop severe cases of the disease.



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