Increased number of reported cases of novel presentation of multi-system inflammatory disease
Please note this is a statement intended for medical professionals who look after critically ill children.
If you are a parent please be assured that serious illness as a result of COVID 19 still appears to be a very rare event in children. If your child is unwell or has the symptoms of sepsis then please seek medical attention in the usual way as set out in guidance from the Royal College of Paediatrics and Child Health.
Over the weekend, PICS members received an email alert from NHS England highlighting a small rise in the number of cases of critically ill children presenting with an unusual clinical picture. Many of these children had tested positive for COVID 19, while some had not. The alert indicated “the cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID 19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation”.
It is important to highlight that both in the UK and in other countries there have still been very few cases of critically unwell children with COVID 19 admitted to paediatric intensive care units. However, an early case report relating to COVID 19 presenting as Kawasaki syndrome has been published recently [ 1], and PICS is aware of a small number of children nationally who appear to fit the clinical picture described in the NHS England alert.
What does this mean in practice?
If you are a healthcare professional and see children presenting with a picture of toxic shock or atypical Kawasaki Disease then please discuss this case early with paediatric infectious disease or paediatric critical care teams via your usual pathways (often paediatric retrieval services).
What are “blood parameters consistent with severe COVID 19”?
Whilst it is too early to say with confidence features appear to include high CRP, high ESR and high ferritin. In adults with COVID 19 disease, hyperinflammation or cytokine storm syndrome, as well as macrophage activation syndrome (MAS) and haemophagocytic lymphohistiocytosis (HLH) have been described .
What is “cardiac inflammation”?
Children are presenting with a picture of myocarditis with raised troponin and proBNP. Some have an appearance of their coronary arteries in keeping with Kawasaki Disease.
PICS will continue to work with PICAnet and other national organisations to collect accurate data relating to critically ill children presenting to hospital with suspected covid 19 disease.
- Jones VG, Mills M, Suarez D, et al. COVID 1 9 and Kawasaki disease: novel virus and
novel case. Hosp Pediatr. 2020; doi: 10.1542/hpeds.2020 0123
- Mehta P, McAuley DF, Brown M , et al. COVID 19: consider cytokine storm syndromes
and immunosuppression. Lancet 2020 Mar 28;395(10229): 1033 1034. DOI:
10.1016/S0140 6736(20)30628 0