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Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

Our take —

Previous studies from Europe and North America have reported a multisystem inflammatory syndrome among children that appears to be associated with SARS-CoV-2 infection. This case series from the UK reported strikingly similar findings, and identified a wide range of clinical outcomes from fever and inflammation to shock and coronary artery aneurysms. Comparisons with historical controls who had Kawasaki disease indicate that this syndrome is distinct. Further study is necessary to determine the timing of these symptoms relative to infection and predictors of inflammatory syndrome.

Study design

Case Series

Study population and setting

This study included 58 children (median age 9 years, 66% male) from 8 hospitals in England who met criteria for pediatric inflammatory multisystem syndrome associated with SARS-CoV-2 infection (PIMS-TS) between March 23 and May 16, 2020, with follow-up through May 22, 2020. Clinical characteristics of these patients were compared with those of historical controls from 2002 to 2019 with Kawasaki disease (KD) (n=1,132) and KD shock syndrome (n=45) admitted to a hospital in San Diego, California, and toxic shock syndrome (n=37) admitted to multiple European hospitals.

Summary of Main Findings

Underlying comorbidities were present in 7/58 (12%) children. PCR tests for SARS-CoV-2 infection were positive in 15/58 (26%), and IgG antibody tests were positive in 40/46 (87%) tested; 45/58 (78%) patients had either a positive PCR or antibody result. All patients presented with persistent fever. Common symptoms at presentation were abdominal pain (53%), erythematous rash (52%), conjunctival infection (45%), mucosal inflammation and red/cracked lips (29%), and headache (26%). Half of the children were admitted to pediatric critical care units, and 45% required mechanical ventilation. There were no deaths by the end of follow-up. The authors described three patterns of the observed clinical course: 1) 23 children had persistent fever without symptoms similar to KD or toxic shock syndrome; 2) 29 children developed shock, often with left ventricular dysfunction and elevated troponin; and 3) 7 children met the AHA criteria for KD, with one progressing to shock; 13 children met KD criteria when coronary artery aneurysms (n=8) were considered. Inotropic support was required for 47% of patients. Relative to controls with KD or KD shock syndrome, children with PIMS-TS were older, had more severe anemia and lymphopenia, and had higher CRP concentrations, white blood cell count, neutrophil count, fibrinogen, and troponin.

Study Strengths

This study characterized the clinical course of children with multisystem inflammatory syndrome in some detail, and benefited from comparison with historical controls with KD and KD shock syndrome.

Limitations

All cases were identified retrospectively, and data collection was idiosyncratic by hospital. Determinants of hospital inclusion in this case series were unclear. The timing of inflammatory symptoms relative to SARS-CoV-2 infection could not be ascertained; similarly, no data were presented on the timing of symptom onset relative to hospital admission. The absence of a national registry for KD made comparison to background prevalence impossible.

Value added

This study adds to the emerging evidence of a multisystem inflammatory syndrome among children, associated with SARS-CoV-2 infection.

This review was posted on: 10 July 2020