Cases of children with rare inflammatory syndrome spike in Italy and France

Doctors in France and northern Italy, one of the areas hardest hit by the new coronavirus, have reported spikes in cases of a rare inflammatory syndrome in young children that appears similar to one reported in the United States, Britain and Spain, according to a report in The Lancet.[1]

It began in Europe about two months ago, has spread to cities along the U.S. east coast and is now being reported in Montréal: clusters of a rare and mysterious illness in children that may be linked to COVID-19. CBC News and The National Post on MSN

By Vishwadha Chander, Medscape May 16, 2020

Reuters — The condition, Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19, shares symptoms with toxic shock and Kawasaki disease including fever, rashes, swollen glands and, in severe cases, heart inflammation.

Reports of cases have raised concerns that COVID-19, the disease caused by the novel coronavirus, could pose a greater risk to children than had been understood. COVID-19 so far has taken its greatest toll on the elderly and those with chronic health conditions.

New York on Sunday said it was investigating up to 85 cases of children with the syndrome. So far three of those children, who also tested positive for COVID-19, have died, and two more deaths are under review, Governor Andrew Cuomo said.

In Bergamo, Italy, between Feb. 18 and April 20, the Hospital Papa Giovanni XXIII admitted 10 children with the syndrome, including eight who tested positive for coronavirus antibodies. Over the last five years, doctors there had seen a total of only 19 children with Kawasaki disease, according to the report published by The Lancet [1] late on Wednesday.

Compared to children with Kawasaki disease in the past, those they saw during the pandemic were older and more severely ill, the report said, with 60% suffering heart complications and half having signs of toxic shock syndrome.

French researchers on Thursday reported Kawasaki disease-like symptoms in 17 children admitted to a Paris hospital between April 27 and May 7, while in an average two-week period they would have expected to see only one such case.

The report by Dr. Martin Chalumeau of Necker Hospital for Sick Children, has not been peer reviewed. It was posted on the medRxiv web site.[2]

Scientists are still trying to determine whether the syndrome is linked with the new coronavirus because not all children with it have tested positive for the virus.

Some researchers have suggested the coronavirus family might trigger Kawasaki disease.

“The symptoms in children are different from adults with COVID-19 in whom the illness is more of a respiratory condition,” said Dr. George Ofori-Amanfo, division chief of Pediatric Critical Care at Mount Sinai Kravis Children’s Hospital, New York.

Children with the rare inflammatory syndrome often have severe abdominal pain and vomiting that progresses to shock, Ofori-Amanfo told Reuters. He said none of the children he has seen recently with this syndrome had any underlying disease, but they all had antibodies for the coronavirus.

Source Medscape Reuters Health Information

Canadian doctors watching for inflammatory illness in children as part of COVID-19 diagnosis. Health officials are growing concerned that a rare inflammatory disease, Kawasaki syndrome, that primarily affects children, may be linked to COVID-19. 1:57 CBC News May 5, 2020
  References

An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study, Lucio Verdoni MD, Angelo Mazza MD, Annalisa Gervasoni MD, Laura Martelli MD, Maurizio Ruggeri MD, Matteo Ciuffreda MD, Ezio Bonanomi MD, Lorenzo D’Antiga, MD. May 13, 2020. The Lancet. DOI: 10.1016/S0140-6736(20)31103-X. Full text

Outbreak of Kawasaki disease in children during COVID-19 pandemic: a prospective observational study in Paris, France, Julie Toubiana, Clement Poirault, Alice Corsia, Fanny Bajolle, Jacques Fourgeaud, Francois Angoulvant, Agathe Debray, Romain Basmaci, Elodie Salvador, Sandra Biscardi, Pierre Frange, Martin Chalumeau, Jean-Laurent Casanova, Jeremie F Cohen, Slimane Allali. DOI: 10.1101/2020.05.10.20097394. PDF

Review of ‘An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study,’ Public Health Ontario. May 15, 2020. PDF

Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19, Scentific Brief. 15 May 2020 World Health Organization WHO. PDF

Also see
U.S. gives doctors guidance on how to spot rare COVID-19-linked syndrome in children The Globe and Mail
Nearly 100 children in New York being treated for rare syndrome believed linked to COVID-19 The Globe and Mail
Doctors race to understand new illness afflicting children Al Jazeera

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