The mysterious illness believed to be a “rare” complication that sometimes follows the development of COVID-19 in children — pediatric multi-system inflammatory syndrome (PMIS) — has arrived in Israel.
Three children are currently hospitalized with the illness: an 11-year-old girl and a 16-year-old boy who are both hospitalized at the Rambam Medical Center in Haifa, and a third child hospitalized at Jerusalem’s Hadassah Medical Center.
In connection with the syndrome, Israel’s Health Ministry has issued an alert to the nation’s hospitals to watch for cases of pediatric myocardial infection.
Here’s why: A young man from Bnei Brak, age 26, has been admitted to Ramat Gan’s Sheba Medical Center at Tel Hashomer with what is believed to be the first adult case of the syndrome.
The young man, originally hospitalized for COVID-19, presented with unusual symptoms for an adult patient: multi-systemic inflammation accompanied by a myocardial infarction.
A bronchoscopy was carried out after two tests for COVID-19 came back with negative results; the sample taken from the young man’s lungs, however, showed a “weak” positive result for SARS-CoV-2, the novel coronavirus that causes COVID-19.
“This is an important case because this is the oldest patient with this complication,” said Professor Galia Rahav, director of the Infectious Disease Unit at Sheba, who is supervising the young man’s diagnosis and treatment. “His case is very severe, and he required resuscitation,” she said.
“This disease is still mysterious to us and there are complications that we don’t know about, or may not link to the coronavirus. [But] the situation seemed similar to that of the multisystemic inflammatory syndrome associated with the coronavirus that appears in children,” Rahav said.
“Once the test came back with weak signs, it was clear to us that he had corona.” She called on her colleagues to be alert to the symptoms of abdominal pain, which brought the young man into the hospital to begin with.
Syndrome Overlaps w/ Kawasaki, Toxic Shock
Pediatric multi-system inflammatory syndrome has elements of both Kawasaki disease and toxic shock syndrome, but doctors say it has come to be recognized as a separate disease.
Kawasaki disease is rarely identified in children older than eight, and it does not cause low platelet counts. It is also believed to be triggered by a virus.
It is not yet clear what triggered the mysterious syndrome, whose symptoms include fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat, according to the Centers for Disease Control and Prevention (CDC).
Symptoms of toxic shock syndrome (TSS), a condition caused by some types of staphylococcus bacteria, include confusion, diarrhea, headaches, high fever, low blood pressure, muscle aches, nausea, vomiting, red eyes, seizures, and organ failure, according to the US National Library of Medicine.
It’s important to emphasize that although some of the symptoms of PMIS are similar to Kawasaki or TSS, others are not: such as the fact that PMIS occurs in older children as well as the very young, with symptoms such as abdominal issues and cardiac dysfunction, including issues with coronary arteries that can lead to coronary aneurysms in children.
Doctors say any combination of these symptoms should cause concern and prompt a parent to have one’s child evaluated immediately.
Children Diagnosed in 11 States
At least 11 states in the US so far have reported children who are ill with the new syndrome, which in New York, at least, has proven deadly.
Cases have been reported in New York, New Jersey, Connecticut, Massachusetts (at least six), Delaware (“a few”), Pennsylvania, Washington and Louisiana, as well as Washington DC and California.
By Tuesday night, close to 100 children in the state of New York were suspected of having PMIS, of which 52 cases were in New York City alone. Health officials in New Jersey were investigating 13 potential cases of the syndrome, and in Connecticut at least six children were diagnosed with the illness.
New York: ‘Truly Disturbing’ Situation
Governor Andrew Cuomo announced last week that New York had begun to help develop national criteria for identifying and responding to the syndrome at the request of the federal Centers for Disease Control and Prevention.
(Boston Children’s Hospital is also helping the CDC research the syndrome, according to a report by WBUR. There have been at least six children with the syndrome treated at BCH so far.)
The New York State Health Department issued a Health Advisory to warn local health departments, hospitals and other health officials about the new syndrome. The state health department is also investigating the effect of COVID-19 on children, Cuomo said at his regular coronavirus briefing on Friday.
Three children had died of the disease by Wednesday, May 13 in the Empire State. A seven year old and a five year old succumbed to the illness in Westchester, according to the New York City Patch. An 18-year-old girl on Long Island was reported by media to be the third victim.
“This is a truly disturbing situation,” Mr. Cuomo said at his Monday news briefing. “And I know parents around the state and around the country are very concerned about this, and they should be.” He added that all hospitals across the state should make it a priority to test any child for COVID-19 if they are displaying symptoms of the syndrome.
New Jersey: ‘Expect to See More’
In New Jersey, doctors are reporting 13 children hospitalized for the disease but so far no deaths. Children reported shortness of breath and fatigue and some – but not all — had a fever, according to a report published by Patch.com.
A hospital spokesperson at Rutgers RWJ Barnabas Health in New Brunswick said a child’s symptoms upon admission actually reflect more serious illness – inflammation of the heart, low red blood cell counts and even the beginning stages of kidney and liver failure.
New Jersey Health Department spokesperson Donna Leusner told the Burlington County Times news outlet her department has turned to the federal Centers for Disease Control and Prevention (CDC) for guidance about the syndrome and criteria for defining it.
Thus far, three children tested positive for COVID-19 and two tested positive for antibodies, all at Rutgers, a hospital spokesperson said. There were five children treated at Hackensack University Medical Center, two treated at St. Joseph’s University Medical Center in Paterson and one child at Morristown Medical Center. All were under age 14, previously healthy and so far all have survived, according to the specialists who have treated them.
Dr. Cecilia Di Pentima, director of pediatric infectious diseases at the Atlantic Health System, last week participated in a call with more than 100 pediatricians to discuss this new inflammatory syndrome and its treatment, according to the Burlington County Times.
Di Pentima said she “absolutely” expects to see more of these cases, adding, “As the country starts to open up, I think the number of cases [is] going to continue to increase and that the number of pediatric patients that we see is going to be higher.”
Connecticut: Watching NY ‘Closely’
At least six patients in Connecticut were diagnosed with the new syndrome by Wednesday (May 13), with three hospitalized at Yale New Haven Children’s Hospital and three at Connecticut Children’s Hospital in Hartford, according to the Hartford Courant.
Yale New Haven Children’s Hospital, the first in the state to diagnose cases of the syndrome, immediately reported its findings to the Connecticut Department of Public Health.
“While these cases are exceptionally rare, given our proximity to New York where there have been a significant number reported, we have been watching their experience closely,” said Clifford Bogue, physician-in-chief of YNHCH.
“We are working diligently with local and state health officials to address this issue and strongly recommend that children who may be suffering from symptoms seek early referrals to pediatric infectious disease specialists, rheumatologists or cardiologists,” he added.
Six European Nations Affected
There have already been more than 100 cases of the mysterious illness identified in at least six countries in Europe, including Britain, France, Italy, Spain, Portugal and Switzerland.
One child, age 14, died in Britain, where so far eight (including the above patient) children were diagnosed last month with what was referred to as “hyperinflammatory shock” in an article for the prestigious medical journal, The Lancet, published on May 7, 2020, describing the course of the eight children.
“All children were previously fit and well,” the researchers noted in the article. “The multifaceted nature of the disease course underlines the need for multispecialty input (intensive care, cardiology, infectious diseases, immunology, and rheumatology).”
The United Kingdom Pediatric Intensive Care Society – and more to the point, the National Health Service — sent out an alert late last month, warning children’s doctors about “a severe COVID-19 related illness in children,” according to an exclusive report by HSJ.
“There is a growing concern that a [COVID-19] related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases,” the alert said.
A separate “urgent alert” was issued by the Paediatric Intensive Care Society to general practitioners, stating, “Please refer children presenting with these symptoms as a matter of urgency.”
Both alerts said, “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. This has been observed in children with confirmed PCR positive SARS-CoV-2 infection as well as children who are PCR negative. Serological evidence of possible preceding SARS-CoV-2 infection has also been observed.”
In Italy, meanwhile, pediatricians are reporting “extraordinarily large” numbers of children under age 9 presenting with what appears to be severe Kawasaki disease, according to Reuters.
In the northern Italian town of Bergamo, there were more than 20 cases of severe pediatric heart inflammation within the past few months, six times more than the number seen over an entire year in the reporting hospital, according to pediatric cardiologist Matteo Ciuffreda, who said specialists in Madrid and Lisbon confirm similar findings.
One can go on and on; a brief Google search using pediatric multi-system inflammatory syndrome as the search term will bring up countless hits, and if one narrows it to a region or country, it is still possible to obtain numerous updates. Needless to say, this is hardly the sign of a “rare” illness.
More likely, it’s the harbinger of another ‘long day’s night’ for Israeli and American wonder-working researchers instead.