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Inflammatory Syndrome Affecting Children: Kawasaki Disease, COVID-19 . . . or Something Else?

There are many medical uncertainties swirling around the COVID-19 story, but one widely accepted observation has been that children are among the least affected, both in number and symptom severity. At least until recently. In the United Kingdom, elsewhere in Europe and in a handful of locations in the U.S. (including New York, New Haven, Los Angeles and the San Francisco Bay Area), reports are surfacing of a pediatric inflammatory syndrome that many are rushing to blame on COVID-19. New York State has attributed the deaths of up to five children to the mystery ailment that, in some cases, has resulted in multisystem organ failure. The potpourri of symptoms “striking newborns and teenagers alike” has prompted clinicians to draw comparisons to the rare childhood inflammatory condition called Kawasaki disease (KD) as well as to toxic shock syndrome (a condition resulting from poisoning by bacterial toxins). Years before COVID-19 came on the scene, the CDC estimated that about 5,450 children, primarily under age five, are hospitalized for KD each year in the U.S.—the equivalent of about 15 every day. While rare compared to other childhood diseases, KD attracts concern as the leading cause of pediatric acquired coronary artery disease, with life-threatening aneurysms being a possible outcome. By early May, while affirming that the new syndrome was “Kawasaki-like,” some researchers were suggesting that “It’s really beyond that” and were latching onto COVID-19 as a convenient explanation—even though, in New York, well under half (40%) of the affected children had tested positive for SARS-CoV-2 with PCR testing. Hypothesizing that the illness could be a late-stage inflammatory reaction to SARS-CoV-2 infection, doctors baptized the apparently new inflammatory syndrome as “pediatric multi-system inflammatory syndrome temporally associated with COVID-19,” later settling on the more acronym-friendly “pediatric inflammatory multisystem syndrome” (PIMS).  Read more.....

 

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