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Coronavirus

New COVID-19 related syndrome showing up in children in Illinois

Some symptoms similar to Kawasaki Disease

Juliet Daly, 12, plays with her brother Dominic, 5, in their family home in Covington, La., Thursday, April 30, 2020. A team of pediatric cardiology specialists found that Juliet had acute fulminant myocarditis (AFM), an uncommon heart condition that tends to present with sudden onset acute heart failure, cardiogenic shock or life-threatening arrhythmias. A nasal swab confirmed that Juliet was also COVID-19 positive and that she had a second viral infection – adenovirus. (AP Photo/Gerald Herbert)
Juliet Daly, 12, plays with her brother Dominic, 5, in their family home in Covington, La., Thursday, April 30, 2020. A team of pediatric cardiology specialists found that Juliet had acute fulminant myocarditis (AFM), an uncommon heart condition that tends to present with sudden onset acute heart failure, cardiogenic shock or life-threatening arrhythmias. A nasal swab confirmed that Juliet was also COVID-19 positive and that she had a second viral infection – adenovirus. (AP Photo/Gerald Herbert)

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Children have been largely spared from developing severe complications from COVID-19, but that could be changing.

A new syndrome, that is believed to be related to the novel coronavirus, has begun developing in school-aged children and teenagers.

Nationwide, nearly 100 children have been diagnosed with the newly identified syndrome, which has been called pediatric multisymptom inflammatory syndrome. The Chicago Tribune reports that about half a dozen children in Illinois have been hospitalized with the condition.

At least eight states — California, Delaware, Louisiana, Massachusetts, New Jersey, New York, Pennsylvania and Washington — and Washington, D.C., have reported cases, according to NBC News. A 5-year-old boy in New York became the first child in the United States to die from the condition, NBC reported Friday.

Dr. Stan Shulman, pediatric infectious diseases specialist for Lurie Children’s at Northwestern Memorial Hospital, said he believes the new syndrome is a delayed response to a COVID-19 infection, as symptoms start developing about 4 to 6 weeks after a child was infected with the virus. Often times, the children previously showed no symptoms of COVID-19.

The symptoms of this new syndrome have some similarities to Kawasaki Disease, in that they both affect the heart, he said.

"Some patients with the new syndrome have one or two Kawasaki- like symptoms, but the way they attack the heart is different," he explained. "Kawasaki attacks the coronary arteries, while the new syndrome attacks the heart muscle, which affects how the heart pumps blood. This new syndrome causes shock and low blood pressure because the heart isn't pumping normally. It can cause difficulties with the GI tract and kidneys, and there is usually vomiting or diarrhea. Some kids develop a rash or red eyes, which are also symptoms of Kawasaki Disease."

Shulman said that kids who present with symptoms of the COVID-related syndrome often end up in the pediatric ICU.

"The good news is that they almost all seem to recover completely so far, but no one has a long track record of treating this," he said. "Between 75 and 85% of children with this syndrome have had a COVID infection, even if they didn't know it, and that it can often be traced back to a family member who was infected. I'm very confident that COVID is the trigger for this."

One perplexing aspect of the new syndrome is that it did not affect children in China and Japan, Shulman said, despite those countries having a higher incidence of Kawasaki Disease. Cases started popping up in England, Spain and Italy after the COVID-19 infections peaked in adults.

"In Italy, when adult cases started dropping, [the new syndrome in children] began showing up," he said. "What that may mean, and this is speculation – that this may be a post-infectious problem. It's not a problem when virus is active in the beginning. But 4 to 6 weeks later when the virus is gone from body and the patient's immune system is making antibodies – that’s when this syndrome seems to develop. There's no way of knowing which kids will get it."

Unlike COVID in adults, which tends to be more severe in those with underlying health conditions, this new syndrome is attacking healthy kids.

Shulman said parents should not panic, but should be aware of the symptoms, which are primarily a high fever, belly pain and diarrhea or vomiting. He said not all kids have the Kawasaki-like rash or red eyes, but they have been seen in some cases.

He said parents should call their pediatrician, who could recommend if the child needs to be taken to the emergency room, if their child develops worrisome symptoms.

"It's a rare disease at present, and we don't want people to be excessively worried," he said. "We're going to learn more about this in the coming weeks and months, and hopefully we'll understand it much better. There is a good possibility of seeing more cases before they start to diminish in frequency."

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