U.S. gives doctors guidance on how to spot rare COVID-linked syndrome in children

The U.S. Centers for Disease Control and Prevention provided advice to physicians on Thursday about recognizing and reporting cases of a rare, life-threatening syndrome in children associated with the new coronavirus.

The guide follows several reports of the syndrome in France, Italy, Spain, and the UK, and more than 100 cases in New York State.

The reports have raised concerns that COVID-19, the disease caused by the new coronavirus, could pose a greater risk to children than previously believed. COVID-19 has so far taken its toll on the elderly and those with chronic conditions.

The syndrome, officially called Pediatric Multi-System Inflammatory Syndrome Potential Associated with COVID-19, shares symptoms of toxic shock and Kawasaki disease, including fever, rash, swollen glands and, in severe cases, heart inflammation.

The new US guideline defines the condition as occurring in children under 21 years of age with fever, signs of inflammation, illness severe enough to be hospitalized, and deterioration of multiple organs such as the heart, kidneys, blood vessels, the intestines, the skin and the nerves.

To meet the criteria, doctors must rule out other plausible diagnoses. Children with the condition should also test positive for the current infection with the new coronavirus or for antibodies showing a recent infection.

On May 12, the New York State Department of Health identified 102 patients with similar presentations, many of whom tested positive for SARS-CoV-2 infection or antibodies to the virus that causes COVID-19. Both New York State and New York City are still receiving additional reports of suspected cases, the CDC said Thursday.

The U.S. guidelines follow recent reports of physician syndrome in France and northern Italy, published in the journal The Lancet.

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

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% heart complications and half showing signs of toxic shock syndrome.

French researchers reported Kawasaki disease on Thursday in 17 children who were admitted to a hospital in Paris between April 27 and May 7, when they were expected to have seen only one such case in an average period of two weeks.

The report by Dr. Martin Chalumeau of Necker Hospital for Sick Children has not been peer-reviewed. It was posted on the medRxiv website, which was a major source of research on COVID-19 before its official publication.

Some researchers have suggested that the coronavirus family may cause Kawasaki disease.

“The symptoms in children are different than in adults with COVID-19, whose disease is more of a respiratory condition,” said Dr. George Ofori-Amanfo, chief of pediatric critical care at Mount Sinai Kravis Children’s Hospital in New York.

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

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