Post-infectious Covid-19 inflammatory syndrome reported in children below 18: study
All the four children are residents of containment zones in the city.Updated: Jun 30, 2020 16:44 IST
Four children who were admitted to the Bharati Vidyapeeth hospital showed symptoms of the Kawasaki disease, like swelling of hands and feet, peeling of the skin, coronary artery (heart blood vessel) dilatation, persistent fever and other signs of inflammation.
All the four children are residents of containment zones in the city.
Covid-19 positive children in countries like the US, UK and Italy have reported similar symptoms. Such cases were also reported in China, and India has also begun reporting these symptoms, in cases in Mumbai.
While experts say it is not exclusively associated with the Covid-19 infection, it can cause a serious condition and must be reported immediately.
The four children at Bharati Vidyapeeth hospital who were admitted on June 3 when first such case was reported were put on a ventilator and needed drugs to increase the pumping action of heart and antibiotics.
Dr Jitendra Oswal, paediatric rheumatologist, Bharati Vidyapeeth hospital and Dr Bhakti Sarangi, -charge of paediatric critical care services, have worked on a study which states that these signs could be caused post the Covid-19 infection and usually occur after four weeks.
The study also states that the condition is seen in children who test positive for Covid-19 RT PCR and exclusively in between the ages of 10-18 years. It is a serious condition which requires intensive care unit (ICU) treatment.
One child among the four in Pune, according to the Bharati Vidyapeeth doctors, developed swelling of hands and feet, peeling off the skin of fingers and coronary artery (heart blood vessel) dilatation similar to that seen in the Kawasaki disease.
A second child also had coronary artery dilatation, but, both these children were discharged.
While the third child died of multi-organ injury, the fourth child is recovering and was recently taken off the ventilator.
Dr Oswal said, “Although none of the kids tested positive for Covid-19 and neither had their family members test positive for the infection, they lived in the Covid-19 containment zone. We have treated about 50 Covid-19 positive kids in April and May most of them were asymptomatic and the rest had only mild symptoms. So it is quite possible that the kids were infected with Covid-19 and it went undetected as they were never tested for it. When we say it could be post infectious Covid-19 inflammatory syndrome it means that the antibodies produced at the time by the immune system attached itself to the internal organ tissues which caused inflammation. When it comes to children, the immune system may work in a different way.”
According to Dr Oswal, three of the four children tested negative, but one child first tested positive at a private lab and then tested negative for the infection within 24 hours when the samples were sent to the National Institute of Virology (NIV).
“It could be because of false negatives which is possible in 33 per cent of the cases or because they never have any respiratory symptoms and so they are never tested,” Dr Oswal said.
Dr Arati Kinikar, head of the department of paediatrician at BJ Medical college said, “Such post-infectious inflammation is known across the globe and also recorded by WHO. It is not exclusive to Covid-19 infection, but it is serious and so has to be reported immediately if a child has recovered from Covid-19 infection or any viral infection in the past four-sixweeks. The child can be tested negative for the infection because the virus has left their body system. The signs of post-infection inflammation include fever, they may appear swollen, redness, rashes, but again it is not exclusively linked to Covid-19. Parents must not panic because of this as many bacterial infections too, especially during the monsoon, could have similar signs; however, it must be reported immediately.”
Dr Kinikar further added that no such case has been reported from Sassoon hospital’s paediatric ward till date.
The study also states that the children usually do not have respiratory symptoms, but more gastrointestinal symptoms, and that the Covid-19 RT PCR test maybe negative. These children’s clinical condition deteriorates very fast in just a few hours, and in an acute phase the child can die due to heart or multi-organ failure. If the coronary arteries are inflamed, it can be damaged and permanently dilated and there is a risk of either a block or rupture and death.