PIMS-TS: new childhood disease linked to Covid-19

PIMS-TS stands for Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2. This is a new inflammatory disease in children and adolescents that causes inflammation of multiple organs. Because antibodies against SARS-CoV-2 are found in the vast majority of children, PIMS-TS is currently (November 2020) linked to the new coronavirus SARS-CoV-2, the virus that causes Covid-19. Although it is a very rare inflammatory disease in children and adolescents, this disease can progress very quickly and seriously.

  • PIMS-TS linked to Covid-19
  • PIMS-TS
  • MIS-C
  • The symptoms of PIMS-TS
  • Mild complaints
  • Serious complaints
  • The diagnosis of PIMS-TS
  • The treatment of PIMS-TS
  • The prognosis of PIMS-TS

 

PIMS-TS linked to Covid-19

SARS-CoV-2 is the new coronavirus that was discovered in Wuhan, China at the end of 2019 and developed into a pandemic within a few months. Covid-19, the disease caused by this new coronavirus, has currently (November 2020) infected millions of people worldwide and killed more than a million people. Anyone, young or old, can be affected by this new coronavirus. The elderly and people with an underlying condition are the most vulnerable. In children and adolescents, Covid-19 is generally asymptomatic or only mild with complaints such as coughing and a runny nose. However, in rare cases, it appears that Covid-19 can cause hyperinflammation in the body in children and adolescents.
In April 2020, pediatricians in the United Kingdom first reported an increasing number of children with Kawasaki-like symptoms. Kawasaki disease causes inflammation of the blood vessels in children . Subsequently, several reports came from various European countries, including the Netherlands, and messages from Canada and the United States. Several studies have now shown that it is a new inflammatory disease that appears to be linked to Covid-19. The majority of children develop symptoms approximately 2 to 6 weeks after an infection with the SARS-CoV-2 virus. Demonstrable active infection via a PCR test is rare, but antibodies against the virus are found in the blood of almost all children. PIMS-TS therefore appears to involve a delayed and abnormal immune response of the body to Covid-19.
Doctors note similarities with other inflammatory diseases such as K awasaki disease , but also differences. For example, PIMS-TS is generally more serious and the average age of the patients is much higher compared to Kawasaki disease. Kawasaki disease most commonly affects toddlers up to age 5. PIMS-TS affects children of all ages, both small children and adolescents, with an average age of 9 years. PIMS-TS also appears to occur slightly more often in boys and in children from certain ethnic groups. In the United States, more Latinos and children of African-American descent have been admitted to hospitals in recent months compared to children of other ethnicities. Previously healthy children also appear to be able to develop this new inflammatory disease. More than half of the children do not appear to have an underlying condition such as asthma or obesity.

PIMS-TS

In the United Kingdom and other European countries, but also in Australia, the abbreviation for this new inflammatory disease in children is PIMS-TS, which stands for Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2.

MIS-C

However, the World Health Organization (WHO) uses the abbreviation MIS-C for the same disease, which stands for: Multisystem Inflammatory Syndrome in Children. The Center for Disease Control and Prevention (CDC) in the United States also refers to MIS-C instead of PIMS-TS.

The symptoms of PIMS-TS

The symptoms that can occur with PIMS-TS are very diverse and differ per child. Sometimes there are only mild complaints, but in about half of the children the complaints are so serious that admission to a hospital intensive care unit is necessary. All children have persistent fever (longer than 3 days) and involvement of multiple organs, including the heart, lungs, brain, skin, stomach and intestines or kidneys.

Mild complaints

Mild complaints can include:

  • stomach and intestinal complaints in the form of abdominal pain, diarrhea, vomiting or nausea
  • edema (swollen) hands and/or feet
  • sore throat or dry cough
  • headache, muscle pain or neck pain
  • enlarged lymph nodes
  • fatigue
  • red and painful eyes (conjunctivitis)
  • redness of the tongue with dots (strawberry tongue)

 

Serious complaints

Serious complaints often arise from the involvement of the heart and/or kidneys, for example due to inflammation of the heart muscle (myocarditis) or the pericardium (pericarditis) or acute renal failure, and can include:

  • extremely low blood pressure
  • fast heartbeat
  • confusion
  • low oxygen content
  • thrombosis
  • severe shortness of breath
  • shock

 

The diagnosis of PIMS-TS

There is no specific test that demonstrates PIMS-TS. Because PIMS-TS overlaps with several other diseases, such as Kawasaki disease, various means will be used to make or reject the diagnosis of PIMS-TS. For example, blood and urine tests, lung x-rays, ultrasound of the heart or an electrocardiogram (ECG).
The WHO has drawn up the following criteria to determine whether PIMS-TS exists in children and adolescents.

  1. It must concern a child or adolescent between the ages of 0 and 19.
  2. Two of the following symptoms must occur: skin rash, eye inflammation or inflammation of the hands and/or feet, low blood pressure or shock, indications of heart complications (myocarditis or pericarditis), signs of blood clotting in the blood vessels (thrombosis) and gastrointestinal complaints.
  3. Increased inflammation values should be visible; such as increased erythrocyte sedimentation rate (ESR) or increased CRP values.
  4. Other bacterial or viral infections must be excluded
  5. There must be evidence of infection with the SARS-CoV-2 virus. This can be done by a positive PCR test (saliva test), a positive blood test showing antibodies against the virus or evidence of close contact of the child with a Covid patient.

 

The treatment of PIMS-TS

The treatment used depends on the severity of the patient’s complaints. About half of the children require intensive treatment. For example, patients must be treated via an infusion with anti-inflammatory or immune-suppressing medication to calm the overactive immune system. Supportive treatment is also often required in the form of administration of extra oxygen or extra fluid.

The prognosis of PIMS-TS

For the time being (November 2020), PIMS-TS is linked to Covid-19. The European Center for Disease Prevention and Control (ECDC) states that it is plausible, but not yet conclusively proven, that this new inflammatory disease in children is caused by the new coronavirus. This body also specifically states that the chance that children will develop PIMS-TS is small and the chance that children will develop serious complications is very small. Doctors worldwide have been made alert and well aware of the symptoms of PIMS-TS. They have also been asked to collect and share information and data so that the right treatment can be started as quickly as possible. In acute situations, the vast majority of patients seem to recover well. The mortality of PIMS-TS is currently (November 2020) less than 2%.

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