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article imageStudy — COVID-related syndrome in children can cause heart damage

By Karen Graham     Sep 8, 2020 in Science
Researchers behind a new study are warning that a rare and unusual inflammatory condition in children, believed to be linked to COVID-19, damages the heart to such an extent that lifelong monitoring and interventions may be needed.
A number of children, after contracting COVID-19 and showing signs of recovery from the virus are coming down with a new disease called multisystem inflammatory syndrome in children (MIS-C), also known as paediatric multisystem inflammatory syndrome (PIMS).
According to a new study published in The Lancet, cases of MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic coronavirus infections. And perhaps more telling, of those children who recovered from MIS-C, echocardiograms showed abnormalities in the heart in 54 percent of the children.
"Children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C, which is frightening," study author Alvaro Moreira told The University of Texas Health Science Center, according to CTV News Canada.
Kawasaki disease: Strawberry tongue and bright red  swollen lips with vertical cracking and bleeding...
Kawasaki disease: Strawberry tongue and bright red, swollen lips with vertical cracking and bleeding.
awasaki_symptoms.jpg: Dong Soo Kim
MIS-C is marked by "severe inflammation in multiple parts of the body, including, the heart, lungs, kidneys, brain, skin, eyes, and more." The symptoms in MIS-C resemble two other conditions – Kawasaki disease and toxic shock syndrome – but the amount of overall inflammation and damage in MIS-C is worse, Moreira says.
And because this new disease affected so many different organ systems, it was initially difficult for doctors to fully understand. The public first became aware of this new disease in April, when Britain's National Health Service sounded the alarm, warning about a small rise in children infected with the coronavirus that have "overlapping symptoms of toxic shock syndrome and atypical Kawasaki disease."
In the study, clinicians analysed 662 MIS-C cases reported worldwide between Jan. 1 and July 25. The study noted that 71 percent of the children were admitted to intensive care, and the average length of hospital stay was about eight days.
According to Science Alert, in every case, the patients showed fever, and the majority also presented with abdominal pain or diarrhoea (73.7 percent of cases) and vomiting (68.3 percent). Conjunctivitis and rash was also common.
Of the 662 children in the study, 11 died , but of those who survived, there was a real concern over what MIS-C might do to their hearts. Of the children who did recover, though, about 90 percent of the children had an echocardiogram (EKG) test, and more than half (54 percent) of the results that came back showed abnormalities.
The abnormalities that showed up were serious, and included dilation of the coronary blood vessels, depressed ejection fraction (reduced ability for the heart to pump oxygenated blood to body tissues), and in about 10 percent of patients, an aneurysm of a coronary vessel, which could put them at higher risk of future cardiac events.
"These are children who are going to require significant observation and follow-up with multiple ultrasounds to see if this is going to resolve or if this is something they will have for the rest of their lives," Moreira says.
"That's catastrophic to a parent who had a previously healthy child and then he/she is in the very small percentage of individuals who developed MIS-C after COVID-19 infection."
The authors write in their study: "Families should seek immediate medical care as children with this condition (MIS-C) decompensate quickly and most children will need management in an intensive care unit. Overall, children will survive this hyperinflammatory condition with administration of IVIG, steroids, a multidisciplinary team of healthcare providers, and in some cases immunomodulatory agents."
More about Covid19, Misc, multisystem inflammatory syndrome in children, Severe acute resspiratory syndrome, cardiac disease
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