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The condition, called pediatric multisystemic inflammatory syndrome, has been reported in about 100 children in New York state, including three who died, Governor Andrew M. Cuomo said this week. Cases have been reported in other states, including Louisiana, Mississippi and California, and the Centers for Disease Control and Prevention have said they will soon issue an alert asking doctors to report cases of children with symptoms of the syndrome.
The authors found that during the five years prior to the coronavirus pandemic (January 2015 through mid-February 2020), 19 children with Kawasaki disease were treated at the Papa Giovanni XXIII Hospital, which has an advanced pediatric department, in the province of Bergamo.
But during the two months from February 18 to April 20, the hospital, which is located at the epicenter of the coronavirus outbreak in Italy, treated 10 children with similar hyperinflammatory symptoms.
Ten cases in two months, about 30 times the rate of Kawasaki disease cases, which occurred at a rate of about one every three months, suggests a group that is driven by the coronavirus pandemic, especially since overall hospital admissions during this time was much lower than usual, the authors said.
However, the authors noted that the number of cases was small, suggesting that the new syndrome was unlikely to become widespread among children, who have generally been less hit by the virus than adults.
None of the 10 children died, but their symptoms were more severe than those experienced by children with Kawasaki disease. They were much more likely to have cardiac complications, and five of them showed shock, which did not occur in any of the Kawasaki disease cases. They had lower platelet counts and a type of white blood cell, typical of Covid-19 patients who defended themselves against infection. And more of the children with the new syndrome needed steroid treatment in addition to the immunoglobulin treatment that both they and the Kawasaki patients received.
Like cases in the United States and elsewhere, the 10 children were generally significantly older than patients with Kawasaki disease, which tends to affect infants and preschool-age children. The average age of the Kawasaki patients was 3. All the children with the new syndrome, except one, were over 5 years old and their average age was 7 ½.
Eight of the 10 children tested positive for antibodies against the coronavirus. The researchers suggested that the negative test results for the other two children might reflect the fact that the tests were not perfectly accurate and that one of the children had just been treated with a large dose of immunoglobulin, which could have interfered with the ability of the test to detect antibodies
The presence of antibodies suggests that Italian children, like many of the cases in the United States, were infected with the virus weeks earlier. Experts say the new inflammatory syndrome appears to be a delayed reaction driven by a child’s immune system response to infection, in contrast to the primary way the virus affects patients by attacking cells in their lungs.
