A fourth child in Louisiana has died from multi-system inflammatory syndrome, the disease associated with coronavirus, the Louisiana Department of Health said Monday.
The condition, known as MIS-C, causes inflammation of the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. Although it is a rare syndrome, children who have it may experience serious illness, need ventilators and life-saving measures.
A 31-year-old woman was rushed to a New Orleans hospital this spring after five days of fever, cough and stomach pain. Hospital workers …
“Because of the numbers, it’s mathematically rare, but it’s a terrible complication and these children can be very sick,” said Dr. Joe Kanter, assistant state officer at the Louisiana Department of Health. “It has certainly not become too big for these families whose children get it.”
MIS-C cases are increasing among youth, according to the state. As of August 10, 44 cases have been diagnosed in Louisiana in children aged one month to 19 years. About 11,000 children in Louisiana have known coronavirus infections.
Doctors in New Orleans began to make a link between the syndrome and COVID-19 when the number of sick children with laboratory tests indicated that high levels of inflammation increased a month after the peak of coronavirus infections in March and April, Drs. Nihal Godiwala, a pediatrician in critical care at a pediatric hospital and an assistant professor of pediatrics at LSU Health New Orleans.
Experts now know that MIS-C is typically reported two to four weeks after the onset of COVID-19, according to the Centers for Disease Control and Prevention.
First, the disease – which is marked by high fever, lethargy, chest pain, stomach pain, vomiting and diarrhea – was compared to Kawasaki disease, a rare but life-threatening immune response to viral disease. But because doctors saw more children with the inflammatory condition, differences appeared in the diseases that distinguished MIS-C than any other disease related to coronavirus.
MIS-C has distinct biomarkers for inflammation in the blood and affects the heart differently than Kawasaki, Godiwala said.
“There is a clear link between COVID and the onset of systemic inflammatory disease in children,” Godiwala said.
What is not yet clear is the exact role that coronavirus plays in triggering the inflammatory response, a connection hidden by the fact that many children do not show symptoms when they are initially infected.
“(They) fall somewhere on the spectrum of exposure and infection,” Godiwala said. “It is unclear where and when children are exposed and infected.”
The state uses the CDC definition to diagnose MIS-C. The patient must be under 21, hospitalized with fever and symptoms involving more than one organ system (e.g. both breathing problems such as breathing problems and gastrointestinal problems such as vomiting), have laboratory tests showing inflammatory markers and no have other plausible diagnoses. They must also have a positive COVID test or known exposure for someone with a positive test in the last four weeks.
In a report published Friday by the CDC, experts said emerging cases of coronavirus could lead to increased MIS-C cases, although this may not be immediately apparent due to the long period between infection and symptoms of MIS-C.
Louisiana ranks fourth in the nation for COVID-19 cases per capita in children among children, behind Arizona, South Carolina and Tennessee, according to a July 30 report by the American Academy of Pediatrics. Louisiana’s rate is 859 cases per 100,000 children compared to a US average of 446.5 per 100,000 children.
MIS-C can escalate rapidly, and parents should call their pediatrician if their child experiences symptoms, experts said.
Two of the four children who died in Louisiana had underlying medical conditions. In the CDC study, which looked at 570 cases of MIS-C from 40 states, two-thirds of children had no underlying conditions. Ten of those children died.
Although cases are sometimes difficult, death is rare. Treatment is supportive based on which organs are involved and often include steroids, aspirin and intravenous immunoglobulin, a treatment made from pooled blood plasma often used in autoimmune disorders.
“We have specific treatment strategies, but we do not have a magic bullet for them,” said Dr. John Schieffelin, an assistant professor of pediatrics at Tulane University School of Medicine and a doctor of infectious disease at Children’s Hospital.
Even among cases identified as MIS-C, some children do better than others, and doctors are still trying to understand why.
“The (thing) I was thinking of was COVID positive and she’s just been overnight,” Schieffelin said. “We’ve had other kids in the ICU for weeks. There’s a wide range of disease.”
Pediatricians recommend that parents stay vigilant against germs, especially if schools reopen.
“Otherwise, the same standards of hand washing, mask wear should be maintained and focus on decreasing exposure to large crowds,” Godiwala said.
Emily Woodruff discusses public health for The Times-Picayune | The New Orleans Advocate as Report for Member of the Corps of America.
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