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The first child in Romania to reach intensive care, infected with SARS-CoV-2, is in stable condition. However, he developed the worst form of the disease, the multisystemic inflammatory syndrome. A child can develop this type of inflammation of all organs even after more than 40 days from infection with the new coronavirus, so it is important to monitor the child even after a possible COVID test has failed.
The child hospitalized in “Victor Gomoiu” is 9 years and 11 months old and did not suffer from any other illness. Doctors believe he contracted COVID with his parents three weeks ago, but was not tested at the time because he was asymptomatic. This is how this severe form of the disease develops. It occurs only 2-4 weeks after infection in asymptomatic children.
The boy first arrived at the Buzau Emergency Reception Unit, where the COVID test came back negative. He had a headache and fever. When he was transferred to the Capital, with suspicion of meningoencephalitis, the test was repeated and this time it was positive.
Dr. Adrian Popp: We have had about 85 such cases in New York State.
The cases of children who developed multisystem inflammatory syndrome after infection with the new coronavirus have been more numerous so far in the West. Dr. Adrian Popp, head of the infectious disease department at a New York hospital, said he has faced dozens of such cases. He stated on Digi24 that this complication in children generally has a severe prognosis. However, the specialist states that the vast majority of children have mild forms, and this syndrome is quite rare.
“It just came to our notice then. In New York State, we’ve had about 85 such cases. Children get COVID just as easily as adults, but their situation is better, in the sense that the vast majority of these children do not have severe forms. Only about 1 percent of these children are hospitalized. Unfortunately, from time to time, we see very serious situations, like this pediatric multisystem inflammatory syndrome, “said Adrian Popp.
“When this happens, the child is very serious, usually on the ventilator, and the prognosis is quite severe,” said Dr. Popp. He explained that it is an immune defense in which the child’s immune system acts excessively. In other words, the inflammation is too high compared to the child’s ability to survive, to overcome this inflammation. “We don’t know why it happens to some children and not to others, but such serious inflammatory syndromes have been described in other viral infections, the so-called Kawasaki syndrome. Fortunately, it is quite rare,” said the Romanian doctor from New York.
The link between multisystem infectious syndrome and SARS-CoV-2 is not yet clear.
“Excessive inflammation is a response of the body to an infectious challenge, that is, a microbe. It does not only appear in the SARS-CoV-2 infection, in fact, it is currently not very clear what the links between this infection and the disease are. appearance of this syndrome, but the same can happen in infections with viruses, bacteria and there are cases in which these manifestations can occur without a detectable infectious factor ”, explained the pediatrician to Digi24. Alexis Pig.
Dr. Radu Țincu: Four working hypotheses
doctor Radu Țincu He explained to Digi24 that this complication can be caused by four factors, including the production of an imbalance in the body with infection by the new coronavirus.
“It is a complication that has been cited in relation to SARS-CoV-2. At the moment there are four working hypotheses, which have not yet been fully elucidated at the international level. The first is that SARS-CoV-2 can represent a trigger (trigger factor – no.) for the body’s inflammatory system and release certain pro-inflammatory substances in that storm of inflammatory cytokines. It is the first hypothesis, which was also the first to be taken into account.
The second hypothesis is that once we have cured of SARS-CoV-2, a immune imbalance which predisposes the organism to subsequently develop, in contact with other pathogens, such a reaction. And this is backed by something very important: Most of the children who developed this complication did not do so during their illness, they did so between 40 and 42 days after they were cured of SARS-CoV-2.
The third explanation is determined by a genetic predisposition. To explain this hypothesis, it was observed, for example, that this complication was not reported in Asian countries and later it was probably considered a genetic predisposition of the inhabitants of certain areas of the globe.
And the fourth, which is the most recent, says that not all SARS-CoV-2 viruses, but only certain mutations of the virus could cause this inflammation in the body, ”said ATI doctor Radu Țincu.
What is really happening? Pro-inflammatory cytokines are released in the body, the most important of which are interleukin 1 and 6. They have been reported to be elevated to very high levels in children who have contracted this disease and will cause inflammation in all organs, especially in the heart, which is called myocarditis, that is, an inflammation of the heart, and in the blood vessels, explained the doctor.
This inflammation, in the brain, mimics meningoencephalitis very well, so a differential diagnosis must be made quickly between this complication and an infectious brain disease, and in the heart we must evaluate cardiac function to see what the cardiovascular parameters are of a disease. to this child, Dr. Radu Țincu said.
Dr. Mihai Craiu: Parents, rest assured, it is a very rare condition.
“Children with covid-fingers (swollen fingers) were a first warning sign. What is different about the multisystemic inflammatory system is that it has some clinical signs in common with Kawasaki syndrome and other signs with toxic shock syndrome. , which makes the diagnosis a bit difficult, ”explained Dr. Mihai Craiu, pediatrician.
However, Dr. Mihai Craiu says the condition is rare and parents with healthy children don’t have to worry.
“In the United States, where there is the largest cohort of these patients, in its national registry there are 790 cases at the beginning of September, in 6.5 million patients. So it’s very weird. And of these cases, the severe evolution towards very serious sequelae or death of cardiovascular origin occurred in only 11 children, all of them with diseases that made survival difficult and without contagion with the new coronavirus, “said pediatrician Mihai Craiu in a statement. intervention in Digi24.
Therefore, doctors tell parents not to panic, because few children have this rare form of the disease. In Romania, 6,700 children were infected with the new coronavirus and half of them were asymptomatic. The others developed mild forms.
Editor: Luana Pavaluca
