Doctors have warned of a rise in children reportedly in intensive care in the UK with an inflammatory syndrome that attacks blood vessels the heart.
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NHS England has compared the features of the unidentified life-threatening condition to toxic shock syndrome or Kawasaki disease in an urgent alert this week.
But it appears medics in the US may have identified the first case in a six-month-old girl earlier this month.
The infant, believed to be from California, was taken to hospital after developing a fever and refusing to eat.
She didn't have a cough or congestion and doctors diagnosed her with a viral infection.
The following day, the infant broke out in a red, blotchy rash which persisted for another two days before her worried parents brought her back to see medics.
She had also developed conjunctivitis and dry cracked lips, while her temperature was still high at 38C and she was starting to suffer from mild congestion.
Doctors also carried out a chest x-ray which showed a faint opacity in the middle of her left lung.
They noted that throughout her illness, she hadn't come into contact with anyone who had been knowingly sick.
Her nine-year-old sibling had upper respiratory symptoms three weeks prior to the infant falling ill.
The family had also been self-isolating due to the coronavirus pandemic and hadn't left the house for school or work for a week before she developed a fever.
But based on her symptoms, they sent her to the emergency department to be tested for Covid-19.
What were her symptoms?
The six-month-old girl, who hasn't been named, suffered from a number of symptoms that left doctors concerned.
- a fever
- a persistent red rash covering her arms and legs
- dry, cracked lips
- bumps on tongue
- swollen hands
- mild congestion
Given her symptoms, she was also tested for Covid-19 which later came back positive.
Doctors suspected she could be suffering from Kawasaki disease – a rare blood vessel disorder – and she was admitted to the children's ward.
By this point, she was on day five of her illness and doctors noted prominent lumps covering her tongue as well as a mottled red rash on her legs and hands – which had left them swollen.
She was treated with high-dose aspirin and intravenous immunoglobulin, also called IVIG, which is a solution of antibodies taken from healthy donors.
An echocardiogram – a scan used to look at the heart and nearby blood vessels – came back normal without any evidence of coronary dilation or aneurysm.
The evening before she was discharged, her Covid-19 test came back positive from the Stanford Clinical Virology Laboratory.
Doctors said the Public Health Department was notified, and the family was instructed to quarantine at home for 14 days from the positive test date.
She was discharged 48 hours after completing IVIG treatment, on low dose of aspirin, with plans to follow-up for repeat echocardiographic evaluation two weeks after discharge – after the mandated 14-day quarantine.
The case was published online in the journal Hospital Pediatrics on April 7.
“To our knowledge, this is the first described case of KD [Kawasaki disease] with concurrent Covid-19 infection,” the authors wrote.
The report, they said, is intended to inform others caring for pediatric patients affected by Covid-19 as clinical presentation patterns evolve.
It comes after doctors have warned of a rise in children reportedly ending up in intensive care with a life-threatening inflammatory syndrome related to Covid-19.
The mysterious condition is understood to have features of toxic shock syndrome and Kawasaki disease.
These conditions can cause harmful internal swelling, fever and breathing problems – which are all also the main symptoms of coronavirus.
Some also reported suffering from abdominal pain and gastrointestinal symptoms, like vomiting and diarrhoea, as well as heart problems.
Up to a dozen children in the UK have reportedly ended up in intensive care fighting for their lives after developing the bizarre syndrome.
According to the Guardian, at least one child had to be put an aggressive form of life support after their heart and lungs started to fail.
NHS bosses were so concerned that they sent an urgent alert to doctors at the weekend warning of a rise in cases in recent weeks.
And the Health Secretary today said "we have lost some children" to a disease "we think is caused by the coronavirus".
SIGNS TO WATCH OUT FOR
NHS doctors have been told to watch out for signs of an 'inflammatory syndrome' in kids, after a rise in cases of the new condition.
Health chiefs said in an alert to GPs the signs include:
- stomach pain
- gastrointestinal symptoms – like vomiting and diarrhoea
The mysterious condition has been compared to toxic shock syndrome and Kawasaki disease.
The signs of TSS are:
- high temperature
- flu-like symptoms, like headache, feeling cold, aches, sore throat and cough
- feeling and being sick
- widespread burn-like rash
- lips, tongue, and whites of the eyes turning bright red
- dizziness or fainting
- difficulty breathing
Signs of Kawaski disease include:
- a rash
- swollen glands in the neck
- dry, cracked lips
- red fingers or toes
- red eyes
Matt Hancock told LBC: "It's a fresh, new disease that we think may be caused by coronavirus and the Covid-19 virus.
"We're not 100 per cent sure because some of the people who got it hadn't tested positive.
"We're doing a lot of research now but it is something we're worried about. What I would also stress is that it is rare.
"Although it is very significant for those children who do get it the number of cases is small."
Professor Stephen Powis said it was "too early to say" whether there is a link between the Kawasaki-like disease and coronavirus.
But chief medical officer Prof Chris Whitty said it was "entirely plausible".
They have instructed medical experts to look into the potential link as a "matter of urgency".
It comes after the UK Paediatric Intensive Care Society (PICS) tweeted an alert it said was from NHS England which says in the "last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK".
NHS England confirmed it had shared the warning through its incident teams to clinical commissioning groups and hospital trusts.
The alert said the effects had been seen in children both with and without Covid-19 but there was evidence that some patients had had coronavirus previously.
It pointed to features of atypical Kawasaki disease, a condition that mainly affects children under the age of five.
Symptoms include a high temperature that lasts for five days or more, often with a rash and/or swollen glands in the neck.
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