New Delhi: Symptoms of a rare condition associated with SARS-CoV-2 in children, known as multisystem inflammatory syndrome, usually gets resolved after six months despite severe illness, according to a new study.
The study, published in the The Lancet Child & Adolescent Health journal, looked at cases of ‘Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS)’ in 46 children treated at the Great Ormond Street Hospital in the UK.
Most children experienced severe effects on different systems in the body during initial illness, with 45 children experiencing gastrointestinal symptoms, 24 children neurological symptoms, and 15 children heart symptoms.
At six months’ follow-up, most symptoms were resolved, with systemic inflammation gone in all but one child. However, two children showed abnormalities in their heart rhythms, while six children still had gastrointestinal symptoms.
“As PIMS-TS is a very rare complication of COVID-19 in children, our study included a small number of children from one hospital. Nevertheless, these findings can hopefully signal cautious optimism that many of the most severe effects of PIMS appear to resolve within six months,” said Justin Penner, co-author of the study from Great Ormond Street Hospital, UK, in a statement.
“However, the persisting fatigue, difficulty exercising, and mental health effects we saw in some children, which can interfere with daily lives, must be closely monitored, and patients should continue to be supported by medical teams with a range of specialisms,” Penner added.
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The study
PIMS-TS, also known as multisystem inflammatory syndrome in children (MIS-C), is a rare condition associated with SARS-CoV-2 infection that was first defined in April last year.
More than 250 cases were identified in the UK and Ireland from March to June 2020. While it is still not known what triggers the condition, it is thought to be a rare immune overreaction that occurs four to six weeks after mild or asymptomatic SARS-CoV-2 infection.
The symptoms include fever, rash, eye infection, diarrhoea, stomach-ache and nausea. In some rare cases, the condition may lead to multi-organ failure.
The UK study is the first to report six-month follow-up findings on the the longer-term effects of the condition. The findings are vital for clinicians treating PIMS-TS and recovering patients.
In the study, 46 children admitted to one specialist paediatric hospital with PIMS-TS between 4 April and 1 Sept 2020 were included. The average age was 10 years old. Thirty patients were male and 16 were female. Only eight had pre-existing comorbidities. None of the patients died.
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Other conclusions
While symptoms cleared up in most children, according to the study, small abnormalities were found on neurological examination in 18 children at six months. However, the children experienced little difficulty walking and carrying out everyday tasks.
This implies that any lasting neurological effects are probably mild and do not cause disability, the researchers noted.
Muscle function also improved significantly among the children after six months, although some 18 patients had some trouble walking.
However, the team called for more research to look for more subtle long-term effects of the disease.
“The levels of fatigue and muscle weakness we found at six months follow-up are concerning and requires close monitoring, but it’s difficult to determine whether this finding is caused directly by PIMS-TS or if it’s a result of the disruption in children’s lives that the COVID-19 pandemic has caused on a wider scale,” said Karyn Moshal from Great Ormond Street Hospital, UK, said in a statement.
“Therefore, it’s crucial that we continue to monitor these conditions as social distancing relaxes and children return to school and more active routines,” Moshal added.
The parents of seven children further reported that the latter were experiencing emotional difficulties, while eight children reported emotional difficulties themselves after six months.
However, the authors say they cannot determine whether all these mental health effects were caused directly by PIMS-TS, as going through any severe illness is likely to have an impact on mental health. The disruption and uncertainty of the wider Covid-19 pandemic could also play a role, they said.
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