COVID-19 and PMIS

Over the past two weeks, there has been a lot of attention paid to a new pediatric condition associated with covid-19 called “Pediatric Multi-System Inflammatory Syndrome”.  We want to reassure parents that the majority of children who contract covid19 will not develop this syndrome.  It is important that parents are aware of the signs and symptoms of this condition and when they should call the doctor.  We have put together a list of answers to some frequently asked questions to help parents make sense of all the information that is out there.  We will conduct an IG live on Thursday at 12:30 to discuss this a bit more and answer any additional questions.

 

What is Pediatric Multi-system Inflammatory Syndrome (PMIS)?

This syndrome is a hyper-inflammatory response to the covid-19 virus. Typically,  when our bodies are working perfectly, our immune system mounts an appropriate response and fights off the infection.  In this situation, the immune system overreacts and this has a detrimental effect on our bodies.

Is it a reaction to covid19?

We are still in the preliminary stage of collecting data on this condition.  It does appear that there is a temporal relationship between contracting the covid19 virus and developing this syndrome. Some children have developed PMIS weeks to a month after contracting the virus. In general, these children did not have obvious symptoms when they were infected with the novel coronavirus, like cough, and were healthy prior to developing PMIS.  Other children developed the syndrome immediately after an acute case of  covid-19. 

Is PMIS Contagious?

At this time we do not believe PMIS is contagious.  PMIS is not a virus.  It is a syndrome that is a response to a previous COVID-19 infection.  If a patient with PMIS has had a recent COVID infection, close contacts are at risk of contracting the COVID-19 virus but not the PMIS syndrome. If a patient is past the acute phase and has developed convalescent antibodies, he or she is past the contagious stage of their COVID-19 infection and presents no risk to others.  

If my child has an underlying medical condition, are they higher risk for PMIS?

PMIS does not appear to be limited to children who have a chronic condition or a significant illness that compromises their immune system;.  Many children who have developed PMIS were otherwise healthy beforehand with no other medical issues. 

What are the symptoms we should look out for?

Pediatric Multi-System Inflammatory Syndrome presents with a fever that last for 4 or more days PLUS any of the following symptoms:

 

  • Minimal effect of antipyretics like motrin or tylenol – if the temperature does come down an hour after taking an appropriate dose of motrin or tylenol.
  • Inconsolability or lethargy – If your child’s level of discomfort or fatigue seems out of proportion to the fever.
  • Abdominal pain, diarrhea, vomiting
  • A generalized rash
  • Both eyes appearing pink or red (conjunctivitis)
  • Enlarged lymph nodes (“glands”) on one side of the neck
  • Peeling lips
  • Swollen hands and feet, which also might be red

 

What is Kawasaki disease and is it different from  PMIS?

Kawasaki Disease (KD) is a known hyper-inflammatory syndrome.  Pediatric Multi-system inflammatory syndrome (PMIS) can present with symptoms that are similar to other  hyperinflammatory syndromes such as KD, toxic shock syndrome, or cytokine storm.  Both Pediatric Multi-system inflammatory syndrome and KD, if not identified early, can cause a dilation of a portion of one or more blood vessels of the heart.  This type of dilation is called an aneurysm.  With early diagnosis and appropriate treatment, we are able to significantly lower the risk of this cardiac sequelae.   

What is the work-up for PMIS?

We ask for you to call our practice if you develop a fever for equal to or greater than 4 days and any other symptoms described above (see answer to question 5).  If we are concerned about the Pediatric Multi-system inflammatory syndrome, we will refer you to the emergency department where they will analyze a series of blood tests, check covid-19 PCR and antibody tests, and conduct an echocardiogram.

How is PMIS treated?

Currently, the treatment for  PMIS is similar to protocols in place to treat Kawasaki Disease. The goal is to reduce inflammation to avoid long-term damage to arteries in the child’s body and heart. This is accomplished through transfusions of plasma via an IV which reduces the body’s own immune response that is causing the inflammation. 

How common is the condition?

It is not common.  There are less than 100 cases in the New York area which is a small percentage of all of the children who have been infected.  It is important to remember that most kids who are affected will have minimal symptoms if any.

Should my child be tested for Covid19?

At this point, Premier Pediatrics policy is to refrain from obtaining Covid19 PCR or antibody testing if your child is otherwise well.     The information that we obtain from the tests does not serve any practical purpose.  If your child tests positive, this does not tell us if he or she is immune from reinfection or at a higher risk for developing PMIS.   We do check for Covid19 as a part of the work-up for PMIS or if your child is sick enough to be admitted to the hospital.

What are the ages that are affected?

PMIS affects children of all ages (through 21 years).  Most of the cases have occurred in children between 5 -9 years old.

When should I call Premier?

In general, we ask for parents to check in if their child has had a fever for 3 days in order to investigate the fever.  We still urge parents to call the office with 3 days of a fever but we will start to consider PMIS in our differential diagnosis once your child has a fever for 4 or more days PLUS any of the following symptoms:  

  1. Minimal effect of antipyretics like ibuprofen (motrin) or acetaminophen (tylenol) 
  2. Inconsolability or lethargy – If your child’s level of discomfort or fatigue seems out of proportion to their fever.  
  3. Abdominal pain, diarrhea, vomiting 
  4. A generalized rash 
  5. Both eyes appear pink or red (conjunctivitis)
  6. Enlarged lymph nodes (“glands”) on one side of the neck
  7. Peeling lips or strawberry tongue
  8. Swollen hands and feet, which also might be red

We also urge you to call if you are uncertain, scared, or anxious.  We will be there to talk it through with you and come up with the right plan.