Clinical picture | May 19, 2020
Experts suspect that Sars-CoV-2 triggers an overreaction of the immune system in the affected children. Instead of protecting the body, the immune system then attacks the tissues and organs. Ten cases of children and adolescents have occurred in Switzerland since the beginning of March.
Persistent fever, severe abdominal pain, rashes and a swollen tongue – symptoms in children that the medicine deals with in the current situation.Photo: Keystone, Gaëtan Bally
At least children and adolescents seem to have been spared from serious illnesses caused by the corona virus. However, cases of seriously ill children, which are suspected to be related to the new virus, are now increasing in some countries. The affected children suffer from persistent fever, severe abdominal pain, rashes and a swollen tongue. The blood vessels become inflamed, sometimes the heart is damaged. Pediatrician Sunil Sood from the Cohen Children’s Hospital in New York reports that around half of the young patients in his clinic had to be transferred to the intensive care unit because of myocarditis.
Doctors speak of the “pediatric inflammatory multisystem syndrome”, abbreviated MIS-C. The disease is similar to the rare Kawasaki syndrome, a vascular disease in children that can lead to organ failure.
Ten cases in Switzerland
In Europe, the suspect syndrome occurred in around 230 children aged up to 14 years of age by the end of last week, according to the European Center for Disease Prevention and Control. Pediatrician and infectiologist Christoph Aebi told the NZZ on Sunday that ten cases have occurred in children and adolescents since the beginning of March. However, none of the children died.
Doctors in Bergamo in northern Italy report that the inflammatory syndrome has been occurring significantly more recently: From mid-February to mid-April, there were ten cases from mid-February to mid-April, compared to 19 cases in the past five years. There were more than a hundred cases in the New York region.
At least five children – three in New York and one each in France and the United Kingdom – died from the syndrome. In at least two other cases, it is believed to be the cause of death.
Overreaction of the immune system
Experts suspect that Sars-CoV-2 triggers an overreaction of the immune system in the affected children. Instead of protecting the body, the immune system then attacks the tissues and organs. “The children had the virus and the body initially fought it off,” says pediatrician Sood. “But now there is this delayed excess immune response.”
This is also supported by the observations of the immunologist Julia Kenny from the Evelina Children’s Hospital in London, where 50 children were treated with the syndrome. Acute corona infection was only detected in a small number of them. “But most of them tested positive for antibodies,” says Kenny. This means that they were previously infected without symptoms.
Genes as a possible cause
The increase in cases appears to be several weeks behind the peak of infections in the general population. This suggests that antibodies may play a role in the development of the syndrome.
A theory is based on a genetic disposition. In the UK, six of the eight children who were the first to fall ill were of Afro-Caribbean descent, according to a study published last week in The Lancet. The boy, who died in France, also had African roots, according to the doctors.