Early treatment key for a childhood syndrome linked to COVID-19

A detailed analysis of children with a rare childhood syndrome linked to COVID-19 has shown that early treatment is a key factor in outcomes. The clinicians leading the study advise parents to seek medical care for their child if they are worried.

The analysis of 58 children with paediatric inflammatory multisystem syndrome (PIMS-TS) was completed by clinicians at Evelina London Children’s Hospital, Great Ormond Street Children’s Hospital and Imperial College London. The clinicians say that the analysis confirms that this is a new condition, and should be treated differently to existing conditions, such as toxic shock and Kawasaki disease.

PIMS-TS is a rare syndrome which has emerged in a small number of children during the COVID-19 pandemic. These children have an immune response that causes severe inflammation in blood vessels and can lead to heart damage.

The first cases of PIMS-TS were treated at Evelina London in mid-April. The team initiated efforts with colleagues at St Mary’s Hospital, Imperial College London and Great Ormond Street Hospital to identify further cases and characterise the disease.

The team analysed the characteristics of the disease in 58 children treated for PIMS-TS at eight hospitals across the UK between 25 March and 20 May 2020.

They looked at patients’ symptoms, laboratory results, treatment and the progress of their disease and compared these to similar records from a large cohort of children previously treated for Kawasaki disease and toxic shock syndrome. This confirmed that the diseases are clinically different, and need to be managed in a different way.

Of the 58 children diagnosed with PIMS-TS, 70% were from black Asian and minority ethnic (BAME) groups. It is not clear why this is the case, and from the small numbers involved, it is not statistically possible to tell whether BAME children have worse outcomes.

The team found that the first cases they saw in April were more severe. With earlier identification and treatment, more recent patients had fewer complications.

Dr Julia Kenny, consultant in paediatric infectious diseases and immunology at Evelina London, said: “Our analysis has shown that this is indeed a new condition. Untreated, there are serious complications but with early identification and treatment, outcome is excellent with the children we are reviewing after discharge completely well. If parents are concerned that their child is becoming seriously ill, please seek health assessment either via your GP, 111 or in an emergency 999/Emergency Department.

“For clinicians, it’s important that we build collaborative research to quickly improve our understanding of the condition and the best evidence based treatment for our patients.”

Lead author Dr Elizabeth Whittaker, from the Department of Infectious Disease at Imperial College London and a consultant in paediatric infectious diseases and immunology at Imperial College Healthcare NHS Trust, said: “The new condition, PIMS-TS, is extremely rare but it can make a child very ill, so it’s important to characterise the disease properly so we can provide close monitoring and the best treatment.”

Dr Alasdair Bamford, consultant and specialty lead in paediatric infectious diseases at Great Ormond Street Hospital, said: “An important next step will be to review this data in the context of other studies being published from around the world. This will help inform management guidelines and also to further refine the case definition. Recruitment of children into observational studies and clinical trials will be key to creating an evidence base for the best treatment.”

The team urge any parents worried about their children to seek advice from healthcare services. Learn more about our response to COVID-19.