• Dr Claudine DeMunter

Multisystem Hyperinflammatory State in Children

Many of you will have been worried by the recent news stories around a possible rise in a new multi-system inflammatory affecting children. The article stemmed from an NHS internal alert to colleagues, a method of communication used to distribute information quickly and effectively to health professionals in order that they are made aware of any potential emerging conditions, so that they are able to give the appropriate care. Such alerts are sent to clinicians very regularly on numerous medical issues.

What we know:

It is based on a small number of observed cases around the UK, currently less than 30 in a population of over 19 million children. These cases were children some whom required intensive care, who exhibited signs of a hyperinflammatory syndrome that affects the walls of blood vessels. Similar better known diseases though very rare, include Kawasaki’s Disease and Toxic Shock Syndrome. The most common symptoms observed amongst these few cases, include a high unremitting fever and abdominal signs including pain. Sometimes red flushed skin. Some children feel very weak and aching everywhere. A few have had a low blood pressure or an unusual lethargy. Fewer cases have had inflammation of the blood vessels in the heart. It would seem that if this is related to a Coronavirus infection, it develops within 7 to 10 days after having tested positive for Covid 19. However, some patients have been tested negative and it is unclear whether these children had been positive some few days before feeling unwell. As for the majority of serious medical issues, blood tests show inflammation and guide the Clinicians. One major issue is that no one knows the percentage of the childhood population in the UK, well or unwell who test positive to the virus - and this is a vital factor in knowing whether there is any link to these observations.

This stays rare: Knowledge base around the Coronavirus pandemic is still limited. One feature which appears very consistent is that babies, toddlers, infants, young children and adolescents, even if they test positive for the Covid 19 virus, appear to have few, if any symptoms, but like any childhood infection there will always be a very few who develop the illness and may develop complications. These are the exception rather than the rule. If a child has a current history of muscle aches, joint aches and some rashes it is unlikely to be specifically Covid 19 related, unless testing proves otherwise. Joint or muscle discomfort is a very common symptom in response to many common viral illnesses. Fever and abdominal pain are also very commonly due to ordinary infections. Signs are similar to any serious illness so this will not be missed: A child presenting to a doctor with any high unremitting fever, rash, lethargy or extreme irritability, fever, abdominal pain or gastrointestinal symptoms continue to be those which would ordinarily warrant further investigation and so your child will receive the appropriate care. Indeed, these are common signs and symptoms for numerous common serious disorders. What is much more relevant is that the NHS is open to childhood illnesses, and GP’s Parents and Child staff remain alert to the more common but equally severe illnesses which require time critical care - such as Long Term Conditions, Sepsis, Pneumonia, Epilepsy, Diabetes and Heart and Lung Conditions unrelated to Covid 19. These occur much more frequently and are as important to treat as the complications of Covid 19.

Our advice: Like for most serious conditions, you should be concerned if there is a very high fever associated with extreme irritability or lethargy, or very high fever lasting for over 3 days resistant to paracetamol and any sign as described above. Do seek advice and help and if needed or directed, do not hesitate to go to an NHS hospital, preferably one with a Paediatric Emergency Department.


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