A leading consultant has urged parents to watch out for the “crucial” symptom of fever in their children, as cases of a Covid-related illness spike following a community outbreak.
At least 32 children have been treated for PIMS (Paediatric Multisystem Inflammatory Syndrome, also known as PIMS-TS) at the Crumlin Children's Hospital in Dublin since the start of the pandemic.
However, this figure could be higher nationally.
The syndrome can affect the heart and has even led to some children being placed on ventilators.
Tommy O’Neill (5), from Clondalkin, Dublin, became seriously ill with PIMS and was treated in the intensive care unit in Crumlin after he complained of a belly ache and a high temperature. He was later moved to the ward.
PIMS cases ‘mirror’ the number of Covid cases in the community, paediatric immunologist Dr Ronan Leahy explained.
He said that up to four weeks after Covid-19 cases spiralled in communities, a number of children would typically be hospitalised with the rare illness.
Thus when there’s a wave of Covid cases, a small number of children will become ill with PIMS.
Dr Leahy, consultant in paediatric immunology and infectious diseases, at the Crumlin hospital, said: “The crucial symptom to watch out for is fever.
“Cases always have fever. The other features we often see are rashes on the hands and feet and redness of eyes.
“Some more consistent features after that are tummy pain, diarrhoea and vomiting.
“In essence, if you have a child with a fever and you don’t have a good explanation, you should bring them to a GP or the emergency department.
“If a child has a fever for three days, go to the ED.”
Dr Leahy said: “The number of PIMS-TS cases does closely mirror the number of Covid-19 cases in the community.
“If we see a wave of Covid-19 in the community, typically a number of weeks later, we see an uptick in PIMS-TS.
“It closely follows the community transmission of Covid-19. There was quite a big surge in Covid-19 in December, so I’m not surprised if there are more cases of PIMS-TS.
“Numerically, the more infections of Covid-19, the probability is we will see more PIMS-TS. We haven’t had any deaths (from PIMS) in Ireland but a number of cases have been ventilated, though not recently.”
Every child who becomes sick with PIMS reacts differently, according to Dr Leahy. The degree to which a child becomes sick depends on their immune response.
Some children have a substantial amount of inflammation and others have a milder response.
For the minority who are treated in ICU, they receive steroids and intravenous immunoglobulin, a protein used to neutralise viruses.
“We use other supportive measures depending on how sick the children are,” Dr Leahy said.
“That sometimes includes antibiotics and sometimes they need fluid if children are not eating and drinking.
“If they are sicker, they go to ICU and in some cases children are treated there, as sometimes there’s a degree of inflammation in the heart muscles and they might need help and support with the blood pressure if their lungs are under pressure.”
In the UK, up to 100 children a week are hospitalised with PIMS, according to the Imperial College Healthcare NHS Trust.
Four out of five children were previously healthy, according to a snapshot of cases. Some children are presenting at hospitals and a small number are treated in ICU, without ever having shown symptoms of having had Covid-19.
“Essentially children are exposed to the virus, or they get the virus. They then produce a delayed inflammatory response,” Dr Leahy said. “The immune system, which is meant to protect from infection, gets confused and produces an exaggerated inflammatory response.
“Probably what happens with these children is they see the virus and in most cases catch the virus and recover from the infection mostly.
“However, the immune system produces an exaggerated response to the virus and it makes the children sick.
“PIMS-TS is temporarily associated with Sars-CoV-2, the virus that causes Covid-19 infection.
“We believe typically two to four weeks after a child has been sick with the virus (Covid-19) and it’s come and gone, they become sick with PIMS.
“With a lot of the children who come to hospital, we don’t see any evidence of the virus.
“But often the parents say the child might have had symptoms two to three weeks ago, or that they’d been in contact with someone that had Covid-19.”
A child’s temperature can flare up to 40C and they can have dangerously low blood pressure. It has affected babies and children up to 10 years of age in Ireland and, on average, more boys than girls.
Many children treated for PIMS show no signs of ever having had Covid-19.
Doctors at Children’s Health Ireland (CHI), the management group that oversees Crumlin, Temple St and Tallaght's paediatric unit, use antibody tests which detect whether children have had Covid-19.
But when that doesn’t alert signs of Covid-19, doctors then refer to medical evidence provided by parents/guardians, which often highlights a timeframe within which a child showed symptoms for Covid-19, or that the child was a contact of someone with the virus.
“Our experience has been that children do well from a cardiac perspective,” he said.
“Some had minor changes to coronary arteries,” he added. “But most kids get better quickly and in a couple of days.”