Early studies from Wuhan, China—the original epicenter of the pandemic—suggested that children under age 10 are not so susceptible to the life-threatening new coronavirus disease (COVID-19). The risk of dying in this age group was shown to be only one in 10,000 compared to one in 82 in the 50-59 age group, and one in 12 in the 60-80+ age bracket.

However, recent published research work from Italy, the United Kingdom and the United States reported on a peculiar type of clinical presentation of COVID-19 in young children, generally under 5 years old.

A few days ago, a patient frantically called me up to ask about her nephew, age 4, who developed high-grade fever six days earlier followed by skin rashes. The fever became intermittent and low grade after three days, and the boy has had no fever the past two days. The skin rashes persisted.

Autoimmune disease

The mother called up the child’s pediatrician and after getting the child’s history, the pediatrician suggested to run some tests to rule out a potentially serious illness similar to Kawasaki disease, which has been linked recently to COVID-19 in children.

Kawasaki disease is a relatively rare ailment in children, causing diffuse swelling or inflammation in the walls of the arteries, including those supplying the heart. Some children can also develop aneurysms and blockages of the heart arteries. The heart muscle and its valves may swell, too, causing heart failure. Hence, it’s also described as multisystemic or polysystemic inflammatory syndrome.

The exact cause is not known yet, although it is believed to be an autoimmune disease. The child’s immune system overreacts to the virus or bacteria, and starts to attack its own cells.

It’s actually a postinfectious reaction, and really sounds ironical because by the time the immune system goes into this excessive reaction—frequently described as an inflammatory cytokine storm—the virus infection has already run its course. The virus is on exit mode already. Perhaps, as a disappointment for not finding active viral colonies to attack and vanquish, the immune system’s natural killer cells vent their ire on the body’s own cells.

Frightening symptoms

In the Italian report, the children were already negative for viral particles, determined by the standard throat and/or nasal swab test, but they had antibodies in the blood, indicating they had recent COVID-19 infection.

The same phenomenon consisting of diffuse inflammation of the entire vascular or circulatory system of the body actually happens more frequently in adults with COVID-19. As a result of the self-damaging inflammatory cytokine storm, the body’s immune system attacks also the arteries, lungs, heart and other vital organs that can lead to shock and multiorgan failure.

Children with COVID-19 and Kawasaki-like disease usually have high fever, skin rashes and redness of the eyes, lips, tongue, hands and toes. The skin is parched and peeling, lips are cracked and extremely red—which can look frightening for parents.

Upon examination, the physician finds swollen, palpable lymph nodes, usually in the neck area. The good news, though, is that frightening as it may look, it is treatable, and the far bigger majority of children recover without any residual blood-vessel problem, although we recommend that they be monitored for the development of a cardiovascular illness later on in adulthood.

The clinical presentations of COVID-19 and Kawasaki disease overlap, so if the child’s fever lasts more than three days with any of the other classical symptoms of Kawasaki disease, it is advised to see the child’s pediatrician immediately.

Prompt evaluation by a physician is important to abort any progressive inflammation in the body and prevent permanent complications in the heart and other organs. With early recognition and treatment with drugs that can modulate the immune system response, most children with COVID-19 and Kawasaki-like disease usually fully recover in a few days.

Overlooked

Why was it reported only recently? It’s likely to have been there, and some Chinese children must have had it, too. But it’s a relatively rare disease, so most likely it was overlooked. It was only after the first report that some countries reviewed their patient records and were convinced they also have a number of cases in their pediatric cases of COVID-19.

My patient sounded extremely worried when she called up about her nephew’s condition. I asked her, “Does he look sick, weak and irritable?”

“No, he’s already playing and has a good appetite,” she replied. Then it’s unlikely to be COVID-19 with Kawasaki-like disease, I told her.

I advised her sister, the child’s mother, to get some sleep and just bring the child to her pediatrician the following day. My patient called me up two days later to inform me her nephew has been diagnosed with measles after a thorough evaluation.

So, awareness of this disease among children is important, but anxious parents must always remember how rare it is, and that there’s probably only one chance in 100,000 that their child with fever and skin rashes could have it. INQ