Tracking a Rare Post-Infectious Complication to COVID-19 in Children

Multisystem inflammatory syndrome in children (MIS-C), is rare and mysterious in its presentation, the effects on young patients, and the immune responses related to it. The condition, also known as PIMS-TS, is a unique complication related to COVID-19 infection and it can have a broad presentation spectrum that may overlap with Kawasaki disease.¹

Investigators from the United Kingdom wanted to see what the long-term physical and psychological outcomes were in children with the syndrome and used a multidisciplinary team to review their cases at a 6 month follow-up. This retrospective cohort study involved 46 children who met the criteria and had been admitted to a hospital in London, between April 4 and Sept 1, 2020.

The findings were published in The Lancet Child and Adolescent Health, and presented at the European Congress of Clinical Microbiology and Infectious Diseases Conference.

At the 6-month follow-up, there were some common conditions. “…Common sequelae included muscular fatigue; neurological sequelae such as proximal myopathy, dysmetria, and abnormal saccades; and anxiety and emotional lability,” the investigators wrote.

From a physiological standpoint, there was a reduced ability to exercise. “The notable reduction in functional exercise capacity in this cohort could be attributed to various factors: the underlying inflammatory nature of PIMS-TS; the high proportion of patients requiring PICU admission, resulting in the possibility of critical illness myopathy; non-compliance with home-based exercise programs; a pre-illness sedentary lifestyle; and side-effects of high-dose corticosteroid use, which might have contributed to proximal myopathy and increased BMI at the initial 6-week follow-up,” the investigators wrote.

The investigators noted that residual neurological effects have been witnessed in other studies looking at PIMS-TS, but not much was witnessed in this study.

“In our cohort, persistence of subtle findings, which were only noticeable on detailed neurological exams, did not correlate with neurological functional impairment (median Expanded Disability Status Scale score 0 at 6 months),” the investigators reported. “Although 98% of patients had resumed full-time education by 6 months, formal neuropsychology testing was not done and the long-term cognitive effects of PIMS-TS require attention given the high frequency of neurological involvement at presentation.”

They stressed the importance of continued follow-up in these patients.

“Whether other longer-term sequelae will manifest beyond 6 months (eg, inflammatory gastrointestinal pathology or renal disease from acute kidney injury) is yet to be determined, stressing the importance of ongoing multidisciplinary follow-up of patients with PIMS-TS,” the investigators concluded.

References

1. Fernández-Sarmiento J, de Souza DC, Jabornisky R. et al. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee. BMJ Paediatr Open. 2021; 5(1): e000894. Published online 2021 Feb 4. doi: 10.1136/bmjpo-2020-000894