multi-system-inflammatory-state-requiring-intensive-care-summary

Context: Recently, the Paediatric Intensive Care Society (PICS) in the United Kingdom(UK) had observed an apparent rise in the number of children (of all ages) with a “multi-system inflammatory state requiring intensive care”. 

More on news: 

  • Children in the UK are reportedly falling ill with symptoms of high fever and swollen arteries, and doctors believe it could be coronavirus-related
  • According to the PICS, there is a growing concern of a SARS-CoV-2 related inflammatory syndrome emerging in children in the UK or that there may be another unidentified infectious pathogen associated with these cases.
  • The National Health Service (NHS) has issued a nation-wide alert, and asked doctors to urgently report any cases with similar symptoms. 
  • Not just the UK, doctors in Italy and Spain have also alerted authorities of similar cases.

What is multi-system inflammatory state?

  • This rare illness causes inflammation of the blood vessels, which leads to low blood pressure. 
  • It affects the entire body as it causes a build-up of fluid in the lungs and other organs. 
  • This condition is similar to Kawasaki disease. Patients suffering from it require intensive care to support the lungs, heart and other organs.
  • Symptoms: 
    • Children were showing abdominal and gastrointestinal symptoms as well as cardiac inflammation. 
    • According to PICS, there were also overlapping symptoms of toxic shock syndrome and atypical Kawasaki disease.

Toxic shock syndrome (TSS) 

  • It is a rare life-threatening condition caused when certain bacteria enter the body and release harmful toxins. If not treated in time, the condition could be fatal. 
  • Symptoms include high temperature, flu-like symptoms including headache, sore throat, cough, diarrhea, dizziness or fainting, difficulty breathing and confusion. 
  • Some patients suffering from TSS may need ICU admissions.

Kawasaki disease 

  • It is an acute inflammatory disease of the blood vessels and usually occurs in children below the age of five.
  • The inflammation caused by the disease affects many parts of the body but has a more serious effect on the heart since it causes inflammation in the coronary arteries that are responsible for supplying blood to the heart. 
  • This results in enlargement or in the formation of aneurysms that can lead to heart attacks. 
  • Symptoms include fever, changes in extremities, rashes, redness of the cornea, red and cracked lips, a red tongue and lymph node enlargement of the neck.

Connection with Covid-19:

Only some of the children with these symptoms tested positive for Covid-19. Therefore, it remains unclear if and how the inflammatory syndrome is related to the coronavirus.

Concerns:   

  • Some doctors have suggested that the illness may be “post-infection inflammatory response”, where the immune system goes into overdrive. 
  • This also explains why some children with this illness could have tested negative for the virus. 
  • They could have already recovered from the virus before the inflammation set in or the tests simply did not detect the virus.
  • Another syndrome associated with an overstimulated immune system response is the cytokine storm syndrome. 
    • It is suspected that some Covid-19 patients, even young ones, can develop this response leading to sepsis, multiple organ failures and even death.

It is important that clinicians are made aware of any potential emerging links with COVID-19, so that they are able to give children and young people the right care fast.

About Cytokine storms

  • A cytokine storm or CSS is characterised by the overproduction of immune cells and the cytokines themselves because of a dysregulation in the immune system process .
    • Cytokines are signalling proteins that are released by cells at local high concentrations.
  • It is an overreaction of the immune systems, which triggers what is known as a “cytokine storm syndrome” (CSS).
  • It is triggered when a virus (or antigen) enters the body for the first time.
  • A cytokine storm can occur due to an infection, auto-immune condition, or other diseases. Signs and symptoms include high fever, inflammation (redness and swelling), severe fatigue, and nausea.
  • Implications:
    • A severe immune reaction, leading to the secretion of too many cytokines in the bloodstream, can be harmful since an excess of immune cells can attack healthy tissue as well.
  • Few diseases in which CSS has been seen
    • Spanish Flu in 1918-20  that killed more than 50 million people worldwide
    • H1N1 (swine flu) and 
    • H5N1 (bird flu) 
  • Cytokine responses against human coronaviruses:
    • SARS-CoV-1 (which caused SARS), SARS-CoV-2 (which is responsible for the current COVID-19 pandemic), and MERS can result in acute lung injury and acute respiratory distress syndrome (ARDS).
  • Correlation with COVID-19:
    • Here a cytokine storm is associated with a surge of activated immune cells into the lungs, which, instead of fighting off the antigen, leads to lung inflammation and fluid build-up, and respiratory distress.
    • If the clinical features of CSS are not recognised and adequate treatment is not promptly instituted, multiple organ failure can result. 
    • Researchers writing in The Lancet recently have suggested that all severe COVID-19 patients should be screened for hyper inflammation.

Source: https://indianexpress.com/article/explained/coronavirus-europe-disease-children-multi-system-inflammatory-state-kawasaki-disease-6384601/

Image Source: Indian Express