Follow-up of a rare post-infectious complication of COVID-19 in children

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

Investigators from the UK 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 during 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 September 1, 2020.

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

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

From a physiological point of view, 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 admission to the PICU, resulting in the possibility of severe myopathy; non-compliance with home exercise programs; a sedentary lifestyle before illness; and side effects of high-dose corticosteroid use, which may have contributed to proximal myopathy and increased BMI at the initial 6-week follow-up, ”the investigators wrote.

Investigators noted that residual neurological effects were seen in other studies of PIMS-TS, but little was seen in this study.

“In our cohort, the persistence of subtle findings, which were only noticeable on detailed neurologic examinations, was not correlated with neurologic functional impairment (median score of the Extended Disability Status Scale 0 to 6 months) “, investigators reported. “Although 98% of patients returned to full-time studies after 6 months, formal neuropsychological testing was not performed and the long-term cognitive effects of PIMS-TS require attention given the high frequency of ‘neurological impairment during presentation. “

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

“Whether other longer-term sequelae will manifest beyond 6 months (for example, inflammatory gastrointestinal pathology or kidney disease due to acute renal failure) remains to be determined, stressing the importance of a Continuous multidisciplinary follow-up of patients with PIMS-TS ”the investigators concluded.

The references

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

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