What is PIMS? The disease affects children who have had COVID-19. Here are the symptoms

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PIMS, or pediatric SARS-CoV-2-related multi-system inflammatory syndrome, is the current name for a rare hyperinflammatory condition observed in children infected with SARS-CoV-2. Most children and young people do not feel seriously ill with COVID-19, but a very small number (less than 0,5%) worldwide have developed a condition in which different parts of the body become inflamed, usually between two and four weeks later. Most children with PIMS will not have serious problems, but in a very small number of cases, they can develop serious complications.

What is PIMS?

PIMS (pediatric inflammatory multisystem syndrome) is a condition that occurs weeks after someone has contracted SARS-COV2 (COVID-19) coronavirus infection. It causes inflammation (swelling) throughout the body, which is one of the ways the immune system fights off infections, injuries, and disease.

Although most children and adolescents who develop COVID-19 have no symptoms or are very mild at this time, it is known that a few weeks later a small number will develop childhood inflammatory multiple system syndrome (PIMS). They are mostly young people in their teens, but children can also have PIMS. As PIMS is a new condition, more information about the condition is still being discovered.

Also read: How does the immune system work?

What causes PIMS?

Research on PIMS is still ongoing, but it appears to be linked to the SARS-CoV-2 coronavirus. It is unclear to what extent emerging PIMS has an etiology similar to Kawasaki syndrome (a condition prior to the onset of SARS-CoV-2, which is now believed to be caused by a distinct viral agent).

Although some cases resemble toxic shock syndrome (TSS), there is no evidence that staphylococcal or streptococcal toxins are involved. The role of comorbidities in PIMS is unclear. Better understanding will have potential consequences for clinical management.

PIMS is known to be caused by the immune system fighting the virus, but then overreacting, affecting other parts of the body.

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PIMS – symptoms

The main symptom of PIMS is a high temperature that lasts for several days. Other PIMS symptoms vary, as do severity, and include:

1. Shock-like symptoms with gastrointestinal symptoms (abdominal pain, diarrhea, vomiting), shock due to myocardial dysfunction, polymorphic rash, headache and altered state of consciousness.
2. Kawasaki-like symptoms in children under five, with fever, polymorphic, non-blanching rash, mucosal involvement and non-suppurative conjunctival hyperaemia. Children may complain of neck stiffness and soreness and may develop cervical lymphadenopathy.
3. Undetermined inflammation with persistent fever and some PIMS symptoms, but no heart problems or shock.

Heart problems are common, and in more severe cases of myocardial dysfunction, admission to an intensive care unit (which occurs in at least half of patients) may be necessary. Coronary aneurysms occur in about 15%.

Serious bacterial infection remains the most common cause of fever and shock in children seeking emergency care.

If you believe you have any other symptoms that may or may not be related to PIMS, let your doctor know.

See also: Anesthesiologist: unvaccinated, young people without any other diseases dominate in intensive care

PIMS – diagnostics

Diagnosis is made on the basis of specialist clinical evaluation. An unexplained persistent fever and clinically significant symptoms following COVID-19 exposure may be diagnostic suspicion. Parents need to seek immediate medical attention as a child’s condition can deteriorate quickly.

The first involvement of pediatricians is often the emergency department. Early diagnosis and multidisciplinary referral to pediatric specialists (intensive care, infectious diseases, cardiology, hematology, rheumatology, etc.) is essential. The tests may include blood tests, chest x-rays, an ultrasound of the heart (echocardiography), and an ultrasound of the abdominal cavity. Doctors will perform blood tests to assess the level of inflammation in the body as well as to see how different parts of the child’s body are working. Together, these results along with the symptoms allow physicians to confirm that we are dealing with PIMS so that they can undertake appropriate treatment.

Doctors also need to rule out other, more common, non-infectious and infectious causes of inflammation including bacterial sepsis, staphylococcal and streptococcal shock, and infections related to myocarditis such as enterovirus (sometimes there may be co-infection with additional pathogens, including human metapneumovirus and various others). microorganisms). Other potentially unrelated sources of abdominal pain include appendicitis and mesenteric lymphadenitis.

Differential diagnosis with Kawasaki syndrome can be difficult given the lack of a diagnostic test for both conditions. It is currently unknown whether the newly described condition superimposes Kawasaki’s disease shock syndrome. Since the prompt diagnosis and timely treatment of actual Kawasaki disease is important to prevent complications, it is accepted that all children with a prolonged fever, especially children under one year old, are suspected of having Kawasaki disease.

PIMS – treatment

PIMS treatment is still being developed to help the patient in the best possible way. The goal of treatment is to ‘turn off’ the immune system to stop inflammation and then ‘reset’ it to reduce the risk of long-term damage.

PIMS is treated with a combination of drugs.

1. Intravenous immunoglobulin (IVIG) – is taken from your blood, checked for infections, and then given through a drip. IVIG contains many antibodies – proteins in the blood that fight infection.
2. Corticosteroids – These are administered intravenously or orally in the form of tablets or liquid. They’re a man-made version of a hormone in our body that calms our immune system. Since corticosteroids suppress the immune system, you may be more at risk for certain infections, especially if you take high doses. When a patient no longer needs corticosteroids, it may be necessary to ‘wean off’ or ‘reduce’ them gradually rather than stopping them suddenly. This helps the body to start making its own steroids again.
3. Anticoagulants (aspirin and dalteparin) – Aspirin makes the blood less ‘sticky’, which reduces the likelihood of a clot forming. Typically, a patient stops taking them after six weeks, if doctors are satisfied with the results and confident that the patient’s heart is working properly. Dalteparin is given by injection and causes the blood to thin. Usually, the patient only receives it while in hospital.
4. Stomach medicine – Corticosteroids and aspirin can irritate a patient’s stomach, so it is likely that a patient will be given another medicine with them to protect the stomach lining.
5. Biological drugs – If IVIG and corticosteroids on their own do not work well, the patient may receive biological drugs intravenously called anakinra and tocilizumab. They also “turn off” the immune system.

Also read: New snobbery: lying under the drip

PIMS treatment and recovery at home

When the patient feels better, he will be able to go home. The team of doctors will only allow this if they are confident that the patient’s health is improving and they will stay in touch with the doctors so that they can keep an eye on him when he is at home. Because PIMS affects all areas of the body, you may still experience some symptoms when you return home, including:

1. problems with concentration or the so-called brain fog;
2. hair thinning or loss;
3. changes in well-being, including outbursts of anger;
4. problems with sleeping;
5. rashes and peeling of the skin;
6. changes in hearing;
7. tingling hands and feet;
8. loss of smell and / or taste;
9. difficulty swallowing or voice changes;
10. diarrhea;
11. changes in appetite;
12. muscle weakness and fatigue;
13. stomach pain;
14. heart, kidney, or breathing problems.

PIMS can affect both the mind and the body, so the patient needs to be aware of their mood when they return home. It’s normal to feel restless and irritable. This is due to PIMS as well as the daily problems that COVID-19 has caused.

Perhaps the patient noticed that after becoming ill, he became weak and tired. The physiotherapy obtained then will enable him to perform appropriate exercises, thanks to which he will regain strength and efficiency of the muscles. The patient may have been sent home with recommendations on exercises to be performed to aid recovery. It is known that exercise is essential to our health, so it is very important to stay active and take part in sports and physical activities such as daily walks.

It’s worth taking the time to recover and not trying to do too much in the beginning. It is recommended to gradually increase the intensity of the activities performed, depending on what is being done, assuming that the patient is not feeling unwell. The key to success is to balance your activity.

See also: Have you lost your sense of smell due to COVID-19? Scientists know when it’s going to be back to normal

PIMS – frequency of occurrence

Epidemiological information is limited and clinical statistics are currently derived from a review of case series. The condition of PIMS is considered rare. Its frequency is unknown. Based on available reports, the death rate among diagnosed cases appears to be around 1,7%. (much higher than 0,07% among children with Kawasaki disease in Japan). A rapid risk assessment by the European Center for Disease Prevention and Control (ECDC) concluded that the overall risk for children in the European Union is considered to be “low”.

Clusters of the newly described condition were recorded 3-4 weeks after the SARS-CoV-2 virus transmission peaks in various local communities. Such observations have proven to support the concept that SARS-CoV-2 can cause a severe Kawasaki-like disease. Frequent symptoms without apparent respiratory symptoms in children who do not appear to have ongoing SARS-CoV-2 infection but who have already developed antibodies suggest that the disease may be driven by a delayed, post-infection mechanism.

The median age of onset appears to be at least 7 years (compared with 2 years for Kawasaki disease, which mainly affects children under 5). PIMS appears to be more common in male children (largely consistent with Kawasaki disease where the male-to-female ratio is approximately 1,5 to 1). Many affected children appear to be free from underlying medical conditions such as asthma or autoimmune disorders, and relatively few reports of known congenital heart disease or pre-existing cardiovascular disease. More than half (52%) of the children had no registered health condition, including overweight or obesity (among those who had some comorbid disease, 51% were overweight or obese).

The Polish definition of PIMS slightly differs from the one adopted by WHO, because it is not required to prove exposure to SARS-COV-2: either through documented illness of a child or contact with an infected person, or through positive laboratory tests: PCR, antigen test or antibodies. In line with these assumptions, Polish statistical studies show that PIMS is most common among children aged 5 to 12 (the average age is 8,6 years), of which 63 percent. they were boys. All the children had a fever, 81 percent. children had a rash, 76 percent conjunctivitis. 82% complained of abdominal pain, 61% of nausea or vomiting, and 60% of diarrhea. 7,7 percent young patients required treatment in an intensive care unit (ICU) setting.

Also read: Coverage of the COVID-19 coronavirus [MAP]

PIMS – frequently asked questions

Can I go back to school after PIMS?

Yes, you can, if the patient is feeling well enough – he or she may probably be quite tired for a while after undergoing PIMS, so shouldn’t overstrain. Perhaps it is worth talking to teachers about gradually increasing the time at school until you fully recover. It is up to the sick person how much and what he will tell his friends and family about the disease. Sharing your experiences can help you stay in good contact with others.

Is it possible to meet family and friends with PIMS?

There is no need for isolation if you have PIMS. While we are not contagious, we should still heed the government’s guidelines for meeting people outside the home (especially if we are interacting with someone who has or may have COVID-19).

Should I avoid sick people with PIMS?

Drugs used to treat PIMS weaken the immune system, so avoid contact with people suffering from chickenpox, measles and tuberculosis. If you think you have been in contact with such people, consult your doctor as it may be necessary to make sure that you are not infected.

I am pre-vaccinated and have PIMS – should I get it?

It is important to keep up with your routine vaccinations when they are appointed. However, the medications used to treat PIMS can affect how they work, so talk to your doctor about the best time to take them.

Regarding IVIG, it is recommended that at 2,0 g / kg bw or 100,0 g for children weighing> 50 kg postponing the measles and varicella vaccination by 11 months. If we got vaccinated a few weeks before PIMS, we may need to get a booster dose if we got IVIG. An inactivated flu vaccine is recommended, even if you receive it within six months of receiving the IVIG.

On the other hand, treatment with glucocorticoids does not contraindicate the administration of inactivated (non-live) vaccines, although their effectiveness is limited when administered during immunosuppression. The administration of live vaccines is possible at least one month after the end of immunosuppressive therapy with glucocorticosteroids.

For anakinra or tocilizumabi, you should wait at least six months to receive any live vaccines.

When it comes to vaccination against COVID, it is currently assumed that the optimal interval to be maintained between PIMS and COVID-19 vaccination is 3 months. It is worth adding that, according to the recommendations of experts from the Polish Society of Vaccinology and the Polish Pediatric Society:

“Current data are sufficient to conclude that COVID-5 vaccination is an effective method of preventing PIMS, not a risk factor for the development of this complication, for the 18-19-year-old population.”

If we have any questions about getting the COVID vaccine, please contact the doctors.

Can I have PIMS again?

When dealing with an infectious disease such as PIMS, our body produces “antibodies” and is therefore protected against it. While there are known cases of people who have had COVID-19 and PIMS and make antibodies, it is not known how long they last. It is known, however, that it is very unlikely that you will get PIMS again.

However, if we have symptoms that could be related to COVID-19, we should follow government guidelines. If we begin to feel the same as during PIMS, let’s ask family members to take us to a local hospital for testing. Remember to inform doctors that we have had PIMS.