RIO – On the 2nd of July, a Thursday, Alice, 3 years old, woke up full of spots on her body and with fever. The concerned parents immediately called the pediatrician, who, due to the symptoms described, excluded the possibility of being covid-19. “It didn’t even occur to me that it could be the new coronavirus because of all the care we were taking,” says the girl’s mother, who chose not to identify herself. “And the doctor herself didn’t think it was, either. Even so, he decided to ask for a exame PCR, which was negative. ”
Due to the peculiarities of her profession, Alice’s mother continued to go to work on a daily basis. However, it followed all the recommended security measures, such as wearing mask and alcohol gel. “I only entered the house after taking off my shoes, I didn’t touch anything”, he says. “My clothes went to the washing machine and I went to the bath.”
Alice’s father stayed in the home office, isolated with his daughter. And even to order food at home, the family was thrifty. They received few meals per delivery. Even so, following all recommended care. “We really followed the quarantine.”
In fact, neither of them had symptoms of the disease. For this reason, they were not surprised when their daughter’s PCR was negative. But the girl’s health began to worsen, without anyone being able to reach a diagnosis. Other unusual symptoms also appeared, such as red eyes, swollen belly, peeling feet and hands and intermittent fever.
On the seventh consecutive day of fever, a blood test revealed widespread inflammation and Alice was admitted to the pediatric ICU of a private hospital in the west of Rio. She had a rare inflammatory syndrome linked to infection with the new coronavirus.
Confirmed cases of covid-19 in children and adolescents account for a maximum of 3.5% of the total records. This age group is the less affected and the vast majority of occurrences are very mild. Still, a small number have serious infection-related problems. These very serious cases that invariably end up in the ICUs are caused by the newly described Pediatric Inflammatory Multisystemic Syndrome (SMIP).
It is a severe inflammatory reaction that only affects children and is associated with a delayed response to Sars-CoV-2. So far, just over 200 cases have been described worldwide. WHO and CDC have already issued alerts on these episodes.
“The syndrome does not occur in the acute phase of covid-19. In general, it appears later and can occur even in children who have had a mild illness ”, explained pediatrician Tania Petraglia, president of the Department of Infectology of the Pediatric Society of the State of Rio de Janeiro (Soperj).
The rare manifestations of the disease in children have not been seen in China, where the epidemic emerged, at the end of the past. It was only in April that doctors in the UK reported the first cases. In May, the Brazilian Society of Pediatrics issued a warning note about the syndrome and its risks.
In Brazil, there are still no official figures on the disease, but pediatricians confirm the occurrence of cases like Alice’s. Only in the Pediatric ICU of Hospital Pedro Ernesto, in Rio, a reference for the treatment of covid-19, eight children have already been treated. The hospital where Alice was admitted registered two other cases.
The reports indicate the presentation of a picture very similar to that of the very rare Kawasaki Syndrome, a systemic inflammation of unknown cause, more common in Asia. Among the most frequent symptoms, fever, conjunctivitis, spots on the body, redness on the soles of the feet and on the palms of the hands. The main complication is the occurrence of aneurysms in the coronary artery. If not treated properly, the disease can lead to death.
Experts do not know why the syndrome only occurs in children, nor why it affects some and spares others. A large study by the US National Institute of Allergies and Infectious Diseases is starting and will follow 6,000 children to try to come up with some answers.
“It usually appears three to four weeks after the peak of the coronavirus,” said the head of the Pediatric ICU at Pedro Ernesto Hospital, Raquel Zeitel, president of the Soperj Emergency Department. “It is an exacerbated immune response, with persistent fever, abdominal symptoms, diarrhea, vomiting, skin lesions, conjunctivitis. And it can evolve into a shock-like condition, with increased inflammatory markers, coronary anomalies and cardiac dysfunctions. ”
Alice was hospitalized for four days. “As we did not know the stage of the disease’s evolution and there was concern about the cardiac part, we thought it best to admit her,” said the girl’s mother. “For 24 uninterrupted hours, she received an infusion of immunoglobulin (antibodies that act to neutralize the pathogen). And had vital signs monitored every 15 minutes. ”
The infusion, which prevents coronary aneurysms, is the standard treatment for Kawasaki syndrome. It has also been used in these complications in post-covid children, along with corticosteroids (anti-inflammatory drugs).
“As it is a disease that results in intense inflammatory manifestations, the treatment includes medications to control this process and prevent heart involvement”, explained doctor Leonardo Campos, member of the Rheumatology Committee of Soperj and Hospital Antonio Pedro, in Niterói , in the metropolitan region of Rio.
Alice had a fever of 40 degrees, but then the inflammation subsided, without compromising her heart. “Even so, in the next two months, she will have frequent examinations and then once a year,” said the girl’s mother. “It was a scare, but I think it is important to talk so that people are aware.
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