PIMS Syndrome: Doctors Warn of Illness in Children Triggered By COVID-19
Despite all the differences, what both syndromes have in common is that they are rooted in an overreaction of the immune system. “What makes PIMS so fascinating is that we know what triggers it,” says Armann. This also allows for some conclusions to be drawn for the classic Kawasaki syndrome: The epidemiological data suggests that a viral infection could be responsible for triggering that illness as well.
The clue: In parallel with the uptick in cases of PIMS, the number of cases of Kawasaki has decreased. Doctors believe the reason for that decrease are the measures aimed at containing the coronavirus: Social distancing has ensured that there has been less spread than usual of the pathogens that cause flu and colds. Because such viruses are hardly being spread any longer, the secondary complications they can have aren’t appearing as often either.
A total of 238 cases of PIMS have now been recorded in the Dresden registry. The occurrences follow the course of the COVID-19 curve, though with a delay of a few weeks. Medical records reflect different progressions of the disease depending on which organs are affected. In every fourth case, the inflammation spreads to the nervous system, which can lead to seizures. In every fifth case, the kidneys or liver are affected.
Disturbing News from America
Of the cases documented in Dresden, 59 percent ended up in intensive care, mostly because the patients’ circulation could no longer be stabilized without medical support. None of the children died.
Meanwhile, doctors are reporting disturbing news from the United States. They suggest that PIMS is becoming increasingly aggressive there, without any explanation for why that might be happening. America’s Centers for Disease Control (CDC) has already reported 33 deaths. “I exchange information with a colleague in New York,” Dohna-Schwake says. “He told me that almost all PIMS patients there now require intensive care.” Six months ago, the rate was still only 40 percent.
Fortunately, such a trend hasn’t yet developed in Germany. Nor is there any evidence so far that the new variants of the SARS-CoV-2 virus will worsen the progression of PIMS.
According to reports from German hospitals, PIMS is quite treatable. “That standard treatment for Kawasaki syndrome is working, ” Armann states. Rebellious immune systems can be calmed with the help of cortisone. Immunoglobulins obtained from donor blood plasma are also effective. It’s unclear why a mix of non-specific antibodies is capable of regulating the body’s defenses. But Dohna-Schwake offers confirmation: “It’s very impressive. Immunoglobulins, high doses of cortisone and, after 48 hours, the nightmare is over. “
The Dresden PIMS register shows that almost half of the patients were discharged in healthy condition. In almost one in 10 cases, however, the children have been left with long-term problems. Fifteen of the children and adolescents suffered lasting damage to their hearts and will have to be monitored by doctors in the long term.
The spectrum of often subtle long-term effects is wide and still far from being fully understood, says Dohna-Schwake. For example, two of the girls he treated in Essen complained of problems with their periods after they were discharged. The six-year-old he discharged last autumn still suffers from muscular weakness today.
After his release from the university hospital in Essen, he first had to be sent to physical rehabilitation, where he had to learn how to walk again. The strength in his arms still hasn’t completely returned – a striking testament to how mistaken it would be to believe that the coronavirus isn’t particularly dangerous for children.