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Young adults in their 20s could be susceptible to inflammatory Kawasaki-like syndrome

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Doctors in America believe the inflammatory Kawasaki-like condition caused by coronavirus could be affecting adults in their early 20s. 

The mysterious condition is affecting children and has been shown to be linked to previous infection with the SARS-CoV-2 coronavirus, which also causes COVID-19. 

Reports in the Washington Post claim several patients in their 20s are being treated for the condition in San Diego and New York.  

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The eight-month-old Alexander had rashes and a high temperature, both symptoms of the mysterious Kawasaki-like disease. Little is known about the condition at the moment but it is believed to be rare

The eight-month-old Alexander had rashes and a high temperature, both symptoms of the mysterious Kawasaki-like disease. Little is known about the condition at the moment but it is believed to be rare

The eight-month-old Alexander had rashes and a high temperature, both symptoms of the mysterious Kawasaki-like disease. Little is known about the condition at the moment but it is believed to be rare

It appears the patients were been infected with the coronavirus but developed antibodies, indicating they contracted the infection several weeks ago. 

It is believed the hyper-inflammatory condition, which resembles Kawasaki disease, is a delayed immune response to the infection. 

It is known as PIMS-TS (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) in Europe and MIS-C (multisystem inflammatory syndrome in children) in the US.

According to US-based doctors, adult patients expressing symptoms of the new condition have more severe symptoms than children, which can affect the lungs and heart. 

Current treatments seem to be effective and involve steroids, anticoagulants, immunoglobulin and, occasionally, ventilation and admission to intensive care.

Children with the illness are usually taken to hospital with a high fever that has lasted a number of days and severe abdominal pain. The most seriously ill may develop sepsis-like symptoms such as rapid breathing and poor blood circulation

Children with the illness are usually taken to hospital with a high fever that has lasted a number of days and severe abdominal pain. The most seriously ill may develop sepsis-like symptoms such as rapid breathing and poor blood circulation

Children with the illness are usually taken to hospital with a high fever that has lasted a number of days and severe abdominal pain. The most seriously ill may develop sepsis-like symptoms such as rapid breathing and poor blood circulation

Younger children have symptoms more closely related to Kawasaki disease, such as inflammation of the blood vessels and rashes. 

However, the emerging condition appears to be able to infect a range of people, from infants to those who have lived for a quarter of a century. 

Some diseases are known to affect children but not adults, and vice versa. The reason for this remains a scientific enigma, lacking a viable explanation. 

Biology does not suddenly change at 18 years old, and the impact of ageing on physiology is a progressive shift which transcends the label of adult and child.  

The first wave of coronavirus patients had COVID-19 and this disease targets the respiratory system, particularly affecting people with underlying health conditions. 

However, the new condition seems to mostly affect previously healthy individuals who develop a fever, nausea and vomit. 

Little is known about the condition at the moment but it is believed to be rare. 

However, there have been deaths from the disease. This week, a 14-year-old boy in London died from the disease.  There have been reports of four deaths in the US.  

The mother of an eight-month-old baby who died of the rare illness urged parents to be ‘vigilant’ to the symptoms, and called for more research into the disease.

Alexander Parsons, from Plymouth, died at Bristol Children’s Hospital last month after being diagnosed with Kawasaki disease, his family said.

WHAT DO WE KNOW ABOUT THE SYNDROME? 

Children are being admitted in what has been described as a ‘multi-system inflammatory state.’

This refers to the over-production of cytokines, known as a cytokine storm – the overreaction of the body’s immune system.

In a storm, the proteins start to attack healthy tissue, which can cause blood vessels to leak and lead to low blood pressure

Doctors say this also happens with Ebola, causing the body to go into shock.

It has also been noted in older COVID-19 patients.

WHAT SYMPTOMS DOES IT CAUSE? 

The majority of the children being hospitalized with the condition have suffered from a high fever for a number of days, severe abdominal pain and diarrhea.

Some develop a rash and red eyes or red lips, while a very small group go into shock, in which the heart is affected and they may get cold hands and feet and have rapid breathing. 

The symptoms are similar to those caused by Kawasaki disease, a rare but treatable condition that affects around eight in every 100,000 children each year in the UK. 

WHEN DID OFFICIALS FIRST START TO SEE CASES?

The UK’s National Health Service (NHS) sent an alert to doctors on April 27, warning them to look out for signs of the syndrome. 

At the time they said cases had been appearing in tiny numbers in London for about three weeks. Since then they have spread further across the country and between 75 and 100 children are known to have been infected.

Cases in the US have been reported in New York and in clusters in other states such as New Jersey and California.. 

IS IT CAUSED BY SARS-COV-2, THE CORONAVIRUS?

Doctors are almost certain the illness is being caused by the coronavirus but they haven’t yet been able to prove it. 

Cases began appearing as the UK’s coronavirus outbreak hit its peak and similar conditions have been reported in China and Italy during the pandemic.

However, not all children with the Kawasaki-like syndrome test positive for the virus. Swab testing has suggested some of the children have not been infected with COVID-19 at the time they were ill.

But all patients have tested positive for antibodies, doctors said, meaning they have had the coronavirus in the past.

They said this suggests it is a ‘post-infectious phenomenon’ which is caused by a delayed overreaction of the immune system, which may happen weeks or even up to a month after the child was infected with COVID-19. 

IS IT TREATABLE? 

Yes. All but one of the children who have been diagnosed with the syndrome have survived. The only child known to have died with it, a 14-year-old boy, died of a stroke that was triggered by the life support machine he was on.

Doctors are currently treating the condition by using medications to calm down the immune system and dampen the overreaction.

Dr Liz Whittaker, a paediatrician at Imperial College Healthcare in London, said the sickest children are usually very ill for four to five days and begin to recover a couple of days after starting treatment.

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Experts believe more than 100 children in Britain have been affected by the new syndrome and more than 20 states have reported cases.  

The exact cause of Kawasaki Disease and the coronavirus-related condition are unknown. 

However, doctors note that almost all of the patients have tested negative for current infection with the SARS-CoV-2 virus. 

These tests are done in a lab and involve a throat swab. They look for the virus itself and a negative test means a person does not currently have the virus. 

However, it does not reveal if a person has previously been infected and fought off the virus. 

For this, antibody tests are relied upon. Antibodies are produced by the body to destroy an invading pathogen and remain in the person’s body for months. 

If an antibody test comes back positive but the swab test comes back negative, it means the person has been infected with, and subsequently fought off, the virus.  

A British study conducted in Birmingham assessed eight children with the condition and found they all had the antibodies but tested negative via the throat swab. 

It remains unknown why the syndrome develops weeks after infection, but scientists believe it may be due to a severe overreaction from the body’s own immune system. 

This ‘immune-mediated pathology’ causes the immune system to go haywire and can cause damage to the body’s own cells.

A similar phenomenon has been seen in adults, dubbed cytokine storm, and can be fatal to the sickest patients.    

Theories claim that the immune system of young people is less experienced due to exposure to less pathogens and this may cause it to overreact. 

Scientists in the UK find first clear evidence that coronavirus infection is linked to Kawasaki-like inflammatory condition

By Joe Pinkstone for MailOnline, 14 May 2020

Scientists have found the first clear evidence that infection with coronavirus causes the Kawasaki-like inflammatory condition affecting children.

A study of eight children admitted to a Birmingham hospital with the condition reveals they were infected with the SARS-CoV-2 virus several weeks before showing symptoms.

All of the children tested negative in the traditional lab-based test used to diagnose COVID-19 in adults.

However, a custom-built antibody test revealed the young patients had been infected with the coronavirus and produced antibodies to fight off the pathogen.

Doctors who treated the children say antibody tests are the only way to accurately identify the presence of the virus in children suffering with the hyperinflammatory condition, which can be fatal.

It remains unknown why the syndrome develops weeks after infection, but scientists believe it may be due to a severe overreaction from the body’s own immune system.

This ‘immune-mediated pathology’ causes the immune system to go haywire and can cause damage to the body’s own cells.

A similar phenomenon has been seen in adults, and it can be fatal to the sickest patients.

Bertie Brown was admitted to Worcestershire Royal hospital last month on his second birthday after developing a fever and rash across his body

Bertie Brown was admitted to Worcestershire Royal hospital last month on his second birthday after developing a fever and rash across his body

Bertie Brown was admitted to Worcestershire Royal hospital last month on his second birthday after developing a fever and rash across his body

The syndrome affecting children has been tentatively called PIMS-TS, for ‘paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2’.

However, the British scientists say the condition’s definition is incorrect as it is not ‘temporally associated’ with the pandemic but is instead ‘triggered by SARS-CoV-2 infection’.

A team of scientists led by Dr Alex Richter and Professor Adam Cunningham of the University of Birmingham studied eight young patients who were admitted to hospital between April 28 and May 8.

Lab tests — which are used to identify COVID-19 and also to screen healthcare workers — came back negative for all eight individuals.

These tests, called PCR tests, are extremely reliable and are ‘the nearest to a gold standard for determining active infection’.

Professor Adam Cunningham, who led on the research alongside Dr Alex Richter and Dr Barney Scholefield, told MailOnline: ‘The PCR picks up the presence of the virus itself, so the virus needs to be present at the site in the throat where the sample (usually a throat swab is taken).

‘If you clear the infection then there will not be virus there to detect.

‘In response to infections, we often make antibodies, and these are usually detectable from 14 days after the first time you are infected.

‘These antibody responses often persist in the body for months and often many years afterwards.’

The average age of the children admitted to hospital was nine years old and five of the patients were boys.

Chloe Knight, 22, revealed her two-year-old son, Freddie Merrylees (pictured), became ill just before the lockdown and was 'like a zombie' due to Kawasaki disease

Chloe Knight, 22, revealed her two-year-old son, Freddie Merrylees (pictured), became ill just before the lockdown and was 'like a zombie' due to Kawasaki disease

The youngster had a rash on his body, a high temperature, red eyes and struggled to eat and drink

The youngster had a rash on his body, a high temperature, red eyes and struggled to eat and drink

Chloe Knight, 22, revealed her two-year-old son, Freddie Merrylees (pictured), became ill just before the lockdown and was ‘like a zombie’ due to Kawasaki disease. The youngster had a rash on his body, a high temperature, red eyes and struggled to eat and drink

Seven of the patients showed symptoms of both hyperinflammation and Kawasaki disease.

One of the patients was expressing symptoms of hyperinflammation as well as some signs of toxic shock syndrome.

The mysterious and dangerous condition is being described by top medical professionals as very rare and symptoms can include fever, abdominal pain, rashes and red lips and eyes.

A very small group go into shock, in which the heart is affected, and they may get cold hands and feet and have rapid breathing.

Of the eight children treated in Birmingham and studied as part of this landmark research, all patients had fever and at least one gastrointestinal symptom such as abdominal pain, vomiting and diarrhoea.

Six of the patients required admission into paediatric intensive care due to heart-related issues and low blood pressure brought on by the disease.

All showed positive signs after treatment and have since been discharged from ICU.

Due to the reports in the media and claims from leading advisers and prominent politicians that this condition may be linked to the coronavirus pandemic, the researchers took blood samples for analysis from all eight children.

They then developed an custom antibody test with the help of researchers at the University of Southampton.

The test involves making an artificial copy of a key protein on the surface of the coronavirus which looks like a spike.

This unique ‘spike’ is a key identifier of the killer virus and was first revealed in detail by Professor Max Crispin of the University of Southampton.

He modelled the protein’s surface spikes and this has allowed his team to produce an almost exact copy of the spike.

In the Birmingham hospital, this artificially created version of the protein spike was mixed with blood samples from the patients.

The researchers saw that some antibodies in the blood of the children bound to the spike, in the same way they would if the virus itself was invading.

In the tests, researchers looked to see which of three different immunoglobulins (the technical name for an antibody) – IgG, IgA and IgM – locked onto the imitation virus.

A positive IgM reading in the tests indicates a recent infection whereas a positive reading for IgG and IgA shows an older infection, the scientists say.

The children in the Birmingham hospital had no IgM antibodies but did have IgG and IgA antibodies, showing that they were infected with SARS-CoV-2 several weeks previously.

This time delay is the reason the PCR test did not detect the infection, the researchers say.

‘IgM was not detected in children, which contrasts with adult hospitalised adult COVID-19 patients of whom all had positive IgM responses,’ the researchers write in the study, which has been submitted to a preprint server and seen by MailOnline.

‘For antibody responses, IgM responses develop first, before eventually waning and IgG responses dominating thereafter,’ the researchers explain.

‘Thus, high levels of IgG in the absence of IgM are typically suggestive of infection weeks or even months previously. ‘

This antibody test is conducted in a laboratory and is not a portable test. It is also fundamentally different to the test approved by the government today, which is manufactured by Roche.

Roche’s method uses a nucleoprotein to mimic the SARS-CoV-2 virus, not the viral spike.

‘Using the native-like viral spike for antibody testing is proving a highly sensitive way of detecting exposure to SARS-CoV-2,’ Professor Crispin told MailOnline.

The researchers say their research shows that the only way to diagnose patients with symptoms of severe inflammatory syndrome who have tested negative for the PCR is via antibody testing.

Dr Cunningham says: ‘In our study, none of the children were positive by PCR, yet all of the children were positive by antibody testing.

‘This may mean that the disease developed after the kids have already cleared the virus.

‘If so, then serology may be more useful diagnostically for kids who are PCR negative.

‘What the antibody test tells us is that these children have definitely been infected with SARS-CoV-2 at some time in the past, which will hopefully help doctors make decisions on how to treat these patients.

‘Ultimately, both PCR and antibody testing have overlapping roles to play in diagnosing this syndrome. Really excitingly, the detection of the antibodies may also provide clues on how this syndrome develops.’

As a result of their findings, the researchers suggest changing the definition of PIMS-TS, as the Kawasaki-like condition is now known.

‘Since all patients were positive serologically, it may be worth considering amending the definition of PIMS-TS so that TS is not just “temporally associated with SARS-CoV-2 pandemic”, but “triggered by SARS-CoV-2 infection”,’ the researchers conclude in their study.    

DailyMail Online


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