How to tell if your child's rash is rare Covid-related disease

DOCTORS are warning parents to get clued up on how to spot a rare Covid-related disease in children.

Experts first linked a mysterious Kawasaki-like skin condition with Covid-19 in kids after a surge of intensive care cases in April last year.

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Further studies found it to be a systemic inflammatory response to coronavirus that can develop up to three weeks after infection.

The rare syndrome was named multi-system inflammatory syndrome in children or (MIS-C) by doctors in the US and paediatric inflammatory multi-system syndrome (PIMS) in the UK.

But medics at the Children's Hospital of Philadelphia (CHOP), who have been studying the condition, found that diagnosis can be difficult as many of the symptoms are similar to other conditions.

This includes a rash, fever and gastrointestinal distress.

However, they note that rashes tended to appear more commonly on the lower limbs, inner thigh, chest and upper extremities.

Out of seven patients whose consent they had to share their findings, they found that more than half had a small to medium circular rash.

They were about the size of a 5p coin with tiny red spots in the centre.

Their study, published this month in the journal Open Forum Infectious Diseases, noted that there wasn't a single type of rash in the children they examined.

Instead, the researchers shared pictures and described the different types seen in patients with MIS-C to help doctors diagnose the condition.

Dr Audrey Odom John, who co-authored the paper, said: "We hope the information provided in this research letter will help general paediatricians and emergency department physicians who may wonder if a patient with a fever requires a more extensive examination.

"Given that some rashes associated with MIS-C are distinctive, we also imagine these images could help many parents who are looking for signs that their child needs prompt evaluation."

In terms of rash location, all patients in the study developed a rash on their lower body, and five of the seven patients had a rash on their inner thighs.

Rashes on the chest and upper extremities – including the shoulders, arms, wrists and hands – were also common, occurring in four out of seven kids.

More than half of the patients presented with small-to-medium annular plaques, which look like coin-sized circles, on their chest and back.

While over 50 per cent of patients in the study also developed purpura – tiny red spots – often in the centre of these round rashes.

Though some patients did develop a cherry-red rash on the bottoms of their feet and palms of their hands, this sort of rash was seen in less than half of the patients in the study.

Rashes on the face were uncommon, and the rashes rarely itched.

"Depending on the age of the child, parents may not regularly look at the child's chest, back or thighs, but this is where the rashes associated with MIS-C tend to appear," said Dr John.

"Given that MIS-C is still largely a diagnosis of exclusion, parents and health care providers should look for rashes in these locations if the child has a fever that seems suspicious."

"Given that MIS-C is still largely a diagnosis of exclusion, parents and health care providers should look for rashes in these locations if the child has a fever that seems suspicious."

Doctors stress the condition is rare – though it affects up to 100 kids a week in the UK.

An unpublished report seen by The Guardian earlier this month revealed that four out of five children getting PIMS after contracting Covid-19 were previously healthy.

The report stated that around one in 5,000 children get the condition after contracting Covid – regardless of whether or not they had symptoms.

It also found that 75 per cent of the children worst affected by PIMS were from the BAME community (black, Asian, or ethnic minority).

Since the pandemic began, two children are believed to have died from PIMS.

What is PIMS/MIS-C?

PIMS was first reported in April, after young patients needed intensive care following serious inflammation of the body.

  • Inflammation is a normal response of the body’s immune system to fight infection
  • But sometimes the immune system can go into overdrive and begin to attack the whole body
  • The inflammation can spread to blood vessels, particularly those around the heart
  • If untreated, the inflammation can cause tissue damage, organ failure or even death
  • Some symptoms include: a rash, abdominal symptoms such as stomach ache, diarrhoea, being sick, a high temperature for more than three days
  • PIMS seems to be linked to Covid-19 because most of the children either had the virus or tested positive for antibodies indicating they had been infected
  • This syndrome is very rare, and most children will not be seriously affected.

Experts say that cases of the illness are higher than in the first wave of the pandemic and say that hospitals have admitted around 100 kids a week compared to around 30 a week last April.

Since the start of the year around 12 to 15 kids a day have fallen ill and experts say most cases have been in London and the south east where the new variant pushed infections up and in turn forced a third national lockdown.

The evidence was collected by an expert in infectious diseases in children and the clinical director for children’s services at Imperial College Healthcare NHS trust in London, Dr Hermione Lyall.

In a presentation to paediatricians she said of the 78 children with PIMS who ended up in intensive care – 47 per cent were of Afro-Caribbean origin.

She also stated that 28 per cent were Asian.

A separate study found that 60 per cent of 107 cases of PIMS treated up to January 13 had been made up of black African or Caribbean children.

Dr Liz Whittaker, the PIMS spokesperson for the Royal College of Paediatrics and Child Health said research is now underway to understand why this group is affected.

She added that genetics could be a factor but said the concern was that poverty was also a key element.

Dr Whittaker said: “We are concerned that it is a reflection of how this is a disease of poverty, that disproportionately affects those who cannot avoid exposure due to their occupation, multi-generational households and crowded housing.”

The figures from Dr Lyall also showed that 78 per cent of patients had no underlying health issues.

It stated that the average age of kids getting PIMS is 11, but that it could range anywhere between eight to 14.

Data also presented at the webinar showed that a small number of kids who had PIMS suffered with confusion, lethargy and disorientation.

It was highlighted that some children started to behave in a “strange way” and some had a stroke.

Out of 75 children, eight were found to have suffered heart problems.

Modelling by doctors predicts that cases will peak next Monday before they start to decline.

Dr Whitakker added that parents should not be alarmed by the surge in hospitalisations.

She said PIMS would not be a reason to keep schools from opening and added that it would not be a reason to close playgrounds.

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